Cutibacterium acnes in Spine Pathology: Pathophysiology, Diagnosis, and Management

J Am Acad Orthop Surg. 2019 Jul 15;27(14):e633-e640. doi: 10.5435/JAAOS-D-17-00698.

Abstract

Cutibacterium acnes, long thought to be skin flora of pathological insignificance, has seen a surge in interest for its role in spine pathology. C acnes has been identified as a pathogen in native spine infection and osteomyelitis, which has implications in the management compared with more commonly recognized pathogens. In addition, It has also been recognized as a pathogen in postoperative and implant-associated infections. Some evidence exists pointing to C acnes as an unrecognized source of otherwise aseptic pseudarthrosis. Recently, it is hypothesized that low virulent organisms, in particular C acnes, may play a role in degenerative disk disease and the development of Modic end plate changes found in MRI. To this end, controversial implications exist in terms of the use of antibiotics to treat certain patients in the setting of degenerative disk disease. C acnes continues to remain an expanding area of interest in spine pathology, with important implications for the treating spine surgeon.

Publication types

  • Review

MeSH terms

  • Actinomycetales Infections*
  • Anti-Bacterial Agents / therapeutic use
  • Humans
  • Intervertebral Disc Degeneration / complications
  • Intervertebral Disc Degeneration / diagnosis
  • Intervertebral Disc Degeneration / microbiology*
  • Intervertebral Disc Degeneration / therapy
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / microbiology
  • Intervertebral Disc Displacement / therapy
  • Low Back Pain / etiology
  • Low Back Pain / therapy
  • Magnetic Resonance Imaging
  • Orthopedic Procedures
  • Osteomyelitis / diagnosis
  • Osteomyelitis / microbiology*
  • Osteomyelitis / therapy
  • Propionibacteriaceae* / isolation & purification
  • Propionibacteriaceae* / pathogenicity
  • Reoperation
  • Spondylitis / diagnosis
  • Spondylitis / microbiology*
  • Spondylitis / therapy
  • Virulence

Substances

  • Anti-Bacterial Agents

Supplementary concepts

  • Cutibacterium acnes subsp. acnes