THE SPINE MICROBIOMESTUDY: ARE BACTERIA IN THE INTERVERTEBRAL DISC INVOLVED IN THE PATHOLOGY OF SOME BACK PAIN PATIENTS?

Jade Perry1,2, Birender Balain1, Bernhard Tins1,2, Sarfraz Ahmad1, Phil Brown1 , Aashish Ghodke1, & Sally Roberts1,2 (Co-I), in conjunction with Profs Frances Williams3 (PI) & Julian Marchesi4 (Co-I) .
1) The Robert Jones and Agnes Hunt Orthopaedic Hospital
2) Keele University
3) King’s College, London & Guy’s and St Thomas’
NHS Foundation Trust
4) Imperial College London

Funded by Versus Arthritis

Low back pain (LBP) is a leading cause of disability globally and commonly believed to be caused by intervertebral disc degeneration (DD), a process which involved the disc as well as other tissues in the spine. Frequent findings are loss of water from the disc, damage to the vertebral bony endplate and in some people, inflammation or fatty infiltration in the adjacent trabecular bone, which is visible on spine magnetic resonance images (MRI), termed ‘Modic changes’.

The process is similar to osteoarthritis in the knee, which also involves both bone and cartilage. Like osteoarthritis, DD is more common as we age. To date, the exact sequence of events remains unclear but it has been shown recently that damage to the endplate may happen early in the process and lead to ‘leakiness’. This potentially allows the passage of material into the vertebral body such as bacteria, perhaps coming from the large bowel which lies adjacent to the spine, or alternatively which are carried in the bloodstream.

We know that simply brushing your teeth can lead to bacteria in the mouth leaving the gums and circulating in the bloodstream. We aim to determine if bacteria that normally reside in another part of the body somehow reach the disc in question and cause degeneration. The microbial community in our body influences many aspects of health and disease; it may be that it also plays a part in spine health, in particular the health of our discs.

The purpose of this study is to determine (i) whether bacteria are found in any surgically removed discs and if so what type of bacteria are they, (ii) if there is a difference in frequency of bacteria in patients who have Modic changes and those who do not and (iii) if present, where the bacteria may have originated from. Some patients with LBP who are undergoing certain forms of back surgery to remove their discs are asked if they would be prepared to take part in the study. If so, the discs are carefully collected in a sterile container, as well as samples from several other body sites in the patient, including saliva, stool, skin swabs, urine and blood samples, and also swabs from the hands of the surgeon and theatre staff. This is to determine if any bacteria from within the operating theatre may confound the results. All samples are stored in RJAH until the collection is complete (with a target of >50 patients from this hospital).

Patients complete an extensive questionnaire about their clinical status, MRIs are taken and scored and samples eventually sent to King’s College and Imperial for analysis of bacterial DNA.

To date at the RJAH we have consented 52 patients, 42 of whom have already undergone disc removal surgery. As this study has an end-point analysis, all scientific investigations remain to be undertaken, apart from an initial pilot of the first 10 patients’ samples collected, to ensure that all the transport and other systems were in place. Perhaps by the next annual report there will be some exciting results to report!