• Todd F Alamin, Marcus Munoz, Alicia Zagel, Agnes Ith, Eugene Carragee, Ivan Cheng, Gaetano Scuderi, Indre Budvytiene, and Niaz Banei.
• Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, Pavillion A FL 1 MC6110, Redwood City, CA, 94063, USA. tfalamin@stanford.edu.
• Eur Spine J. 2017 Aug 1; 26 (8): 2038-2044.

PurposeTo determine the presence of infectious microorganisms in the herniated discs of immunocompetent patients, using methodology that we hoped would be of higher sensitivity and specificity than has been reported in the past. Recent studies have demonstrated a significant rate of positive cultures for low virulent organisms in excised HNP samples (range 19-53%). These studies have served as the theoretical basis for a pilot trial, and then, a well done prospective randomized trial that demonstrated that systemic treatment with antibiotics may yield lasting improvements in a subset of patients with axial back pain. Whether the reported positive cultures in discectomy specimens represent true positives is as yet not proven, and critically important if underlying the basis of therapeutic approaches for chronic low back pain.MethodsThis consecutive case series from a single academic center included 44 patients with radiculopathy and MRI findings of lumbar HNP. Patients elected for lumbar microdiscectomy after failure of conservative management. All patients received primary surgery at a single spinal level in the absence of immune compromise. Excised disc material was analyzed with a real-time PCR assay targeting the 16S ribosomal RNA gene followed by amplicon sequencing. No concurrent cultures were performed. Inclusion criteria were as follows: sensory or motor symptoms in a single lumbar nerve distribution; positive physical examination findings including positive straight leg raise test, distributional weakness, and/or a diminished deep tendon reflexes; and magnetic resonance imaging of the lumbar spine positive for HNP in a distribution correlating with the radicular complaint.ResultsThe PCR assay for the 16S rRNA sequence was negative in all 44 patients (100%). 95% CI 0-8%.ConclusionsBased on the data presented here, there does not appear to be a significant underlying rate of bacterial disc infection in immunocompetent patients presenting with radiculopathy from disc herniation.

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