# Microbiome dysbiosis in spinal pathology: Mechanisms, evidence, and research limitations

## TL;DR

This paper reviews how gut microbiome imbalances may contribute to spinal diseases like ankylosing spondylitis and highlights gaps in current research.

## Contribution

The paper systematically explores non-GI microbiomes and their role in spinal health, emphasizing the need for further research in this underexplored area.

## Key findings

- Dysbiosis increases gut permeability and immune activation, potentially leading to autoimmunity and spinal pathologies.
- Human intervertebral discs have a distinct microbiome that changes with disease.
- Probiotics may help reduce spondyloarthropathies, according to preliminary trials.

## Abstract

The microbiome's relevance has become increasingly discussed amid the rising prevalence of chronic illnesses. Microbiome research to date focuses predominantly on its relationship with the GI tract while largely ignoring any impact on the rest of the body. This narrative review aims to lay a foundation of knowledge to fill this gap in the literature and discuss other microbiomes within the human body and their relation to spinal health.

What is the relationship between the human microbiome and spinal pathologies?

A narrative review of all available literature (written or translated to English) was performed using PubMed, MEDLINE, and Google Scholar using relevant search terms including: “microbiome”, “spine”, “spinal pathology”, “ankylosing spondylitis”, and “seronegative arthropathies”.

This review found that with dysbiosis, specific bacterial such as Bacteroidaceae and Rikenellaceae proliferate, altering the cytokine microenvironment and subsequently increasing gut wall permeability. This immune overactivation and improper cell function results in an increased susceptibility to autoimmunity; specifically ankylosing spondylitis and seronegative arthropathies. This review also highlights the significant gaps in the available literature.

This review aims to equip clinicians with an understanding of how the collection of microbiomes in the human body have specific implications for spinal health. By building on the current literature and integrating this knowledge into practice, more patient-specific practices in the treatment of spinal pathologies can be implemented, ultimately improving and optimizing patient care in a field in which the microbiome is not currently at the forefront of pathology.

•There is a strong connection between spondyloarthropathies and gut inflammation (Speca and Dubuquoy, 2017).•Human intervertebral discs have a distinct microbiome that is altered in disease (Rajasekaran et al., 2020).•Improper dendritic cell processing might cause SpA (Berthelot and Claudepierre, 2016; Krajewska-Włodarczyk et al., 2017).•In spondyloarthropathies, preliminary trials show that probiotics may reduce disease (Cammarota et al., 2014).

There is a strong connection between spondyloarthropathies and gut inflammation (Speca and Dubuquoy, 2017).

Human intervertebral discs have a distinct microbiome that is altered in disease (Rajasekaran et al., 2020).

Improper dendritic cell processing might cause SpA (Berthelot and Claudepierre, 2016; Krajewska-Włodarczyk et al., 2017).

In spondyloarthropathies, preliminary trials show that probiotics may reduce disease (Cammarota et al., 2014).