Antibiotic treatment in patients with cLBP

Eur Spine J. Apr;22(4). 2013.

As has been reported for the last few years, infectionary-processes may account for a substantial percent of cLBP. For instances Stirling et al found 53% of patients were infected with P. Acnes in nuclear tissue removed under sterile conditions. In a cross comparison of patients with herniation vs. scoliosis, fractures and tumors over 37% of herniation patients were infected with P. Acnes.

The authors conclude IF skin contamination accounted for the bacterial presence the percentage of patients would be similar.

It is thought that these anaerobic mouth and skin commensal organisms gain access to the disc during normal bacteremias as a result of neo-vascularisation associated with disc degeneration or herniation. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production i.e. the infection is in the disc and the Modic change is a “side effect” manifest in the bone. P. Acnes cannot live in the highly vascularized/aerobic bone and is not present.