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1.
Vet Sci ; 8(3)2021 Mar 16.
Article in English | MEDLINE | ID: mdl-33809558

ABSTRACT

The anaerobic bacterium Cutibacterium acnes has been increasingly linked to the development of degenerative disc disease (DDD), although causality is yet to be conclusively proven. To better study how this organism could contribute to the aetiology of DDD, improved animal models that are more reflective of human disc anatomy, biology and mechanical properties are required. Against this background, our proof-of concept study aimed to be the first demonstration that C. acnes could be safely administered percutaneously into sheep intervertebral discs (IVDs) for in vivo study. Following our protocol, two sheep were successfully injected with a strain of C. acnes (8.3 × 106 CFU/disc) previously recovered from a human degenerative disc. No adverse reactions were noted, and at one-month post inoculation all triplicate infected discs in our first animal grew C. acnes, albeit at a reduced load (5.12 × 104 to 6.67 × 104 CFU/disc). At six months, no growth was detected in discs from our second animal indicating bacterial clearance. This pilot study has demonstrated the feasibility of safe percutaneous injection of C. acnes into sheep IVDs under fluoroscopic guidance. The design of follow-up sheep studies to investigate the potential of C. acnes to drive pathological changes within infected discs should now be pursued.

3.
Eur Spine J ; 28(4): 783-791, 2019 04.
Article in English | MEDLINE | ID: mdl-30506486

ABSTRACT

PURPOSE: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. METHODS: Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. RESULTS: Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). CONCLUSION: Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.


Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Cefazolin/pharmacokinetics , Clindamycin/pharmacokinetics , Gram-Positive Bacterial Infections/prevention & control , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Intervertebral Disc/metabolism , Propionibacterium acnes , Vancomycin/pharmacokinetics , Adult , Anti-Bacterial Agents/therapeutic use , Cefazolin/therapeutic use , Clindamycin/therapeutic use , Humans , Vancomycin/therapeutic use
4.
PLoS One ; 12(4): e0174518, 2017.
Article in English | MEDLINE | ID: mdl-28369127

ABSTRACT

BACKGROUND: In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. METHODS: Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. RESULTS: Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). CONCLUSIONS: This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.


Subject(s)
Biofilms/growth & development , Intervertebral Disc Displacement/microbiology , Intervertebral Disc/microbiology , Propionibacterium acnes/isolation & purification , Propionibacterium acnes/physiology , Adult , Aged , Aged, 80 and over , Diskectomy , Female , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/microbiology , Humans , Intervertebral Disc/surgery , Intervertebral Disc Degeneration/etiology , Intervertebral Disc Degeneration/microbiology , Intervertebral Disc Displacement/etiology , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Phenotype , Propionibacterium acnes/pathogenicity , Young Adult
5.
Spine (Phila Pa 1976) ; 41(24): 1860-1865, 2016 Dec 15.
Article in English | MEDLINE | ID: mdl-27669046

ABSTRACT

STUDY DESIGN: Patients scheduled for spinal surgery were screened prospectively for a microbial presence associated with intervertebral disc specimens. Inclusion was limited to patients requiring surgery for any of five conditions: study patients with cervical spine intervertebral herniation (IVH), lumbar spine IVH, lumbar spine discogenic pain, and control patients with idiopathic scoliosis/Scheurermann's kyphosis or trauma/neuromuscular deformity. Exclusion criteria included ongoing systemic infection, abnormal pre-operative white cell counts, documented or suspected spinal infection, or previous surgery to the involved disc. OBJECTIVE: The aim of this study was to test for an association between the presence of a bacterial entity in operated discs and a diagnosis of pathologic disc disease. SUMMARY OF BACKGROUND DATA: An association has been described between microbial colonization and progressive intervertebral disc degeneration in 36 herniation patients undergoing microdiscectomies. A total of 19 patients had positive cultures on long-term incubation, with Propionibacterium acnes present in 84% of discs. MATERIALS AND METHODS: Discs were harvested during surgery, using strict sterile technique. Each disc was divided, with half the sample sealed in a sterile, commercially prepared anaerobic culture transport container, and half fixed in formalin. Live specimens were cultured for bacteria at a university-affiliated laboratory in a blinded fashion. Fixed pathologic specimens were gram-stained and read by a board-certified pathologist. RESULTS: A total of 169 intervertebral discs from 87 patients were evaluated (46 males, 41 females). Positive cultures were noted in 76 of 169 discs (45%), with 34 discs positive for P. acnes and 30 discs positive for Staphylococcus. No pathologic evidence was seen of microorganisms, acute or chronic inflammation, or infection. Pooling the IVH and discogenic pain patients and contrasting them with control patients showed a significant association of IVH with positive bacterial cultures (χ = 15.37; P = 0.000088). CONCLUSION: Endemic bacterial biofilms are significantly associated with IVH and discogenic pain. LEVEL OF EVIDENCE: N/A.


