Letter to the Editor concerning “Bacteria: back pain, leg pain and Modic sign: a surgical multicenter comparative study” by Fritzell, P., Welinder-Olsson, C., Jönsson, B. et al. Eur Spine J (2019)

[摘要] We have read with interest the paper by Fritzell et al. which suggests the association of bacteria, especially the anaerobic bacterium Cutibacterium acnes (previously Propionibacterium acnes), with pain-generating degenerated discs is likely to refect contamination arising from the skin. We fnd this view surprising given that the recent studies of Capoor et al. [1] and Ohrt-Nissen et al. [2] directly visualized C. acnes as a bioflm within surgically removed intervertebral disc tissue. Such observations are practically impossible to explain by contamination as this would require the contaminant to form a bioflm deep within a retrieved nucleus tissue fragment during the brief time between removal and freezing. Against this background, we would like to highlight a series of potential methodological limitations within the Fritzell et al. study that could impact on their fnal results and conclusions regarding the association of C. acnes with degenerated discs.