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  • George Etzl
    Post count: 4

    recently in the news many of the large news media outlets here on the East coast have been publicizing that 40% of chronic back pain is caused by a bacteria infecting the disc. This is of course sensationalized reporting of a legitimate study in the European spine journal entitled “Does nuclear tissue infection with bacteria following disc herniations lead to Modic changes in adjacent vertebrae?”. I would like to hear some of your thoughts on both the study and the sensationalization in the media with some saying “Back surgery may be replaced in the future with a course of about 100 days of antibiotics.” this really scares me because of antibiotic resistance. All the best -George

    Donald Corenman, MD, DC
    Post count: 8465

    These articles are discussing the possible finding of P. Acnes infection in aspirations from some patients with lower back pain. P. Acnes is a typical skin organism (a bacteria that lives on the skin without harm to the host).

    First, I will say that the estimation of up to 40 percent of patients having this infection is highly unlikely. This organism, if it causes an infection will have certain findings associated with the infection. Laboratory tests would indicate infection in many cases. Some to many patients would have chills, fevers and possibly sweats. The disc, being avascular is an excellent culture medium and I would expect the infection to become overwhelming in many cases. I have not seen this.

    If the patient underwent surgery- let’s say for a herniated disc and also was serendipitously infected in the past (which should not be too uncommon according to the incidence rate), the tissues would have a certain appearance that would tip the surgeon off to this infection. I have never come across this “unexpected infection” in about 6000 surgeries (unless the surgery was for an infection- rare where I am located).

    One possible explanation is that the aspiration of the disc would have to be performed by placing a needle through the skin to get to the disc space. Possible contamination could occur from the skin puncture. It is interesting that if really true, possibly some patients could have been colonized from other activities (skin abrasions, cleaning the nails, brushing the teeth). I would want to see the actual data before I begin to draw conclusions. This organism is not virulent (does not have the ability to cause severe infection) but is difficult to kill (cure the infection).

    Dr. Corenman

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