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Herniated or Slipped Disks, Back Pain, and Bacteria

Updated on June 17, 2017
AliciaC profile image

Linda Crampton is a teacher with a first class honors degree in biology. She writes about human biology and the scientific basis of disease.

Illustration of a vertebra with a herniated disk and an MRI (magnetic resonance imaging) picture of a herniation
Illustration of a vertebra with a herniated disk and an MRI (magnetic resonance imaging) picture of a herniation | Source

Bacteria in Herniated Disks

A herniated disk in the spine is often a painful condition. Physical therapy and anti-inflammatory medicines frequently reduce the pain and help the body to heal itself. Sometimes the pain persists, however, and the problem becomes chronic. In this situation spinal surgery may be recommended.

Researchers from the University of Southern Denmark have made an exciting discovery which suggests that surgery could sometimes be avoided. The scientists have found bacterial infections in some herniated disks. They believe that 20% to 40% of chronic back pain cases associated with a herniation are produced by a bacterial infection. The scientists also say that antibiotics can reduce the pain.

The research has created a great deal of interest amongst spinal surgeons. A leading surgeon in the UK has said that the Danish discovery is so important that the researchers deserve a Nobel Prize. Other spine doctors are more cautious in their evaluation of the research and say that talk about a Nobel Prize is far too premature. Many doctors and scientists say that the research results are promising but that further investigations are needed.

The Human Vertebral Column or Backbone

There are seven cervical vertebrae in the neck, twelve thoracic ones in the upper back, five lumbar ones in the lower back, five fused sacral ones, and three to five fused vertebrae in the coccyx.
There are seven cervical vertebrae in the neck, twelve thoracic ones in the upper back, five lumbar ones in the lower back, five fused sacral ones, and three to five fused vertebrae in the coccyx. | Source

What is a Spinal or Intervertebral Disk (or Disc)?

Disks are short, cartilaginous cylinders that are located between the vertebrae, or bones, of the spine. The disks absorb shock created by movements such as running and jumping and also prevent the vertebrae from grinding against each other and breaking down.

Parts of a Spinal Disk

  • The annulus fibrosis is the tough and fibrous outer surface of the disk.
  • The nucleus pulposus is the gelatinous inner portion of the disk.
  • The nucleus pulposus is made of loosely arranged fibres in a gel made of molecules called mucoproteins.
  • Mucoproteins consist of both protein and a type of carbohydrate called a glycosaminoglycan. Glycosaminoglycans make liquids viscous.

Structure of a Cervical Vertebra in the Neck

The spinous process faces the back of a person's body. The gray and white matter form the spinal cord.  The blue-green area is the intervertebral disk. It lies on top of the vertebral body. The disc annulus is usually known as the annulus fibrosis.
The spinous process faces the back of a person's body. The gray and white matter form the spinal cord. The blue-green area is the intervertebral disk. It lies on top of the vertebral body. The disc annulus is usually known as the annulus fibrosis. | Source

What Is a Herniated Disk?

Most back pain is often due to arthritis or a problem with back muscles, ligaments (which attach bones to one another), or tendons (which attach muscles to bones). A doctor's diagnosis is needed to confirm that a back problem is actually due to a herniated disk.

Herniated disks are also known as slipped, ruptured, or prolapsed disks. A slipped disk hasn't moved out of place, despite its name. Instead, the outer layer of the disk has ruptured, allowing the softer inner tissue to bulge outwards. A prolapse is a condition in which an entire organ moves out of place. The term "herniated disk" is probably the best one in reference to the spine because it's the most accurate. A hernia is a condition in which part of an organ protrudes through the structure that encloses it.

The body attempts to heal the broken surface of a disk and remove the expelled material. Before the area is repaired, however, the person may be in pain. The pain arises due to the inner tissue of the disk pressing on a spinal nerve and irritating it.

Herniated disks are most common in middle-aged people. Being overweight increases the risk of a disk rupture. A sudden strain or repetitive activities may be the immediate cause of the injury, however.

