Advantages of Next-Generation Technologies in Comparison to Standard and Commonly Used Methods in the Identification of Colonized Bacteria in the Herniated Lumbar Disc

Abstract

The prevalence of low back pain (LBP) due to lumbar disc herniation (LDH) was recorded as 31.9% in the year 2022. Studies carried out around the world have failed to confirm the primary cause of disc herniation. Among the multiple hypothesized contributing factors, a low-grade bacterial infection has been identified as one of the major causes of LDH. Researchers have reported that Propionibacterium acnes (P. acnes) is the predominant bacterial species isolated using culture-derived methods. However, biofilm formation leads to a low bacterial yield in culture methods. Although culture methods remain the gold standard for the identification of bacterial species, there is a growing need for the usage of advanced techniques that are more sensitive, reliable, less time-consuming, and precise. Advancement of high-throughput sequencing tools allows thorough mining of complete bacterial profiles, even for bacteria that are challenging to cultivate in conventional laboratory settings. Currently, both high-throughput sequencing and omics have opened a new avenue, providing clear evidence for addressing queries related to bacterial contamination that have been frequently addressed in culture isolates of herniated discs over the past few decades. This review evaluates how advanced techniques in microbial identification have revolutionized our understanding of bacteria in disc health. Traditional methods confirmed the existence of known bacteria, but advanced techniques revealed a vast, previously unseen diversity, challenging the output of culture-based methods. This new information has even overturned the understanding of the role of P. acnes in evaluating disc health. Advanced techniques have opened a window to the hidden world of microbes and have been attributed to altered views on bacterial communities in healthy and herniated discs.