319. Is Chronic Vertebral Disk Infection With Low Virulence Bacteria a Common Cause of Back Pain?

BACKGROUND: In 1998 Modic described changes in vertebral body marrow with magnetic resonance imaging, and related those changes to pathological findings in the adjacent disc that were similar to those seen in bacterial discitis. As early as 2001 Stirling noted a relationship between sciatica and Propionibacterium acnes cultured from disc space material obtained at discectomy. In 2013 Albert demonstrated that Modic type I changes, strongly associated with low back pain, responded to 100 days of antibiotic treatment in a large randomized controlled trial. The findings were controversial, and we proposed that modern microdiscectomy techniques would minimize the potential for contamination with the common skin bacteria reported most often in previous studies. METHODS: We performed a prospective uncontrolled case series of patients undergoing microdiscectomy for symptomatic disc degeneration or herniation. Subjects were greater than 18 years old, nonpregnant, with chronic low back pain, and meeting standard criteria for microdiscectomy. After giving informed consent, data were extracted from existing medical records and cultures of disc material were obtained at discectomy prior to perioperative prophylactic antibiotics, and were processed by standard methodology for aerobic, anaerobic and acid-fast bacterial growth. RESULTS: Thirty-three patients were included in the study, mean age 52.6 (SE 3.1), 19 females and 14 males. The study was terminated after these 33 cases when only one aerobic culture was positive from one male subject, and this for a minimal growth of Staphylococcus epidermidis. CONCLUSION: If a significant fraction of chronic low back pain is indeed caused by chronic infection with low-virulence bacteria, this would be a paradigm shift in the evaluation and management of a common and often debilitating condition. In our study of patients with chronic low back pain undergoing microdiscectomy, we did not find evidence of chronic low-virulence bacterial infection. DISCLOSURES: All authors: No reported disclosures.