Skip to main content
European Spine Journal logoLink to European Spine Journal
. 2004 Dec;13(8):702–706. doi: 10.1007/s00586-004-0719-z

Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection

Peter Fritzell 1,, Tomas Bergström 2, Christina Welinder-Olsson 2
PMCID: PMC3454053  PMID: 15138861

Abstract

A local inflammatory and potentially painful response, of which the ultimate cause is unknown, has been described in nervous tissues in contact with degenerated disc material in patients with low back and leg pain. With the rationale that a possible cause of such inflammation could be bacterial infection, we utilized PCR (polymerase chain reaction) amplification of the 16S rRNA (ribosomal RNA) gene followed by gene sequencing, to investigate whether bacterial DNA might be detected in the degenerative discs of 10 patients operated for disc herniation or post-discectomy syndrome. One patient with disc hernia harbored DNA homologous to Bacillus cereus, and in one patient suffering from post-discectomy syndrome, Citrobacter braaki/freundii DNA was detected. The finding demonstrates that 16S rRNA PCR can be a useful tool in search of bacterial DNA in degenerated discs, which in turn may be indicative of low-grade infection, manifesting itself only as pain rather than as clinical infection.

Keywords: Low back pain, Herniated disc, Discitis, Polymerase chain reaction, Bacterial DNA

