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

• ABSTRACT
  
  • I. INTRODUCTION
    
• II.MATERIALS AND METHODS
  
• III. RESULTS
  
  • SOCIO-DEMOGRAPHIC CHARACTERISTICS OF PATIENTS
    
  • SEX OF PATIENTS
    
    • Table I: Distribution of patients by age and sex
      
    • Table II. Distribution of patients by profession
      
    • ORIGIN
      
    • ANTHROPOMETRIC CHARACTERISTICS OF PATIENTS
      
      • The study of the body mass index gave rise to the results reported in the table below.
        
      • Table IV. Patient distribution according to BMI
        
    • CLINICAL PARAMETERS
      
      • Table V below shows the various installation modes of lumbar disc herniation.
        
      • Table V. Distribution of patients according to the mode of installation of the herniated disc
        
      • Table VI. Distribution of patients according to the admission delay
        
      • It can be seen from this table that 89.4% of patients were admitted within 1 to 7 months and 1.3% were more than 16 months old. The median admission time was 17.5 days.
        
      •  
        
      • *. RADICULAR PATH
        
      • The analysis of the various root paths is summarized in Table VII.
        
      • Table VII. Distribution of patients by root path
        
      • CLINICAL EXAMINATION
        
      • *. SPINAL SYNDROME
        
      • Limitation of spinal mobility
        
      • Table VIII. Distribution of patients according to spinal mobility
        
    • The following table shows that in 57.9% of patients, the hand-to-ground distance was limited to 51 cm and more.
      
      • Table IX. Patient distribution according to the Lasègue sign
        
    • The sign of Lasègue was present in 66, 75%, absent in 8,125% and bilateral in 7, 5% of cases.
      
      • NEUROLOGICAL SYNDROM
        
      • Sensitivity balance sheet
        
      • Table X below shows the distribution of patients according to the sensitivity examination.
        
      • Table X. Distribution of patients by sensitivity examination
        
      • The table above shows that sensitivity was normal in 75% of patients and disrupted in 25%.
        
      • Motricity (or traction) balance sheet (or records)
        
      • Table XI below reports the distribution of patients according to the motricity (or traction) examination.
        
      • .Table XI. Distribution of patients according to the examination of motricity
        
      • COMMON SCIATICS AND LDH REBELS TO MEDICAL TREATMENT.
        
      •   Table XII below illustrates the various clinical situations that may require a hernia cure. Among the 160 patients, there are 51 cases of hernias that are resistant to medical treatment. Table XII gives a distribution according to their clinical manifestations or etiological diagnosis.
        
      • Table XII. Distribution of patients according to clinical forms and LDH rebels to medical treatment
        
  • Table XII shows that the hyperalgic form was the most encountered in this series.
    
  • PARACLINIC FOCUS
    
  • *. INFLAMMATORY balance sheet (records) AND HEMOGRAM
    
  • All patients had performed the laboratory examinations mentioned above. The distribution of these various results is shown in Table XIII
    
  • Table XIII. Distribution of patients according to the results of the inflammatory balance sheet and the hemogram
    
    • It can be seen from Table XIII above that no inflammatory marker is specific for LDH.
      
    •   MEDICAL IMAGING
      
    • * Standard radiography
      
    • Standard X-rays were performed in all 160 patients, in whom there were 32 common X-rays. This is summarized in Table XIV below:
      
    • Table XIV. Patient distribution according to the results of standard radiography
      
    • Table XIV shows that disc pinching was the most common anomaly with 59.3%.
      
      • *Computed tomography (CT)
        
      • The previous herniated disc was not found in any patient. All cases were of the posterior type as summarized in Table XV below.
        
      • Table XV. Distribution of patients by type and subtype of lumbar disc herniation at CT.
        
    • This table shows that the median and posterolateral hernias were predominant in the proportions of 50% and 53.1%, respectively.
      
      • ANATOMICAL AND TOPOGRAPHIC DISTRIBUTION OF LESIONS
        
      • Table XVI below illustrates the distribution according to the number and disc level concerned.
        
      • Table XVI. Distribution of patients by number and level of disc level affected
        
  • Table XVI shows that multiple localization is quite common in our environment.
    
