Spine Labs, St. George & Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia.
Charles Perkins Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia.
Eur Spine J. 2022 Apr;31(4):917-925. doi: 10.1007/s00586-022-07152-8. Epub 2022 Mar 14.
Low back pain (LBP), a widely prevalent and costly disease around the world, is mainly caused by intervertebral disc (IVD) degeneration (IDD). Although numerous factors may trigger this degenerative process, microbiome dysbiosis has recently been implicated as one of the likely causes. However, the exact relationship between the microbiome and IDD is not well understood. This review summarizes the potential mechanisms and discusses microbiome dysbiosis's possible influence on IDD and LBP.
Prospective literature review.
Alterations in microbiome composition and host responses to the microbiota causing pathological bone development and involution, led to the concept of gut-bone marrow axis and gut-bone axis. Moreover, the concept of the gut-disc axis was also proposed to explain the microbiome's role in IDD and LBP. According to the existing evidence, the microbiome could be an important factor for inducing and aggravating IDD through changing or regulating the outside and inside microenvironment of the IVD. Three potential mechanisms by which the gut microbiota can induce IVD and cause LBP are: (1) translocation of the bacteria across the gut epithelial barrier and into the IVD, (2) regulation of the mucosal and systemic immune system, and (3) regulation of nutrient absorption and metabolites formation at the gut epithelium and its diffusion into the IVD. Furthermore, to investigate whether IVD is initiated by pathogenic bacteria and establish the correlation between the presence of certain microbial groups with the disease in question, microbiome diversity analysis based on16S rRNA data can be used to characterise stool/blood microbiota from IVD patients.
Future studies on microbiome, fungi and viruses in IDD is necessary to revolutionize our thinking about their possible role in the development of IVD diseases. Furthermore, we believe that inflammation inhibition and interruption of amplification of cascade reaction in IVD by targeting the gut and IVD microbiome is worthwhile for the treatment of IDD and LBP.
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
下腰痛（LBP）是一种在全球范围内普遍存在且代价高昂的疾病，主要由椎间盘（IVD）退变（IDD）引起。尽管许多因素可能引发这种退行性过程，但微生物组失调最近被认为是可能的原因之一。然而，微生物组与 IDD 的确切关系尚不清楚。本综述总结了潜在的机制，并讨论了微生物组失调对 IDD 和 LBP 的可能影响。
前瞻性文献综述。
微生物组组成的改变和宿主对微生物组的反应导致了骨发育和退化的病理变化，从而产生了肠-骨髓轴和肠-骨轴的概念。此外，还提出了肠-椎间盘轴的概念，以解释微生物组在 IDD 和 LBP 中的作用。根据现有证据，微生物组可能通过改变或调节 IVD 的内外微环境，成为诱导和加重 IDD 的重要因素。肠道微生物群通过以下三种潜在机制诱导 IVDD 并引起 LBP：（1）细菌穿过肠上皮屏障并进入 IVDD；（2）调节黏膜和系统免疫系统；（3）调节肠上皮的营养吸收和代谢物形成及其向 IVDD 的扩散。此外，为了研究 IVDD 是否由致病菌引起，并确定特定微生物群与疾病之间的相关性，可以使用基于 16S rRNA 数据的微生物组多样性分析来描述 IVDD 患者的粪便/血液微生物群。
未来有必要对 IDD 中的微生物组、真菌和病毒进行研究，以改变我们对它们在 IVDD 疾病发展中可能作用的认识。此外，我们认为通过针对肠道和 IVDD 微生物组抑制炎症和中断 IVDD 级联反应的放大，对 IDD 和 LBP 的治疗是值得的。
证据水平 I：诊断：具有一致应用参考标准和盲法的个体横断面研究。
