Abstract
BACKGROUND AND PURPOSE: Research on the association between Propionibacterium acnes in the disc space and type 1 Modic changes in adjacent vertebrae is limited and has produced mixed results. The prevalence of bacteria in intervertebral discs contradicts the prior understanding that skeletal areas in the human anatomy are sterile; yet it opens new treatment possibilities. We investigated the relationship of P acnes and type 1 Modic changes in the cervical spine.
MATERIALS AND METHODS: Over a 36-month period, we collected intraoperative biopsies of patients undergoing a routine cervical spine operation for degenerative disc diseases. The disc material was cultured aerobically and anaerobically for 7 days. All preoperative MR images were evaluated for Modic changes by a board-certified neuroradiologist. Medical records were reviewed for other spine interventions before the operation.
RESULTS: The study population consisted of 48 patients. Of these, 14 patients tested positive for P acnes (29%) at ≥1 level. Additionally, 13 patients had type 1 Modic changes (27%) at ≥1 level; 54% (95% CI, 27%–84%) of patients who had type 1 Modic changes were also positive for P acnes compared with 20% (95% CI, 7%–33%) of patients without type 1 Modic changes. The difference between these proportions was 34% (95% CI, 4%–64%). The Fisher exact test produced a P value of .03 for the association between P acnes and MC1, and .53 for the association between P acnes and prior procedures.
CONCLUSIONS: We conclude that P acnes was prevalent in the degenerated cervical spine and that type 1 Modic changes were predictive of a culture positive for P acnes. We also found that the prevalence of P acnes was not associated with previous interventions. If these results are validated by future studies, they could have a major impact on the standard of care for back and neck pain.
ABBREVIATION:
- MC1
- type 1 Modic changes
Footnotes
Disclosures: Kieran Murphy—UNRELATED: Board Membership: IZI Medical Products, Active O, Comments: radiation therapy guidance systems and vertebroplasty devices, also ozone-generating devices; Patents (Planned, Pending or Issued): IZI Medical Products, Comments: I have 66 patents; Royalties: IZI Medical Products; Stock/Stock Options: Syunaptive Medlantis, CoraMed, Active O, Comments: I have invented devices that are the basis of multiple companies; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: IZI Medical Products, Comments: for a hands-on training courses in spine intervention.
Paper previously presented at: Annual Meeting of the American Society of Neuroradiology and the Foundation of the ASNR Symposium, April 22–27, 2017, Long Beach California; American Society of Spine Radiology Annual Symposium, February 14–18, 2018, Scottsdale, Arizona; and Griboi Meeting, an Interdisciplinary Research Conference on Image-Guided Spine Therapy, Biomaterials and Interventional Implants, March 17, 2018, Los Angeles, California.
- © 2018 by American Journal of Neuroradiology