References

  • 1.Abrutyn E, Berlin J, Mossey J, Pitsakis P, Levison M, Kaye D. Does treatment of asymptomatic bacteriuria in older ambulatory women reduce subsequent symptoms of urinary tract infection? J Am Geriatr Soc. 1996;3:293–295. doi: 10.1111/j.1532-5415.1996.tb00917.x. [DOI] [PubMed] [Google Scholar]
  • 2.Aoki Y, Rydevik B, Kikuchi S, Olmarker K. Local application of disc-related cytokines on spinal nerve roots. Spine. 2002;15:1614–1617. doi: 10.1097/00007632-200208010-00004. [DOI] [PubMed] [Google Scholar]
  • 3.Bone RC. The pathogenesis of sepsis. Ann Intern Med. 1991;6:457–469. doi: 10.7326/0003-4819-115-6-457. [DOI] [PubMed] [Google Scholar]
  • 4.Brisby H, Byrod G, Olmarker K, Miller VM, Aoki Y, Rydevik B. Nitric oxide as a mediator of nucleus pulposus-induced effects on spinal nerve roots. J Orthop Res. 2000;5:815–820. doi: 10.1002/jor.1100180520. [DOI] [PubMed] [Google Scholar]
  • 5.Brisby H, Olmarker K, Larsson K, Nutu M, Rydevik B. Proinflammatory cytokines in cerebrospinal fluid and serum in patients with disc herniation and sciatica. Eur Spine J. 2002;1:62–66. doi: 10.1007/s005860100306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Brisby H, Balague F, Schafer D, et al. Glycosphingolipid antibodies in serum in patients with sciatica. Spine. 2002;4:380–386. doi: 10.1097/00007632-200202150-00011. [DOI] [PubMed] [Google Scholar]
  • 7.Byrod G, Olmarker K, Konno S, Larsson K, Takahashi K, Rydevik B. A rapid transport route between the epidural space and the intraneural capillaries of the nerve roots. Spine. 1995;2:138–143. doi: 10.1097/00007632-199501150-00002. [DOI] [PubMed] [Google Scholar]
  • 8.Chia JK, Nakata MN. intervertebral diskitis caused by Propionibacterium acnes: a report of four cases. Clin Infect Dis. 1996;3:643–644. doi: 10.1093/clinids/23.3.643. [DOI] [PubMed] [Google Scholar]
  • 9.Cornefjord M, Olmarker K, Farley DB, Weinstein JN, Rydevik B. Neuropeptide changes in compressed spinal nerve roots. Spine. 1995;6:670–673. doi: 10.1097/00007632-199503150-00007. [DOI] [PubMed] [Google Scholar]
  • 10.Cuchacovich R, Japa S, Huang WQ, et al. Detection of bacterial DNA in Latin American patients with reactive arthritis by polymerase chain reaction and sequencing analysis. J Rheumatol. 2002;7:1426–1429. [PubMed] [Google Scholar]
  • 11.Ford DK. The clinical spectrum of Reiter’s syndrome and similar postenteric arthropathies. Clin Orthop. 1979;143:59–65. [PubMed] [Google Scholar]
  • 12.Garfin SR, Rydevik BL, Brown RA. Compressive neuropathy of spinal nerve roots. A mechanical or biological problem? Spine. 1991;2:162–166. [PubMed] [Google Scholar]
  • 13.Gronblad M, Habtemariam A, Vim J, Seitsalo S, Vanharanta H, Guyer RD. Complement membrane attack complexes in pathologic disc tissues. Spine. 2003;2:114–118. doi: 10.1097/00007632-200301150-00004. [DOI] [PubMed] [Google Scholar]
  • 14.Hedstrom SA. Septic bone and joint infections. Curr Opin Rheumatol. 1996;4:322–326. doi: 10.1097/00002281-199607000-00008. [DOI] [PubMed] [Google Scholar]
  • 15.Hennequin C, Bouree P, Hiesse C, Dupont B, Charpentier B. Spondylodiskitis due to Candida albicans: Report of two patients who were successfully treated with fluconazole and review of the literature. Clin Infect Dis. 1996;1:176–178. doi: 10.1093/clinids/23.1.176. [DOI] [PubMed] [Google Scholar]
  • 16.Ho WZ, Evans DL, Douglas SD. Substance P and human immunodeficiency virus infection: psychoneuroimmunology. CNS Spectrum. 2002;12:867–874. doi: 10.1017/s1092852900022483. [DOI] [PubMed] [Google Scholar]
  • 17.Kahn MF. Why the “SAPHO” syndrome? J Rheumatol. 1995;11:2017–2019. [PubMed] [Google Scholar]
  • 18.Kayama S, Olmarker K, Larsson K, Sjogren-Jansson E, Lindahl A, Rydevik B. Cultured, autologous nucleus pulposus cells induce functional changes in spinal nerve roots. Spine. 1998;20:2155–2158. doi: 10.1097/00007632-199810150-00002. [DOI] [PubMed] [Google Scholar]
  • 19.Lamont JT (2002) Theodore E. Woodward Award. How bacterial enterotoxins work: insights from in vivo studies. Trans Am Clin Climatol Assoc: 167–180; discussion: 180–181 [PMC free article] [PubMed]
  • 20.Lidslot L, Olmarker K, Kayama S, Larsson K, Rydevik B. Nucleus pulposus inhibits the axonal outgrowth of cultured dorsal root ganglion cells. Eur Spine J. 2000;1:8–13. doi: 10.1007/s005860050002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;1:193–199. doi: 10.1148/radiology.166.1.3336678. [DOI] [PubMed] [Google Scholar]
  • 22.Nachemson A, Vingård E. Assessment of patients with neck and back pain: a best-evidence synthesis. Philadelphia: Lippincott Williams & Wilkins; 2000. pp. 189–235. [Google Scholar]
  • 23.Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine. 1998;23:2538–2544. doi: 10.1097/00007632-199812010-00008. [DOI] [PubMed] [Google Scholar]
  • 24.Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine. 1993;11:1425–1432. doi: 10.1097/00007632-199318110-00005. [DOI] [PubMed] [Google Scholar]
  • 25.Olmarker K, Blomquist J, Stromberg J, Nannmark U, Thomsen P, Rydevik B. Inflammatogenic properties of nucleus pulposus. Spine. 1995;6:665–669. doi: 10.1097/00007632-199503150-00006. [DOI] [PubMed] [Google Scholar]
  • 26.Olmarker K, Brisby H, Yabuki S, Nordborg C, Rydevik B. The effects of normal, frozen, and hyaluronidase-digested nucleus pulposus on nerve root structure and function. Spine. 1997;5:471–475. doi: 10.1097/00007632-199703010-00001. [DOI] [PubMed] [Google Scholar]
  • 27.Orhan I, Onur R, Ilhan N, Ardicoglu A. Seminal plasma cytokine levels in the diagnosis of chronic pelvic pain syndrome. Int J Urol. 2001;9:495–499. doi: 10.1046/j.1442-2042.2001.00358.x. [DOI] [PubMed] [Google Scholar]
  • 28.Rand N, Reichert F, Floman Y, Rotshenker S. Murine nucleus pulposus-derived cells secrete interleukins-1-beta, -6, and -10 and granulocyte-macrophage colony-stimulating factor in cell culture. Spine. 1997;22:2598–2601. doi: 10.1097/00007632-199711150-00002. [DOI] [PubMed] [Google Scholar]
  • 29.Rask MR. Low back pain due to neisseria prostatitis: report of three cases. Clin Orthop. 1977;127:120–122. [PubMed] [Google Scholar]
  • 30.Robinson SC. Bacillus cereus septic arthritis following arthrography. Clin Orthop. 1979;145:237–238. [PubMed] [Google Scholar]
  • 31.Skouen JS, Brisby H, Otani K, Olmarker K, Rosengren L, Rydevik B. Protein markers in cerebrospinal fluid in experimental nerve root injury. A study of slow-onset chronic compression effects or the biochemical effects of nucleus pulposus on sacral nerve roots. Spine. 1999;21:2195–2200. doi: 10.1097/00007632-199911010-00004. [DOI] [PubMed] [Google Scholar]
  • 32.Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TS. Association between sciatica and Propioni-bacterium acnes. Lancet. 2001;9273:2024–2025. doi: 10.1016/S0140-6736(00)05109-6. [DOI] [PubMed] [Google Scholar]
  • 33.Stricker T, Frohlich S, Nadal D. Osteomyelitis and septic arthritis due to Citrobacter freundii and Haemophilus influenzae type b. J Paediatr Child Health. 1998;1:90–91. doi: 10.1046/j.1440-1754.1998.00161.x. [DOI] [PubMed] [Google Scholar]
  • 34.Trotha R, Hanck T, Konig W, Konig B. Rapid ribosequencing — an effective diagnostic tool for detecting microbial infection. Infection. 2001;1:12–16. doi: 10.1007/s15010-001-0064-7. [DOI] [PubMed] [Google Scholar]
  • 35.Wirtz DC, Genius I, Wildberger JE, Adam G, Zilkens KW, Niethard FU. Diagnostic and therapeutic management of lumbar and thoracic spondy-lodiscitis — an evaluation of 59 cases. Arch Orthop Trauma Surg. 2000;5–6:245–251. doi: 10.1007/s004020050457. [DOI] [PubMed] [Google Scholar]
  • 36.Youssef PP, York JR. Septic arthritis: a second decade of experience. Aust N Z J Med. 1994;3:307–311. doi: 10.1111/j.1445-5994.1994.tb02178.x. [DOI] [PubMed] [Google Scholar]

Articles from European Spine Journal are provided here courtesy of Springer-Verlag

RESOURCES