Modic changes in the adjacent vertebrae due to disc material infection with Propionibacterium acnes in patients with lumbar disc herniation

Eur Spine J. 2017 Dec;26(12):3129-3134. doi: 10.1007/s00586-016-4887-4. Epub 2016 Nov 24.


Introduction: Modic changes (MCs) in vertebral bones are induced by two mechanisms of mechanical factors and infection. As Propionibacterium acnes (P. acnes) have been reported to be associated with LBP. The aim of this study is to evaluate the MCs in patients with disc herniation and positive for P. acnes.

Methods and material: A total of 120 patients with disc herniation surgery were enrolled into the study. The samples were excised during discectomy and then cultured in both anaerobic and aerobic incubations. Gram staining was employed for investigation of all colonies. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction (PCR). MCs of baseline MRI were evaluated.

Results: In this study, 120 subjects (69 male and 51 female) with mean age of 43.15 ± 12.62 years were investigated. Sixty disc samples and eight muscle samples were positive for microorganisms. Moreover, 16S rDNA gene was identified in 46 (38.3%) disc samples. Moreover, 36/46 patients with P. acnes in their sample had MCs.

Conclusion: According to the results and presence of 36/46 MCs in patients with lumbar disc herniation, positive for P. acnes suggests that P. acnes can lead to edema on the vertebrae endplates near to infected area.

Keywords: Low-back pain; Lumbar disc herniation; Modic changes; Propionibacterium acnes.

MeSH terms

  • Adult
  • Cohort Studies
  • Diskectomy
  • Female
  • Gram-Positive Bacterial Infections* / complications
  • Gram-Positive Bacterial Infections* / epidemiology
  • Gram-Positive Bacterial Infections* / microbiology
  • Humans
  • Intervertebral Disc / microbiology
  • Intervertebral Disc Displacement* / complications
  • Intervertebral Disc Displacement* / epidemiology
  • Intervertebral Disc Displacement* / microbiology
  • Intervertebral Disc Displacement* / surgery
  • Male
  • Middle Aged
  • Propionibacterium acnes* / genetics
  • Propionibacterium acnes* / isolation & purification