Subject(s)
Biofilms , Intervertebral Disc/microbiology , Lumbar Vertebrae/microbiology , Propionibacterium acnes/isolation & purification , Adolescent , Adult , Aged , Cervical Vertebrae/microbiology , Cervical Vertebrae/pathology , Coagulase/metabolism , Female , Humans , Intervertebral Disc/surgery , Intervertebral Disc Degeneration/microbiology , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/microbiology , Intervertebral Disc Displacement/surgery , Low Back Pain/complications , Lumbar Vertebrae/surgery , Male , Middle Aged , Young Adult
6.
PLoS One ; 11(8): e0161676, 2016.
Article in English | MEDLINE | ID: mdl-27536784

ABSTRACT

BACKGROUND: The relationship between intervertebral disc degeneration and chronic infection by Propionibacterium acnes is controversial with contradictory evidence available in the literature. Previous studies investigating these relationships were under-powered and fraught with methodical differences; moreover, they have not taken into consideration P. acnes' ability to form biofilms or attempted to quantitate the bioburden with regard to determining bacterial counts/genome equivalents as criteria to differentiate true infection from contamination. The aim of this prospective cross-sectional study was to determine the prevalence of P. acnes in patients undergoing lumbar disc microdiscectomy. METHODS AND FINDINGS: The sample consisted of 290 adult patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation. An intraoperative biopsy and pre-operative clinical data were taken in all cases. One biopsy fragment was homogenized and used for quantitative anaerobic culture and a second was frozen and used for real-time PCR-based quantification of P. acnes genomes. P. acnes was identified in 115 cases (40%), coagulase-negative staphylococci in 31 cases (11%) and alpha-hemolytic streptococci in 8 cases (3%). P. acnes counts ranged from 100 to 9000 CFU/ml with a median of 400 CFU/ml. The prevalence of intervertebral discs with abundant P. acnes (≥ 1x103 CFU/ml) was 11% (39 cases). There was significant correlation between the bacterial counts obtained by culture and the number of P. acnes genomes detected by real-time PCR (r = 0.4363, p<0.0001). CONCLUSIONS: In a large series of patients, the prevalence of discs with abundant P. acnes was 11%. We believe, disc tissue homogenization releases P. acnes from the biofilm so that they can then potentially be cultured, reducing the rate of false-negative cultures. Further, quantification study revealing significant bioburden based on both culture and real-time PCR minimize the likelihood that observed findings are due to contamination and supports the hypothesis P. acnes acts as a pathogen in these cases of degenerative disc disease.


Subject(s)
Diskectomy/statistics & numerical data , Gram-Positive Bacterial Infections/epidemiology , Intervertebral Disc Degeneration/microbiology , Intervertebral Disc/microbiology , Propionibacterium acnes , Adult , Age Factors , Cross-Sectional Studies , Diskectomy/methods , Female , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/microbiology , Humans , Intervertebral Disc/surgery , Intervertebral Disc Degeneration/complications , Intervertebral Disc Degeneration/surgery , Lumbar Vertebrae/surgery , Male , Middle Aged , Prevalence , Prospective Studies , Real-Time Polymerase Chain Reaction , Risk Factors
7.
J Spinal Disord Tech ; 15(6): 526-8, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12468983

ABSTRACT

There have been 40 previously reported cases of lumbar facet joint pyogenic infection. These have been well characterized earlier. Intradural pyogenic extension has never been reported from a facet joint origin. This case demonstrates an elderly diabetic man with acute onset of nontraumatic back pain with no other source of infectious pathology. Surgical exploration identified a purulent left L4-L5 facet joint with epidural and intradural extension. Minimal spinal fluid leak was present. Wound cultures were positive for Group B beta Full resolution occurred with appropriate intravenous vancomycin antibiotic therapy.


Subject(s)
Arthritis, Infectious/diagnosis , Dura Mater/pathology , Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Aged , Arthritis, Infectious/complications , Humans , Male , Spinal Diseases/complications , Suppuration/etiology
8.
J Spinal Disord Tech ; 15(5): 431-5, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12394670

ABSTRACT

The only previously reported series of lumbar intracanalicular discal cysts, which were termed "intervertebral discal cysts", described Asian male involvement with verification of diagnosis via discography ( 1). Two cases are presented in non-Asian males under the age of 21 years, one of which was diagnosed preoperatively by MRI scan. Both patients did well with microsurgical intervention.


Subject(s)
Cysts , Intervertebral Disc/pathology , Intervertebral Disc/surgery , Lumbar Vertebrae/surgery , Spinal Diseases/surgery , Adult , Cysts/pathology , Cysts/surgery , Humans , Magnetic Resonance Imaging , Male , Spinal Diseases/diagnosis , Tomography, X-Ray Computed
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