A herniated disk in a lumbar vertebra as viewed from the side
A herniated disk in a lumbar vertebra as viewed from the side | Source

Symptoms of a Herniated Disk

Some people have no symptoms from a herniated disk. The rupture may be small or may not affect a nerve. In other people there may be pain for a while, but the pain disappears as the body repairs the rupture and breaks down the material that was released from the disk. The healing process may take weeks or even months, however. Unfortunately, some people experience chronic (long-term) pain from a herniated disk.

Herniated disks most often occur in the lower back but may also appear in the neck. The nerve irritation caused by the hernia can produce pain, numbness, and tingling. There may also be weakness in the muscles controlled by the affected nerves.

If a disk in the neck is herniated, the pain usually appears in a shoulder and arm. If the damaged disk is in the lower back, the person generally feels pain in their buttocks, thigh, and leg. Sometimes pain will appear in the foot, too. If the pressure on a nerve in the lower back is intense, the person may lose control of urination or defecation. These conditions are medical emergencies and require immediate attention. Coughing, sneezing, laughing, urinating, and defecating can all increase the pain from a herniated disk.

Anyone with chronic back pain should visit a doctor for a diagnosis and treatment recommendations.

What Happens During a Disk Herniation?

Bacteria and Chronic Back Pain

The research done so far suggests that in order for an intervertebral disk to be infected by bacteria it must first rupture. The rupture causes the initial pain when the contents of the disk affect a nerve. The Danish researchers say that as the body heals the injury, blood vessels extend into the disk. Bacteria in the blood can therefore enter the disk, where they multiply and cause an infection. Inflammation, swelling, and tiny fissures have been observed in the bones of the vertebrae around herniated disks. The investigators believe that bacterial infections cause these conditions.

One treatment for a herniated disk that's causing continuous problems is to surgically remove the displaced tissue. The Danish researchers examined the spinal tissue taken from people who had undergone surgery for chronic back pain. They followed "stringent antiseptic sterile protocols" to avoid contamination of the samples with bacteria from another source. The researchers found that nearly half of the samples were infected by bacteria. In addition, they discovered that more than eighty percent of the infected samples contained a bacterium called Propionibacterium acnes—the same bacterium that is involved in acne.

Propionibacterium acnes normally lives on our skin, in our mouths, and in our large intestine. It can also enter our blood. The researchers think that the bacterium travels to damaged spinal disks in the bloodstream and then releases chemicals that trigger inflammation.

A Herniated, Ruptured, or Slipped Disk: An Animation

Using Antibiotics to Treat Chronic Back Pain

In another experiment, the Danish researchers gave antibiotics to people who had suffered from back pain for at least six months and had evidence of spinal disk damage and vertebral swelling around the damage. (The subjects weren't tested for the presence of bacteria in their spine.) Other people with these same conditions were given a placebo.

Antibiotic treatment for 100 days reduced pain and other problematic conditions significantly in people given an antibiotic compared to those given a placebo. The increased benefits were still present and in some cases had even improved one year after the initial evaluation.

It's important to note that the people in the test had specific problems in their spine. Antibiotics haven't yet been tested on other people with back pain. In addition, since the overuse of antibiotics has led to frightening resistance to the medications in bacteria, it's vital that antibiotics aren't prescribed for back pain patients "just in case" they help them.

Antibiotics may help some types of chronic back pain.
Antibiotics may help some types of chronic back pain. | Source

Some Possible Problems in Disk Research

Research involving humans is often difficult because so many factors are involved. For example, bacteria are tiny and ubiquitous creatures and often appear where they're not wanted. Very careful procedures are needed to prevent contamination of a tissue sample when the sample is extracted or examined.

Good experiments use a placebo. A placebo is a harmless substance that has no medical benefit when administered to a patient. Some subjects in an experiment are given a placebo and some are given the test treatment. The subjects don't know which type of treatment they are receiving. This procedure enables the researchers to take the "placebo effect" into account when analyzing the results of the experiment. Sometimes knowing that something may help us enables us to feel better, even when the treatment has no known benefit.

