Back Pain Bacterium

Recent evidence indicates that bacteria may have a role in low back pain with disc herniation.


A patient may be scheduled to have spinal surgery for lower back pain, but antibiotics may be the proper treatment. Researchers from Monash University, Australia, say of 11 studies they reviewed for a meta-analysis, 10 reported bacteria in the spinal disc material of patients undergoing spinal surgery.

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Propionibacterium acnes (P acnes) was the most common organism reported in 7 of 9 studies that examined spinal disc material. Although P acnes is part of the normal human microbiota and has been shown to stimulate protective responses against some cancers, the researchers point to “growing evidence” that it might have a pathologic role as well, including causing infections in injured structures and around indwelling medical devices. The predominance of P acnes, they say, may reflect the “unusual environment in the disc,” where lack of vascularity leads to very low oxygen tension and low pH—ideal breeding ground for low virulence anaerobic bacteria. Moreover, most patients with lower back pain were in their 40s, a time when water content of spinal discs begins to drop, putting the discs at risk.

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The researchers concluded that there was “moderate” evidence to indicate that low virulent bacteria have a role in low back pain with disc herniation and “modest” evidence for causation.

Only 6 studies reported on administration of antibiotics. In 3 patients, the dose was given before the spinal tissue was excised. In the other 3, the dose was given after the excision. In one study, antibiotic treatment was effective in treating chronic low back pain after disc herniation.

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The researchers caution that antibiotics may work only in a select subgroup of patients. However, that research they add—as with the changes wrought by the discovery of Helicobacter pylori’s role in peptic ulcers—has the potential to cause a “paradigm shift” in the treatment of low back pain.

Source: Urquhart D, zheng Y, Cheng AC, et al. BMC Med. 2015:13;13
doi: 10.1186/s12916-015-0267-x.

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