title: Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine.
abstract: BACKGROUND
  The modern literature is producing a rapidly growing number of articles which highlight the relationship between infection and lumbar disc degeneration. However, the means by which samples are collected is questionable. Posterior approach surgery is not free from skin contamination. The possibility of intraoperative contamination of disc biopsies cannot be excluded.
  
  
  OBJECTIVE
  The objective of this study was to determine if an association existed between lumbar disc degeneration and chronic infection of the intervertebral disc.
  
  
  METHODS
  313 patients (186/127, F/M) with chronic low back pain secondary to degenerative disc disease which was resistant to medical treatment were included in a single-centre prospective study. All underwent a lumbar anterior video-assisted minimally invasive fusion or disc prosthesis in L4-L5 and/or L5-S1 via an anterior retroperitoneal approach. The patients MRI scans demonstrated in Pfirrmann's classification grade IV or V disc degeneration; 385 disc drives were taken. In terms of Modic changes, 303 Modic 1, 58 Modic II and 24 absence of Modic change, respectively. All underwent intraoperative biopsy, performed according to a strict aseptic protocol. The biopsies were then cultured for 4 weeks with specialised enrichment cultures and subjected to histopathological analysis.
  
  
  RESULTS
  The mean age was 47 ± 8.6 years sterile cultures were obtained in 379 samples (98.4%) and 6 were positive (1.6%). The cultured bacteria were: Propionibacterium acnes (n:2), Staphylococcus epidermidis (n:2), Citrobacter freundii (n:1), and Saccharopolyspora hirsuta (n:1). Histopathological analysis did not demonstrate any evidence of a neutrophilia. There were no delayed or secondary infections.
  
  
  CONCLUSIONS
  Unlike the posterior approach where contamination is common, the anterior video-assisted approach allows a biopsy without skin contact. This approach to the spine is the most effective way to eliminate the risk of contamination. Our results confirm the absence of any relationship between infection and disc degeneration. We suggest that the 6 positive samples in our study may be related to contamination. The absence of infection at 1-year followup is an additional argument in favour of our results. In conclusion, our study shows no association between infection and disc degeneration. The pathophysiology of disc degeneration is complex, but the current literature opens new perspectives.
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Rigal
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thelen
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Fergus
authors.initials: F
authors.lastname: Byrne
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Cogniet
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Boissière
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Aunoble
authors.affiliation: Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France. j-c.lehuec@u-bordeaux2.fr.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Le Huec
mesh_terms: D000328:Adult; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D007431:Intraoperative Complications; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013123:Spinal Fusion / Q000379:methods; D020535:Video-Assisted Surgery / Q000379:methods
keywords: Disc degeneration; Infection; Low back pain; Modic 1; Propionibacterium acnes
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