Is Low Grade Infection a Contributing Factor of Disc Degeneration?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
Intervertebral disc degeneration (IVD) has a multi factorial origin. Genetic and environmental factors are major determinants. However the pathomechanisms of IVD is inadequately understood. Low grade infection has also been implicated, however, its scientific rigor has been questioned. This article reviews the current literature in this field. Evidence suggests that low grade infection can also be imputed as a potential causative factor of IVD and perhaps serves as a paradigm shift of our current thinking in this entity.Our current consensus is that the underlying causes of disc degeneration are multi factorial but in many aspects obscured. Different factors including ageing, genetic predisposition, mechanical loading, metabolic disorders, toxins and infection acting independently or collectively activate or contribute to the degeneration cascade [1]. However, a generally accepted disease model has not been established. In a recently published paper the authors suggested a vicious circle as a model of the disease which involves abnormal mechanical forces, catabolic cell response, and alterations in extracellular matrix [2]. They also suggest that low grade infection could possibly trigger cells to decay the extracellular matrix of the intervertebral disc [2].The concept that spinal infection can cause intervertebral disc degeneration is not new [3,4]. Several studies have drawn the attention to the relationship between Modic I signals in MRI scan (high intensity bone marrow signal in T2-weighted and low signal intensity in T1-weighted series) and infection [5]. In fact when the patients do not have a persistent severe back pain, abnormal blood count and elevated inflammatory markers, it is challenging to differentiate between Modic I changes and low-grade infection [5]. The strong relationship between Modic I changes and back pain has been also reported [6]. Furthermore, there is an increasing interest and debate on the theory that low grade spondilodiscitis from anaerobic bacteria play an important role in the pathogenesis of disc degeneration and the clinical manifestation of the disease. Stirling cultured Propioni bacterium acne in 84% of patients with disc herniation and sciatica [3]. More recently Propionibacterium and mainly Propionibacterium acne has been associated with Modic I changes and back pain [7]. Other authors isolated anaerobic pathogens from disc tissue however, the possibility of tissue contamination during harvesting cannot be excluded [8,9].
Authors and Affiliations
Kalliopi Alpantaki, Alexander G Hadjipavlou
Keywords
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- EP ID EP570638
- DOI 10.26717/BJSTR.2017.01.000278
- Views 190
- Downloads 0
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