(A)–(C) Dynamic lateral lumbar plain radiographs and (D), (E) lumbar T1- and T2-weighted MRI noting spondylolisthesis at L4-L5 and L5-S1 in a 65-year-old female. Credit: JOR SPINE (2024). DOI: 10.1002/jsp2.70005

Are back problems influenced by your gut? Researchers at Rush think there may be a connection.

In a paper published in JOR Spine, researchers looked at patients with and without lumbar degenerative spondylolisthesis to examine the differences in gut microbiome in the two groups.

“Research shows that certain changes in the spine can be caused by many factors,” said Dino Samartzis, DSc, professor in the Department of Orthopedic Surgery at Rush and the primary investigator of the study.

“We know that the changes can be related to lifestyle, obesity, occupation and genetics among others,” Samartzis said. “But, what about the gut? We wanted to see if there are any changes in the microbiome—the group of bacteria, microbes that live in the gut—in those who have degenerative spine conditions compared with people who do not, while accounting for the traditional factors we know in the past can impact the spine.”

The researchers collected disk samples from surgery and imaging, along with blood, stool and saliva samples in those without and those with lumbar degenerative spondylolisthesis. This often common condition involves slippage of one vertebral body over another due to intervertebral disk or facet joint degeneration—and can lead to pain, disability and surgery.

The cause is relatively unknown and has been under heated debate, but researchers theorize that the gut microbiome could stimulate systemic inflammation, alter one’s metabolism and/or expose one to bacterial invasion that can lead to back disorders.

“What we found was interesting,” Samartzis said. “When we compared these two groups of patients in terms of their age, sex, weight, pain, diet, alignment, pain profiles, etc., there was no difference between them. The only difference was largely and significantly noted in the gut microbiome—the gut bacteria.”

“There were a few very significant gut bacteria that had a big spike, which happen to be associated with degenerative spondylolisthesis of the lower back. The association of these bacteria to spondylolisthesis was as high as threefold.”

The study included 33 people over the age 50, 12 of whom did not have lumbar degenerative spondylolisthesis and 21 who did. The individuals with spondylolisthesis had higher levels of pro-inflammatory bacteria in their gut.

“This discovery significantly broadens our understanding of clinically relevant degeneration of the spine that can oftentimes be debilitating,” Samartzis said. “Our work has the potential to lead to new treatment options for back pain sufferers that should be more targeted, in this case focusing on the gut.

“Our multidisciplinary research opens up new possibilities for more personalized spine care management that can optimize patient outcomes. We have perhaps entered an era that a healthy gut may translate into a healthy and pain-free spine, and we should perhaps make that a priority for future spine research, clinical practice and personal lifestyle choices.”

More information: Khaled Aboushaala et al, Gut microbiome dysbiosis is associated with lumbar degenerative spondylolisthesis in symptomatic patients, JOR Spine (2024). DOI: 10.1002/jsp2.70005