Evaluation of Intraoperative Discectomy Specimens for Cutibacterium Acnes in Patients with Degenerative Disc Disease

Introduction: Degenerative disc disease (DDD) caused by disruption of normal disc architecture with or without Modic changes represents an exceedingly common source of low back or neck pain and radiculopathy. Recent evidence has suggested low virulence bacterial organisms such as Cutibacterium Acnes (C. acnes) may play a role in DDD with series reporting up to 44% of discectomy samples sent for culture returning positive. The purpose of this study was to evaluate culture specimens taken from intra-operative discectomy samples in patients with DDD for C. acnes.

Methods: After institutional review board approval, intra-operative discectomy samples taken from patients with a diagnosis of DDD seen on magnetic resonance imaging (MRI) and clinical symptoms of low back or neck pain or radiculopathy were sent for culture. Cultures were specifically held for 21 days by the microbiology lab to allow for the detection of low virulence organisms such as C. acnes.

Results: 18 patients with a diagnosis of DDD and correlating clinical symptoms underwent operative intervention with discectomy prior to interbody cage insertion resulting in 25 discectomy specimens sent for culture. 10 patients underwent single level discectomy while 8 patients underwent multi-level discectomy. 16 patients underwent lumbar discectomy and 2 patients underwent anterior cervical discectomy. Of the 25 disc specimens, only one patient who underwent L2-L3 transforaminal interbody fusion had a culture return positive for C. acnes at 13 days post-operatively.

Conclusion : While previous series have demonstrated a correlation between DDD and C. acnes, this series of 25 disc specimens in 18 patients undergoing discectomy found a very low rate of C. acnes with only one positive specimen. Further research with larger sample sizes is warranted to determine the role, if any, C. acnes plays in degenerative disc disease.