PURPOSE To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence. METHODS Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33-49) and 20 control patients with scoliosis (median age 17, IQR 15-20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes. RESULTS No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated. CONCLUSIONS Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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细菌：背部疼痛，腿部疼痛和Modic征象-一项外科多中心比较研究。

目的比较接受腰椎间盘突出症（LDH）手术且大多数还患有下背痛（LBP）的成年疼痛性退化性椎间盘的细菌学发现，以及青少年非退化性非疼痛性椎间盘的发现进行脊柱侧弯手术，并评估与磁共振成像（MRI）的Modic征象的关联。在疼痛的退化椎间盘中发现了痤疮皮肤杆菌（痤疮丙酸杆菌），为什么有人建议用抗生素治疗LDH / LBP患者。由于耐多药细菌是全世界关注的问题，因此使用抗生素的新适应症应基于可靠的科学证据。方法在2015年至2017年之间，40名LDH / LBP成人（中位年龄43岁，IQR 33-49岁）和20名脊柱侧凸对照患者（中位年龄17岁）IQR 15-20）在七家瑞典医院接受了手术。从皮肤，手术伤口，椎间盘和椎骨培养样品。使用单核苷酸多态性分析调查痤疮丙酸杆菌的遗传相关性。使用基于16S rRNA的PCR测序分析从椎间盘/椎骨收集的DNA样品。评估MRI结果是否有Modic变化。结果与3/20（15％）的脊柱侧弯患者相比，LDH患者中没有细菌生长的占6/40（15％）。两组中大多数阳性样品均从皮肤中分离，然后从皮下或伤口深处分离。通过细菌PCR，在60名患者中的每位患者的四个椎间盘和椎骨样本中，235/240（98％）的DNA阴性。仅在每个组的一名患者的椎间盘/椎骨中发现一种痤疮丙酸杆菌。在LDH组中，29/40（72％）患者至少有一个带有痤疮丙酸杆菌生长的样本，而脊柱侧弯组为14/20（70％）。细菌发现和Modic变化无关。结论成人变性椎间盘椎间盘突出症的手术过程中，椎间盘和椎骨中存在痤疮杆菌可能是由污染引起的，因为该组的发现与对照组的年轻脊柱侧凸和未变性椎间盘患者相似。此外，这些发现几乎总是与皮肤和/或伤口上的细菌发现结合在一起。术前Modic变化与细菌发现之间没有关联。腰椎间盘突出症伴坐骨神经痛和/或腰背痛的抗生素治疗，无临床上的椎间盘炎/脊柱炎的迹象，应受到严重质疑。