Low back pain resulting from intervertebral disk degeneration is a cause of substantial disability and productivity loss. Over the past few years, growing evidence exists which suggests that low-grade bacterial infection, particularly infection with Cutibacterium acnes, may be associated with degenerative disk disease in the lumbar spine. Positive cultures are obtained in approximately 30% of intervertebral disk specimens removed at the time of surgery. In addition, one randomized trial has shown that antibiotic therapy for low back pain in patients with disk degeneration can slow the progression of degeneration and improve pain and disability levels. Although these results are encouraging, the link between infection and disk degeneration remains controversial. Investigators have attempted to address the limitations of clinical research by using translational methods and animal models. These methods have shown that seeding of the disk with bacteria can lead to increased local inflammation and an in vivo phenotype that is similar to human disk degeneration. This review seeks to provide an overview of the clinical, translational, and animal model data linking infection to disk degeneration. We review mechanisms for disk degeneration in the setting of infection and explore areas for future investigation.
From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Iyer), and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Louie, Dr. Nolte, and Dr. Phillips).
Dr. Louie or an immediate family member has stock or stock options held in StreaMD. Dr. Phillips or an immediate family member has received IP royalties from Medtronic, NuVasive, and Stryker; serves as a paid consultant to NuVasive and SI Bone; has stock or stock options held in Mainstay, NuVasive, PearDiver, Providence, SI Bone, Spinal Simplicity, Surgio, Theracell, Vertiflex, and Vital 5; and serves as a board member, owner, officer, or committee member of the Cervical Spine Research Society, ISASS, and Society of Minimally invasive Spine Surgery. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Iyer and Dr. Nolte.