DOI: 10.1097/01.brs.0000259207.83839.3a

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Issn Print: 0362-2436

Publication Date: 2007/04/01


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Letters

Rohit Rambani

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We read the article entitled “Association Between Sciatica and Microbial Infection: True Infection or Culture Contamination?” by Ben-Galim et al (Spine 2006;31:2507–9). We compliment the authors for a well-designed study. However, there are few queries that require the authors’ attention. In the study, consecutive adults scheduled for surgical lumbar disc excision as a result of severe back pain and sciatica were recruited. They all had clinical evidence of sciatica and disc herniation causing nerve root compression shown on computerized tomography and/or magnetic resonance imaging. We do accept the stringent measures the authors took to avoid contamination in taking samples, but the authors have not clarified the criteria for patient selection. It is a widely accepted fact that mechanical pressures on the discs cause sciatica and subsequent inflammation, but it would have been more useful if the patients with minimal compression on magnetic resonant imaging and significant inflammation would have been included in the study. Stirling et al1 did report an increase in immunoglobulin G in patients with sciatica and no evidence of infection.
It would have been more useful if the inclusion criteria would have incorporated patients with minimal radiologic compression signs and significant radiologic inflammatory signs for the study. There is a huge population of patients with backache with minimal radiologic features that should be investigated for a low-grade infection.
The authors did conclude that the inflammatory process associated with intervertebral disc herniation and sciatica apparently does not have a bacterial infectious etiology. However, this cannot be completely ruled out based on this study. We believe that a multicentric, double-blind randomized control trial in patients with sciatica with significant inflammatory signs should be checked for low-grade infection and then treated with antibiotics to prove or disprove the hypothesis.

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