All experiments involving humans need to be double blind. A double blind experiment is one in which neither the subjects nor the person administering a treatment know its identity. Unfortunately, the Danish antibiotic experiment may not have been completely double blind. Some of the subjects that were given antibiotics may have suspected that they had received a medication because they experienced diarrhea as a side effect of the treatment. This suspicion may have affected the outcome of the experiment.

As strong as this research is, it is not definitive.

— NHS (National Health Service)

Further Research Is Needed

While the results of the Danish investigations are very interesting and have impressed many people, they don't prove that bacteria contribute to the pain of herniated disks. Just because bacteria are present in an area of the body that is experiencing problems doesn't necessarily mean that the bacteria are causing the problems. In addition, some scientists have suggested that the antibiotic treatment decreased pain because it reduced inflammation and not because it killed bacteria.

The Danish research was reported in 2013. Since that time, other researchers have found bacteria in herniated disk material. In 2015, a group of Australian doctors and researchers analyzed the scientific literature with respect to the possible link between bacteria in herniated disks and chronic pain. They found that bacteria are commonly detected in herniated disks. They say that at the moment there is "modest" evidence supporting the idea that the bacteria are responsible for a patient's pain. They also say that further research is needed to demonstrate that the bacteria that have been discovered are not the result of tissue contamination.

Thumbs up! We're not there yet, but one day some people may get relief from herniated disk pain by taking antibiotics instead of undergoing surgery.
Thumbs up! We're not there yet, but one day some people may get relief from herniated disk pain by taking antibiotics instead of undergoing surgery. | Source

Cautious Optimism

Many scientists seem to have an attitude of cautious optimism with respect to the idea that bacteria can cause back pain. They are intrigued by the research but want to see the results of more investigations. They say that not only should more research be done but also that more patients should be involved in the studies. In the future, however, doctors may have another treatment to offer some people who are suffering from long-term back pain due to a herniated disk.

References

Herniated disk facts from the U.S. National Library of Medicine

Antibiotics may help ease chronic back pain (An analysis of the Danish research published by the National Health Service)

Low back pain and bacterial infection information from Medscape (A summary and analysis of the Danish research with links to the scientific papers.)

An analysis of research linking bacteria to herniated disk pain published by the NIH (National Institutes of Health)

© 2013 Linda Crampton

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    • AliciaC profile image
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      Linda Crampton 4 years ago from British Columbia, Canada

      I am so sorry for what you are going through, CJGrace. I very much hope that you find a new doctor who can give you the help that you need. My best wishes to you. I hope healing happens very soon.

    • CJGrace profile image

      Chris 4 years ago from California

      Awesome article. I've had a major problem since a car accident in '08. I have two bulging disks in my lower back, a broken back, sciatica, scoliosis, and now due to my age, arthritis, and disgenerative disease. The problem has spread to my neck now too. The nerve damage is so bad, I feel it down to my feet. I feel like I have the shoe on the wrong foot. Three years after the accident, I bent to pick something up, and not only did I feel a snap, I heard it too. I lost bodily function control. I still have not had surgery, just pain meds. I just moved and need to get in with a new doctor. I know what pain is and I feel for anyone who suffers.

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      Thank you very much for the comment, Audrey. I hope that you find more permanent relief for your sciatica. I appreciate the share!

    • vocalcoach profile image

      Audrey Hunt 4 years ago from Nashville Tn.

      Great news! I, too suffer from chronic sciatica. I've had physical therapy but the improvement only seems to last for a short time. Stretching, walking and limited sitting at the computer gives me temporary relief. Really like the information in your hub. You are very kind to share this.

      Thanks and sharing!

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      I'm sorry about your slipped disks, always exploring. Having one is bad enough, but having two slipped disks is horrible! I'm glad that you've found ways to relieve the pain. Thanks for the comment.

