BACKGROUND: In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. METHODS: Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. RESULTS: Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). CONCLUSIONS: This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.

Cedars Sinai Institute for Spinal Disorders Los Angeles California United States of America

Celgene Corporation Information Knowledge and Utilization San Francisco California United States of America

Center for Biofilm Engineering Montana State University Bozeman Montana United States of America

Department of Anesthesia The Johns Hopkins Hospital Baltimore Maryland United States of America

Department of Microbiology Faculty of Medicine Masaryk university St Anne's Faculty Hospital Brno Czech Republic

Department of Molecular Oncology Central European Institute of Technology Masaryk University Brno Czech Republic

Department of Neurosurgery St Anne's University Hospital Masaryk University Brno Czech Republic

Department of Neurosurgery The Johns Hopkins Hospital Baltimore Maryland United States of America

Department of Neurosurgery The Warren Alpert Medical School of Brown University Rhode Island Hospital Providence Rhode Island United States of America

Department of Neurosurgery University Hospital Brno Masaryk University Brno Czech Republic

Department of Neurosurgery University Hospital Ostrava Ostrava University Ostrava Czech Republic

Department of Orthopaedic Surgery David Geffen School of Medicine University of California Los Angeles California United States of America

Department of Orthopaedic Surgery University of California Irvine School of Medicine Irvine California United States of America

Department of Orthopaedic Surgery University of California San Diego San Diego California United States of America

Department of Orthopedic Surgery Kaiser Permanente Oakland Medical Center Oakland California United States of America

Department of Orthopedic Surgery Kaiser Permanente San Jose Medical Center San Jose California United States of America

Department of Orthopedic Surgery OrthoIndy Hospital Indianapolis Indiana United States of America

Department of Orthopedic Surgery Stanford University Medical Center Stanford University Stanford California United States of America

Department of Orthopedic Surgery University Southern California Los Angeles California United States of America

Department of Orthopedics Physical Medicine and Rehabilitation University of Munich Munich Germany

Department of Pathology Microbiology and Immunology Vanderbilt University School of Medicine Nashville Tennessee United States of America

Laboratory of Bacterial Pathogenesis and Immunology Rockefeller University New York New York United States of America

Scripps Clinic Division of Orthopedic Surgery San Diego California United States of America

Spine Center UCSF Medical Center San Francisco California United States of America

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