Clinical, radiological and therapeutic aspects of the lumbar disc herniation operated in central Africa (DRC/ Kinshasa)

CLINICAL, RADIOLOGICAL AND THERAPEUTIC ASPECTS OF THE LUMBAR DISC HERNIATION OPERATED IN CENTRAL AFRICA (DRC/ INSHASA)

Frederick Tshibasu Tshienda MD¹, Jean Mukaya Tshibola MD PhD¹, Emmanuel Ndoma Kabu MD PhD ¹, Michel Lelo Tshikwela MD PhD¹ , Jean Marie Mbuyi Muamba MD PhD².

1. ¹Division of Diagnostic Imaging, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo

2. Department of Internal Medicine, Division of Rheumatology, University Hospital of Kinshasa, School of Medicine, University of Kinshasa , Kinshasa, Democratic Republic of Congo

Corresponding author: Frederick Tshibasu [e-mail]

ABSTRACT

Objectives:Showing the clinical and radiological aspects of the lumbar disc herniation operated in hospital environments of Kinshasa then establishing the link between radiology and surgery results.

Materials and methods:Retrospective and documentary study of 160 cases of lumbar disc herniation operated in Biamba Marie Mutombo hospital over 4 years: from January, 2012 till December, 2016.Taking advantage of the fact that among 160 Computed Tomography Scans (CT scans) of the 160 patients, 48 patients have also effectuated Magnetic Resonance Imaging Scans (MRI scans), a data sheet allowed the collection of clinical, radiological and surgical data.

Results: The mean age of patients is 44, 7#177;12, 3 years. The most interesting age group range from 31 to 50 years (68, 8%). Females were the most affected with 55.6%. Housewives were more affected with 35.6%. Sciatica L5 was found in 28.8% of cases, sciatica S1 in 15.6% and left lateralization in 48, 1%. As for imaging results, the posterolateral type was the most common with 53.8% of cases.The disc level: L4-L5 was the most affected in 61.1% of cases.The single lumbar disc herniation was the most common. The discrepancy between imaging and surgery results was 6.3% for medial herniated discs and 24.4% for posterolateral disc herniation.

Conclusion: Lumbar disc herniation is a pathological reality in hospitals of Kinshasa. The aspects found mainly corroborate literature observations, except for some environment peculiarities. The discrepancy between imaging and surgery results was statistically insignificant.

Keywords: disc herniation- Sciatic- Magnetic Resonance Imaging- Computed Tomography scan

I. INTRODUCTION

Lumbar Disc Herniation (LDH) is a major public health issue around the world [1], whose disabling low back pain, whether associated or not with sciatica, is the clinical expression [2]. It is defined as an overflowing focal disc containing, in addition to the annulus fibrosus, the nucleus pulposus, migrated from its central position to the periphery, roughly associated with the cartilaginous elements of plateaus, marginal listella and inflammatory reaction tissue in the presence of nucleus pulposus [3]. According to the World Health Organization (WHO), LDH causes 15% of absenteeism in force workers [1]. In France, low back pain is the most common reason for consulting in rheumatology with around 26% of hospitalized patients and 30% of outpatients [4].In the US, 50 to 90% of Americans have low back pain that causes serious work disabilities and LDH is responsible for 1 to 30% of low back pain (or subjects or cases to avoid repetition) [5, 6].The incidence of LDH varies from one country to another. In Burkina Fasso and Mali, there are, respectively, 47% and 23.6% of cases [7, 8]. While in Ivory Coast and Tunisia, the rate is quite low at 10.3% [9] and 2.2% [10], respectively.In theDemocratic Republic of the Congo, observations made in Kinshasa by Mukuna in 1990 and Kutoloka in 2002 reported respectively 2.3 and 4.3 patients per year [11, 12]. Nzanzu in 2011 reported a rate of 26.4% [13]. It should be noted that until 2005, the only scanner available at University Clinics in Kinshasa presented some difficulties in terms of functioning [11, 12].LDH is certainly a reason for absenteeism from work and the alteration of quality of life because of the professional incapacity it provides. The WHO reports a rate of 15% of absenteeism from work among forced laborers, demonstrating its economic impact in terms of productivity [1, 2]. Its financial impact is dramatic in the industrialized countries, then all the more so in low-income countries such as the Democratic Republic of the Congo.In France, there are approximately 37000 surgical procedures per year for disc herniation [4, 14]. In England, the financial impact would be in the range of 16 to 50 billion U.S. dollars [15]. However, it should be noted that upstream of any surgical sanction, medical Imaging thrones, useful in the diagnostic confirmation. This is the opportunity to wonder about the regulatory role of surgical decisions, played by medical imaging? This is all the more relevant because, to the best of our knowledge, no prior study has so far defined the relevance of medical imaging in the management of lumbar disc herniation operated in hospitals in Kinshasa. In view of this impact, we propose to meet the following objectives:

Main objective: Describe the clinical, radiological and therapeutic aspects of LDH operated in hospitals in Kinshasa.

Specific objectives:To determine the sociodemographic characteristics of patients who undergone surgery forLDH, Describe the triggers of LDH, locate the most affected intervertebral discs, highlight the type and subtype of the operated LDH, analyze the biological profile in the operated LDH and compare the results of the imaging before the surgery to the intraoperative result of the LDH.