Review of lumbar disc diseases at Tikur Anbessa Hospital

Abstract

Background: Disc degeneration is common, the pattern and prevalence of various signs of disc degeneration is unclear. Neither hospital nor population-based data or study is available on lumbar disc diseases in Ethiopia. The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Lumbar disc disease refers to a collection of degenerative disorders that can lead to low back pain as people age.

Objective: Review the pattern, clinical manifestation, diagnostic method and management decision of patients with degenerative lumbar disc disease at the neurosurgical referral clinic of Tikur Anbessa Hospital during the fiscal year 2009.

Patients and methods: This is a hospital based cross sectional study of patterns of patients with lumbar disc diseases seen at the neurosurgical referral clinic, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Surgery, Addis Ababa, Ethiopia in the period between January and December 2009 (12 months). Data taken while clerking patients and patents' medical record at referral clinic were main source of information. Standardized and structured questionnaire prepared for this purpose were used to analyze the sociodemographic, clinical manifestation, diagnostic modalities such as lumbar myelography, CT and MRI, patterns of disc disease in lumbar spine at NSRC with reference to age, severity and level distribution were reviewed. Difference in proportions were examined using Chi-square test.

Results: The study reviews 364 patients with lumbar disc diseases at the neurosurgical referral clinic, TASH over the one-year period (2009), their age ranged from 20 to 82 years (median, 44.0). Pain, numbness and neurologic claudication were the three most common presenting symptoms, occurring in 337(92.5%), 232 (63.7.6%) and 111 (30.5%) respectively. Lumbar MRI was the statistically significant investigation modality of choice (p < 0.0001). Two hundred thirty-five (70.1%) patients had disc prolaps (P < 0.0001), 18.5% had disc bulge. Lumbar degenerative disc disease was most frequently seen at L4-L5 level in 309 (54.5%) patients (P < 0.0001). both L4-L5 and L5-S1 accounted for 79.1% of the disc displacements. On MRI, disc displacements, were central in 61.2%, lateral in 9.3% and posterolateral in 15.8%.