  • ASSOCIATED PATHOLOGIES
    
  • Figure 3 below shows the pathologies associated with hernia in this study.
    
  • Figure 3. Pathologies associated with operated lumbar disc herniation.
    
    • Figure 3 indicates that hypertrophy of the yellow ligament was frequently associated with lumbar disc herniation (62.5%).
      
    • STATISTICAL ANALYSIS
      
    • * RELATIONSHIP BETWEEN THE SUB-TYPES OF HERNIA AND SEX
      
    • Table XVII represents a comparative study of the subtypes of the encountered LDH and sex.
      
    • Table XVII. Cross representation between subtypes of hernia and sex
      
    • Table XVII reveals that there was no statistically significant relationship between subtypes and sex. In contrast, the risk was 3 times higher in women with foraminal hernias and 1 time higher in men with extra foraminal hernias.RELATIONSHIP BETWEEN THE SUBTYPES OF LDH AND THE LIFTING EFFORT AS A TRIGGER FACTOR.
      
    • The notion of lifting force as a triggering factor was found in 16.3% of the patients. Below is the distribution of these cases according to this triggering factor.
      
    • Table XVIII. Relationship between the subtypes of the hernia and the effort of uplift.
      
    • Table XVIII indicates that there was no statistically significant relationship between the subtypes and the lifting effort. However, the risk was multiplied by 1.202 for median DH, 1.035 for posterolateral DH, and 1.300 for foraminal DH, respectively.
      
    • The median and posterolateral DH had a statistically significant relationship with the sport with p = 0.002 and p = 0.027, respectively. The risk was multiplied by 7.688 in the posterolateral hernia (Table XX).
      
      • RELATIONSHIP BETWEEN THE SUBTYPES OF LDH AND HYPERTROPHY OF YELLOW LIGAMENT AS AN ASSOCIATED PATHOLOGY.
        
      • Hypertrophy of the yellow ligament was the most predominant associated pathology at 62.5%. Table XXI summarizes its relationship with the various subtypes.
        
      • Table XXI. Relationship between subtypes of hernia and hypertrophy of ligament.
        
    • RELATIONSHIP BETWEEN THE SUB-TYPES AND THE Lumbar spinal stenosis AS ASSOCIATED PATHOLOGY
      
    • The Lumbar spinal stenosiswas found as an associated pathology in 21.9% of cases. Table XXIII below illustrates the relationship with the various subtypes.
      
    • Table XXIII. Relationship between the subtypes of the hernia and the Lumbar spinal stenosis
      
      • RELATIONSHIP BETWEEN DIAGNOSIS OF MEDICAL IMAGING AND INFLAMMATORY BALANCE SHEET
        
      • A relationship between the result of the inflammatory balance sheet and the various subtypes of LDH has been sought. Table XIV below generates a summarization.
        
      • Table XXIV. Imaging diagnosis and results of inflammatory balance sheet
        
      • All 160 patients underwent laminectomy with hernia repair. Table XXV below reports the concordances and discrepancies found between the diagnosis of imaging and the intraoperative results.
        
      • Table XXV. Comparative illustration between the diagnosis of imaging and the intraoperative results.
        
• Table XXV shows that the discrepancies between the imaging results and the intraoperative results were of the order of 6.3 and 24.4% concerning the medial and posterolateral disc hernias respectively. A statistically significant link was noted between subtypes of LDH and intraoperative diagnosis (p?0.001).
  
• DISCUSSION
  
  • The sex
    
  • Profession
    
  • The origin
    
  • Cauda equina syndrom 
    
    • PARACLINIC EXAMINATIONS
      
    • Biology
      
    • ? Inflammatory balance sheet and hemogram
      
    • Our study shows that of the 160 patients, 130 patients (81.3%) had a normal inflammatory balance sheets. Thirty patients (18.7%) had a disturbed inflammatory balance, of which 12.5 with increased CRP and 6.2% with accelerated VS. Note also that the blood count was disrupted in 3.1% of cases.
      
  • · A delay of less than or equal to 7 months: 89.4% of patients operated on for surgical emergencies, including hyperalgic sciatica, paresis, paralyzing sciatica and Cauda equina syndrome. Our observations are consistent with those in the literature, which report an admission period ranging from one week to 10 years with a maximum frequency between 1 month and 1 year [23].