Today I want to talk about a very interesting topic that is current in the world of the back. It is the possibility that a bacterium is behind many of the lumbalgias and herniated discs. If this were true, they could theoretically be cured with antibiotics. Let’s count it.
It all comes from two studies by a Danish group. The researchers studied patients who were to be operated on from a lumbar disc herniation. They cultivated in a laboratory the rest of the disc that had been extracted during the surgery. They found that 46% of the samples they took were infected. This fact is already very striking and invites to think that perhaps many of the hernias begin with an infection. This silent infection could be the cause that weakens the intervertebral disc and causes damage to the surrounding vertebrae.
Before I go on I want to make a point. The infections we know from disks are called “discitis”. The discitis are very striking pictures very different from what we are counting today. Then we will see why.
The next curious fact of the study is the cause of the infections. In 86% of cases the bacterium was the same, Propionibacterium acnes. The name will not sound much but this bacterium is what causes acne. This bacterium would perform a silent infection causing damage to the discs and spine. This infection would be very different from what we have known so far. When we saw the doctors an infection in the disk it was a very dramatic picture, the discitis. These infections produce significant pain with severe destruction of the disc and bone, sometimes with fever, malaise and alterations in the analytical. This discovery opens the door to the existence of other silent infections that we had ignored so far.
These gentlemen then did a second study where they treated some patients with antibiotics. They took patients with chronic lower back pain from disc herniation and inflammation in the vertebrae (seen on MRI). They were treated for 100 days with an antibiotic (a combination of amoxicillin and clavulanic acid) to some and others with a placebo. A placebo is a substance that has no effects. With this is intended that the patient cannot know if it is being treated or not. That is, some patients were treated and others were not, but they could not know because everyone was taking a pill. The surprise of the study was to see how patients who had received antibiotic treatment had a greater reduction of pain and had improved inflammatory changes in MRI.
Doctors all sound like something to us. In 1982 two men named Marshall and Warren discovered the association between the stomach ulcer and a bacterium called Helicobacter Pylori. Until then we associated the ulcers with stress, alcohol, tobacco, food and other factors nothing related to an infection. Not that these factors are not important, is that the culprit that triggers the stomach ulcer is this bacteria. Without it there would not be an ulcer in the vast majority of patients.
Is this credible? These studies must be taken into account as they have been carried out with a good research methodology. We still cannot say today that we are going to cure a herniated disc with antibiotics. However, the suspicion is there. In many places more studies are being done to try to understand these findings.
If we assume that this bacterium is responsible for herniated discs, we must take into account some things:
It would only apply to some specific cases. It would have to be fine-tuned to know which people would benefit from antibiotic treatment.
The treatment applied to the patients of the study was during 100 days, which is not exempt of other problems. Antibiotics do not penetrate the disc so easily. Research in this field is probably needed to improve the efficacy of antibiotics in these cases.
In short, this is a new line of research in the world of low back pain and herniated discs. An exciting discovery that may bear fruit in the future.
For those of you interested, I leave the links to these studies:
– Does nuclear tissue infect with bacteria following disc herniations lead to modic changes in the adjacent vertebrae?
– Antibiotic treatment in patients with low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy.