Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc.
OBJECTIVE
Propionibacterium acnes (P. acnes) in the intervertebral disc may result in low back pain. The purpose of this study was to determine how P. acnes accesses the disc.


METHODS
Patients with low back pain and/or sciatica were examined using X-ray and MRI before surgery. The intervertebral disc space height was measured on X-ray image. Disc and muscle samples were obtained from 46 patients undergoing discectomy at the lumbar spine. The tear of annulus was inspected before discectomy. In the disc and muscle tissue cultures, 16S rDNA gene specific for P. acnes was examined using PCR.


RESULTS
The discs from 11 (23.9 %) patients were identified as 16S rDNA positive, in which two patients also had 16S rDNA in their muscles. 16S rDNA gene was significantly more likely to appear in the discs with annular tear than those without tear (P < 0.05). The disc space height was significantly decreased when the disc contained P. acnes.


CONCLUSIONS
P. acnes is significantly more likely to be present in herniated discs with an annular tear than in herniated discs without such a tear. Since in the vast majority of these cases, no P. acnes was found in control muscle samples, a true infection with P. acnes is far more likely than a contamination.
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Zezhu
Z
Zhou
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Zhe
Z
Chen
Department of Orthopedics Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Yuehuan
Y
Zheng
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China. dr_caopeng8@163.com.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. dr_caopeng8@163.com.
Peng
P
Cao
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Yu
Y
Liang
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Xingkai
X
Zhang
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Wenjian
W
Wu
Department of Medical Microbiology and Parasitology, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Jiaqi
J
Xiao
Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China. qiu@bjc.hfh.edu.|Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. qiu@bjc.hfh.edu.|Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, MI, USA. qiu@bjc.hfh.edu.
Shijing
S
Qiu
D000328:Adult; D000368:Aged; D004269:DNA, Bacterial / Q000032:analysis; D017586:Diskectomy; D005260:Female; D016908:Gram-Positive Bacterial Infections; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000293:injuries / Q000382:microbiology* / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000382:microbiology / Q000601:surgery; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000382:microbiology*; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D011859:Radiography; D012585:Sciatica / Q000382:microbiology; D055815:Young Adult
D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S
Annular tear; Infection; Intervertebral disc; Muscle; P. acnes