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Background  The relationship between intervertebral disc degeneration and chronic infection by  Propionibacterium acnes  is controversial with contradictory evidence available in the literature. Previous studies investigating these relationships were under-powered and fraught with methodical differences; moreover, they have not taken into consideration  P .  acnes’  ability to form biofilms or attempted to quantitate the bioburden with regard to determining bacterial counts/genome equivalents as criteria to differentiate true infection from contamination. The aim of this prospective cross-sectional study was to determine the prevalence of  P .  acnes  in patients undergoing lumbar disc microdiscectomy.    Methods and Findings  The sample consisted of 290 adult patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation. An intraoperative biopsy and pre-operative clinical data were taken in all cases. One biopsy fragment was homogenized and used for quantitative anaerobic culture and a second was frozen and used for real-time PCR-based quantification of  P .  acnes  genomes.  P .  acnes  was identified in 115 cases (40%), coagulase-negative  staphylococci  in 31 cases (11%) and alpha-hemolytic streptococci in 8 cases (3%).  P .  acnes  counts ranged from 100 to 9000 CFU/ml with a median of 400 CFU/ml. The prevalence of intervertebral discs with abundant  P .  acnes  (≥ 1x10 3  CFU/ml) was 11% (39 cases). There was significant correlation between the bacterial counts obtained by culture and the number of  P .  acnes  genomes detected by real-time PCR (r = 0.4363, p<0.0001).    Conclusions  In a large series of patients, the prevalence of discs with abundant  P .  acnes  was 11%. We believe, disc tissue homogenization releases  P .  acnes  from the biofilm so that they can then potentially be cultured, reducing the rate of false-negative cultures. Further, quantification study revealing significant bioburden based on both culture and real-time PCR minimize the likelihood that observed findings are due to contamination and supports the hypothesis  P .  acnes  acts as a pathogen in these cases of degenerative disc disease.

Prevalence of Propionibacterium acnes in Intervertebral Discs of Patients Undergoing Lumbar Microdiscectomy: A Prospective Cross-Sectional Study