II.MATERIALS AND METHODS
It was a retrospective and documentary study conducted from
January 2012 to June 2017, a period of four and a half years. The study was
mono-centric and involved patients who received hernia treatment at Biamba
Marie Mutombo Hospital (BMMH). The study population consisted of records of
patients operated for Lumbar Disc Herniation, each having a sectional imaging
examination (CT or MRI). The sample was exhaustive and included all patients
undergoing Lumbar Disc Herniation.The study included any patients of Congolese
nationality, male or female, aged at least 15 years, operated on for Lumbar
Disc Herniation and with a medical record containing the desired variables of
interest.This study does not include patients with incomplete medical records.
Any patient operated on LDH outside the study period or in another hospital
institution or any patient before surgery on LDH, was not included in this
study.
To carry out this work, the following materials were used:
patient files, collection cards and data entry materials including statistical
software. Each file included a consultation sheet containing the information
sought.A pre-established data collection sheet was used to transcribe all data
for each patient. It included the parameters or study variables. As for the
data collection, it was carried out in two stages: the first stage consisted in
the search of the cards and the second stage consisted in the data
transcription on the card of collection of the data.A Dell computer equipped
with software: Epidata 3.1, SPSS version 21, Excel and Word 2010 was used for
data entry and analysis.The following variables were included in each data
sheet: socio-demographic characteristics (age, sex and origin of the patient),
clinical parameters (weight, height, hernia installation wayand trigger factor
for Lumbar Disc Herniation),Para clinical parameters (laboratory tests,
standard radiography, CT scan and MRI results), classification of lesions
according to level, number, type and subtype of LDH.The intraoperative result
as well as the intraoperative incidents and complications.Quantitative
variables were expressed as mean, standard deviations or median with extremes
and qualitative variables as a percentage. The Pearson chi-square test was used
in the comparison of the qualitative variables. The materiality threshold was
set at 0.05. The odd ratio (95% confidence interval) had studied the risk
existing between the variables. The results are presented in the form of tables
and figures.The principle of confidentiality was rigorously observed when
collecting, entering and analyzing data using anonymity. No manifestation of
any conflict of interest has been brought to our attention.
As operational definitions:
Ø Age was expressed in years, patients were grouped by
10-year age groups, conventionally.
Ø The body mass index (BMI) is the weight-to-height
ratio squared ( ), expressed in kilograms per square meter .
· weight loss: 
· normal: 
· overweight: 
· obesity: 
Ø The admission delay was the period between the date
on which the LDH diagnosis was made on imaging and the date on which the
patient had undergone hernia repair. This period was divided into age groups:
1-7 months, 8-16 months and ? 16 months.
Ø Provenance, defined the various institutions of
origin of the operated patients.
Ø "Paralyzing" and "paresiante" sciatica was defined
as lumbar pain radiating to the lower limbs responsible for deficit of the
levator or flexor foot.
Ø The hyperalgesic sciatica defined an intense
radicular pain, causing insomniaand hardly relieved by morphine.
Ø Sciatica + having the cauda equine syndrome defined
pain related to the compression of the other lumbosacral roots with sphincter
disorders such as incontinence and anesthesia in saddle or hemi-saddle.
Ø Alternating sciatica and bilateral sciatica defined
bilateral synchronous or successive radicular pains.
Ø L3 sciatica defined radiculalgiaon the anteromedial
aspect of the thigh and then stopping at the inner side of the knee.
Ø L4 sciatica, defined the radicular pain on the
anterior aspect of the thigh, the leg and which stops on the kick.
Ø L5 sciatica, defined the root pain on the
posterolateral side of the thigh, external side of the leg, bypassing the
external malleolus and stopping at the big toe.
Ø S1 sciatica defined the radicular pain in the
posterior aspect of the buttock, thigh, leg, heel, and plantar surface of the
foot which stops at the small toe.
Ø Disc herniation, defined as a focal discal overflow
containing, in addition to the annulus fibrosus, nucleus pulposus, migrated
from its central position towards the periphery associated with the
cartilaginous elements of the plateau, the marginal listel and the inflammatory
reaction tissue to the presence of the nucleus pulposus.
Ø Sub-ligamentous disc herniation: protrusion of disc
material under LVCP. The sub-ligamentous migrated disc herniation: sliding of
the disc material between the LVCP and the vertebral body, adopting a
descending or ascending path.
Ø Extra ligamentous disc herniation: it is a protrusion
of the disc material with rupture of the LVCP.
Ø Excluded disc herniation: defined by the presence of
a disc material having lost all connection with the rest of the nucleus
pulposus and migrated into the spinal canal at a distance from its floor (or
level).
Ø The median disc herniation: protrusion of the disc
material in the medial part of the vertebral canal or in zone A. It is less
common (10%).
Ø Posterolateral disc herniation: protrusion of the
disc material in the paramedian part of the vertebral canal or in zone B. It is
the most common (80%).
Ø The foraminal disc herniation: it is a localization
of the disc material within the foramen of conjugation. It is very rare.
Ø Extraforaminal disc herniation: it is a localization
of the disc material outside the foramen of conjugation. It is very rare.
Ø The inflammatory balance sheet: divided into normal
and disturbed, was considered as disrupted when one of the exams (VS, CRP)was
elevated beyond normal values.
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