Department of Orthopedics, Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
Department of Orthopedics, Tokushima University, Tokushima, Japan.
J Med Invest. 2020;67(1.2):21-26. doi: 10.2152/jmi.67.21.
Propionibacterium acnes (P. acnes) is part of the normal flora of human skin, oral cavity, intestinal tract and external ear canal. However, breach in the mucosa as well as ruptured annulus fibrosus provide favorable pathway for P. acnes to nucleus pulposus where it can proliferate under anaerobic condition. In past two decades many authors have identified P. acnes in routine culture of discs. There studies showed that almost 50% of discs cultured were positive for various organism, and in vast majority of culture positive disc, P. acnes was the primary organism isolated. However, there are few studies that refute the hypothesis that P. acnes has a role in pathogenesis of Modic type 1 changes. Identification of P. acnes in culture indicates the infective patho-mechanism in the pathogenesis of Modic type 1 changes, which may be ameable to antibiotic treatment. However, it is still difficult to identify which subset of these patients (patients with low back pain with type 1 Modic change) are infective in nature. Further investigation and more clinical trails will be required for clear identification of the infective subgroup among low back patient in general. J. Med. Invest. 67 : 21-26, February, 2020.
痤疮丙酸杆菌（P. acnes）是人体皮肤、口腔、肠道和外耳道正常菌群的一部分。然而，黏膜的破裂以及纤维环的破裂为 P. acnes 提供了进入髓核的有利途径，在那里它可以在厌氧条件下增殖。在过去的二十年中，许多作者已经在常规椎间盘培养中鉴定出了 P. acnes。这些研究表明，几乎 50%的培养椎间盘呈阳性，有各种不同的微生物，而在绝大多数培养阳性的椎间盘，P. acnes 是主要分离的微生物。然而，很少有研究反驳 P. acnes 在 Modic 型 1 变化发病机制中起作用的假说。在培养中鉴定出 P. acnes 表明了 Modic 型 1 变化发病机制中的感染病理机制，这可能对抗生素治疗有效。然而，仍然很难确定这些患者中（腰痛伴 1 型 Modic 改变的患者）哪些亚组是感染性的。需要进一步的调查和更多的临床试验，才能明确一般腰痛患者中感染亚组的情况。J. Med. Invest. 67:21-26, 2020 年 2 月。
