Evidence map›Paper›PMID 40576768›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025

Microbiome impacts surgical outcomes- comparison of gut microbiome dysbiosis in patients undergoing lumbar microdiscectomy: results from the MISO pilot study.

Stone Sima, Thomas Jeffries, Alisha Sial, Suhani Sharma, Robert De La Lande, Neha Chopra, Saeed Kohan, Peter Khong, Ashish Diwan

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Stone SimaSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia.
Thomas JeffriesSchool of Clinical Science, Western Sydney University, Richmond, Australia.
Alisha SialSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia.
Suhani SharmaSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia.
Robert De La LandeSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia.
Neha ChopraSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia.
Saeed KohanDepartment of Neurosurgery, St George Hospital, University of New South Wales, Sydney, Australia.
Peter KhongDepartment of Neurosurgery, St George Hospital, University of New South Wales, Sydney, Australia.
Ashish DiwanSpine Labs, Department of Orthopaedics, St George and Sutherland Clinical Campus , UNSW Sydney, Sydney, Australia. a.diwan@unsw.edu.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMore than 10% of patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation (LDH) develop failed back surgery syndrome (FBSS) often without clear cause. Recent findings of pathobiont gut bacteria in degenerative intervertebral discs (IVDs) suggest a potential “gut-disc axis,” where microbiome-mediated inflammation and disc colonization might undermine surgical outcomes. This novel pilot study aims to determine whether changes in gut microbial composition (dysbiosis) can predict FBSS after one level lumbar microdiscectomy for symptomatic LDH.

methods20 adult patients undergoing one-level lumbar microdiscectomy for symptomatic LDH were prospectively studied. Numerical rating scale (NRS) and Oswestry Disability Index (ODI) scores were collected preoperatively and at 3 months and 6 months postoperatively. Achievement of minimum clinically important difference (MCID) was defined as a > 30% improvement in NRS and ODI score. Preoperative Stool samples were analyzed using 16 S rRNA sequencing. Alpha diversity and beta diversity were assessed to determine microbial diversity differences. Taxonomic composition was compared at the phylum and genus levels.

resultsOf the 20 patients, 16 achieved MCID, while 4 developed FBSS at 3 and 6 months. There were no significant differences in age, sex, BMI, race, level of surgery, and pre-operative NRS and ODI between groups. Alpha diversity was similar (p = 0.437), but beta diversity showed significant differences in microbial community structure (p < 0.05). Differential abundance analysis identified patients who experienced FBSS had higher levels of pro-inflammatory Prevotella (U = 2, p = 0.002) and lower levels of commensal Bacteroides (U = 61, p = 0.003)) and Faecalibacterium (U = 53, p = 0.047).

conclusionThis study is the first to identify a Prevotella-dominant enterotype, along with a reduction in the anti-inflammatory genera Bacteroides and Faecalibacterium, as potential contributors to an increased risk of FBSS. Studies of higher power are required to estimate the effect sizes of these associations, investigate causation, and consider the viability of synbiotic therapy to improve spine surgery outcomes.

Indexed as

DiskectomyDysbiosisFailed Back Surgery SyndromeGastrointestinal MicrobiomeIntervertebral Disc DisplacementLumbar VertebraeAdultAgedFemaleHumansMaleMiddle AgedPilot ProjectsProspective StudiesTreatment OutcomeDysbiosisFailed back surgery syndromeGut-disc axisMicrobiomeMicrodiscectomyMinimal clinically important difference

Identifiers

PMID40576768

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.