    • always exploring profile image

      Ruby Jean Fuller 4 years ago from Southern Illinois

      This is wonderful news. I have two herniated disks, 4th and 5th lumbar. I find that stretching and yoga are two exercises that relieve pain. Thank you for an informative hub.

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      The research does sound promising. I hope it helps people with herniated disks. Thanks for the comment, drbj.

    • drbj profile image

      drbj and sherry 4 years ago from south Florida

      The new Swedish research, Alicia, seems very promising, especially if it will prevent invasive surgery in patients with severe back pain. Thanks for this scientific heads-up.

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      Hi, Deb. Yes, I know someone who doesn't do anything about pain until they absolutely have to! Thank you for the comment.

    • aviannovice profile image

      Deb Hirt 4 years ago from Stillwater, OK

      Great work, Alicia. I'm sure a lot of people out there with back pain will like to read this, as it can give them a heads up on what is wrong. Many people tell friends about the pain, but usually don't do anything until they are forced to do so.

    • AliciaC profile image
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      Linda Crampton 4 years ago from British Columbia, Canada

      Thanks for the comment and the vote, Nell. I appreciate your visit. Herniated disks sound like they can be very painful!

    • Nell Rose profile image

      Nell Rose 4 years ago from England

      Great information Alicia, I never knew about the bacteria involvement. My brother had a bad back, slipped disc a few years ago, and the pain he was in was awful. I did my back in once years ago, and its not a pleasant thing to do, took me ages to recover, I was carrying bags of shopping and just twisted as I put them down, the ironic thing was that I did weightlifting at the time and that didn't hurt it! voted up, nell

    • AliciaC profile image
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      Linda Crampton 4 years ago from British Columbia, Canada

      Thank you for such a wonderful comment, Martie! I appreciate it very much. I hope the doctors find the cause for your leg pain. It must be so frustrating - as well as painful - to continue experiencing leg problems with no effective treatment being offered.

    • MartieCoetser profile image

      Martie Coetser 4 years ago from South Africa

      Very interesting! My doctor's suspicion that this could be the reason for the cronic, painful swelling of my legs has been refuted by X-rays. So we are still searching for the real cause.

      Very interesting, informative and well-written article about slipped disks, bacteria and back pain. Voted up and higher :)

      Thank you, Alicia. Your hubs are feathers in HubPages's cap :)

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      What a horrible injury, cloverleaffarm! Thank you for sharing your very interesting experience. Walking was a wonderful alternative to surgery!

    • cloverleaffarm profile image

      Healing Herbalist 4 years ago from The Hamlet of Effingham

      I had 3 herniated disks with a loose bone fragment. The pain was horrendous. My doctor told me I had two options; surgery or walking. Either one would have the same outcome. I chose walking. I walked up to four miles a day (that is what I worked up to). I not only healed my back, but I lost weight.

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      Thanks for the comment and for sharing the interesting and useful information, RTalloni. I appreciate the pin, too! I hope that you're able to continue dealing with your back pain successfully.

    • RTalloni profile image

      RTalloni 4 years ago from the short journey

      Very interesting info. I keep thinking that if I wait long enough a discovery will be made that could prevent invasive treatment. Maybe… :)

      Choosing chiropractic care over surgery in past years has been a helpful choice for me, but since I've used a balance ball chair I get wonderful relief when in trouble just by sitting (correctly) on it and I think it helps keep me from having as much trouble as I used to have with the disc problem.

      Pinning to my Back Pain board.

    • AliciaC profile image
      Author

      Linda Crampton 4 years ago from British Columbia, Canada

      That sounds like a very unpleasant experience, Bill. I'm glad that the operation solved the problem. I hope that I never experience a herniated disk. Thanks for the comment (and the pun)!

    • billybuc profile image

      Bill Holland 4 years ago from Olympia, WA

      Good information, Alicia. I had a back operation in 1989 for a herniated disk....all has been well since then, but it was more painful than anything I have ever experienced. I literally could not walk. So glad that is behind me. :) Kind of a pun. LOL