Profession
This study indicates that 57 out of 160 patients (35.6%) were
housewives. This category of the population is exposed to a sedentary life,
predisposing to develop obesity which is incriminated in the imbalance of
spinal biomechanics, because of the overload it imposes. Our observations
corroborate the data in the literature. Davis reports a higher prevalence of
LDH among sedentary people, without providing any application.This could be
explained either by obesity or by the accentuation of the early degeneration of
the disc by repeated trauma and micro trauma [22].It should be noted that
professional activity is criminalized in 36.6% of cases of forced or manual
workers and 26.7% of those in sedentary jobs [17, 23, and 24].Nevertheless, it
should be noted that, according to De Korvin et al, lumbosciatica affects all
professional sectors, that they make use of the muscles (20% of the handlers,
40% of the building workers and 40% of the caregivers) or that they are
sedentary (30% of women and 40% of men clerks) [4].
The origin
The majority of patients in the series, 53 patients or 33.1%
came from the National Society of Electricity. This can be explained by several
reasons: notably by an offer of care more granted to the National Society of
Electricity agents and their family members, the heavy work that some agents
face, not to mention the large number of the National Society of Electricity
agents who attend the hospital as part of their agreement with Biamba Marie
Mutombo Hospital.
Triggers
Uplifting effort was the most criminalized factor with 16.3%
of cases. It is a risk factor for both lumbosciaticaand lumbosciaticaon LDH
[17], concomitantly with other factors such as sports, trauma, prolonged
standing, cold, obesity and driving. . No statistically significant link was
noted between the subtype of the hernia and the lifting effort.
On the other hand, the risk was multiplied by 1,202 for the
medial hernia, 1,035 for the posterolateral hernia and 1,300 for the foraminal
hernia.The high incidence of this factor could also be explained by the fact
that the majority of patients in this series consisted of housewives who are
exposed to muscular efforts to provide for their families. Our data are close
to those of the literature: Deshayes and Mandour had also incriminated the
lifting effort in their series with respectively 38% and 49.1% of cases [25,
26]. This difference in percentages could be explained by the fact that in this
series the triggering factor was not specified in 66.3% of cases.
ANTHROPOMETRIC PARAMETERS OF PATIENTS
Body mass index (BMI)
In this series, obesity was found in 39.4% of cases. The
housewives were the most frequent professional category. This category of
people is subject to a sedentary life, exposing them to obesity that is one of
the triggers of the LDH [21]. Another reason is that the abdominal musculature
counterbalances the powerful action of the extensors. Its deficiency, its
distension in obese or pregnant women, as well as its inefficiency accentuate
lumbar lordosis, which, in turn, accelerates disc degeneration [21].
CLINICAL STUDY
Installation mode
This study showed that 71 patients (44.4%) had a progressive
mode of LDH installation. This could be explained by a high rate of
self-medication with analgesics and anti-inflammatories in our environment.It
should be noted that LDH sciatica are installed in two modalities: acute and
progressive. In the first, pains occur from the start in lightning, associated
with a more or less marked functional impotence. As for the second, it spreads
in a few days and follows a history of low back pain or lumbago.In this series,
acute onset was noted in 25% of cases. This is in accordance with the results
generated by Mandour and Lazorthes with 27.5% and 28% respectively [26, 27]. On
the other hand, the progressive start of the 44.4% recorded in this series was
far lower than the observations of Mandour and Deshayes, who reported
respectively 58.8% and 60% [25, 26]. This difference was probably due to the
fact that the installation method was not specified in our series in 49
patients (30.6%).
The admission period
The admission delay in this series ranged from 1-7 months in
143 patients (89.4%). This delay corresponds to the time elapsed between the
date when the diagnosis of disk herniation was made in imaging and the
hospitalization for a surgical cure for LDH. During this period, patients
consulted several doctors and received various therapeutics. The median
admission delay was 17.5 days in this series. This is probably due to the
terror that the surgical procedure caused in many people. In the different
series of the literature, the admission period ranges from one week to 10 years
with a maximum frequency between 1 month and 1 year [23]. Our results are close
to those of the literature on this point.
Mode of admission to the hospital
This study showed that 50.6% of patients were admitted to the
hospital in emergency, against 49.4% of patients admitted to hospital by
appointment. This is explained by the fact that the majority of patients
operated on (68.2%) had symptomatic forms of LDH hernia (the hyperalgic,
paralyzing, and Cauda equina syndromes), which were found in 50%, 11.9% and
6.3% of cases respectively, while the LDH rebels to medical treatment were
found in only 31.9% of cases.
The radicular path
The study of radicular path in our series showed a
predominance of poorly systematized lombosciatalgia in 46 cases (28.8%),
followed by L5 locations in 46 cases (28.8%) and S1 in 25 cases (15.6%). This
large number of poorly systematized lumbosciatalgia could be explained by the
fact that the neurological examinations were probably brief, carried out by the
general practitioners. The frequent attack of the L5 root could be explained by
the vulnerability of the root L5 with respect to the root S1, whose lesion can
evolve slowly for a long time before manifesting itself. Our data are in
agreement with the results of Mandour and Lazorthes [26, 28].The predominance
of lateralization on the left was noted in this series in 77 cases (48.1%)
compared to 46 cases (28.8%) in the right side. We have no explanation to give
in this regard.Bilateral sciatica was found in our series in 19.3% of cases. We
do not have a particular reason to provide against this observation.
Nevertheless, our data are close to the results of Gandin who reported 16% of
cases [29].
PHYSICAL EXAMINATION
Spinal syndrome
Low lumbar stiffness was assessed by hand-to-ground distance
in all patients,among which 116 patients (82.9%) had a distance greater than 30
cm. This rate was slightly higher than that reported by Mandour, accounting for
53.2% of cases [26].Lasègue's maneuver was the most explored gesture in
the neurological examination. It was noted in 147 patients (91.9%), 68.75% of
these patients are noted with an ipsilateral positive Lasegus, 15.625% with a
contralateral positive Lassec and 7.5% with a bilateral positive Lassec.
Indeed, following its impact on the nerve root, disc herniation, in most cases,
reduces the normal amplitude of root slip in the inter-disco-apophyseal parade
[30]. This is why it shows correlations with the degree of progression of LDH
[31]. For Klat M and Mbuyi M, the first degrees of the sign of Lasègue
are the most determining for the diagnosis of sciatica of disc origin [31]. A
Lasègue sign below 25 ° -30 ° indicates severe sciatica. When
the sciatic pain of the patient is reproduced by the elevation of the
contralateral lower limb, it is a contralateral Lasègue. At Gandin and
El Azhari the sign of Lasègue was positive in 75% and 87% respectively
[29, 32].
The neurological syndrome
Sensitivity study
In this series, these disorders were investigated in all
patients, 120 of these patients (75%) had normal sensitivity, 25 patients
(15.6%) had hypoesthesia, while anesthesia was found in 15 patients
(9,4%).Sensitivity disorders generally consisted of hypoesthesia, see,
superficial anesthesia in the L5 or SI territory (on the antero-external part
of the leg, the back of the foot and the big toe in case of L5 involvement and
On the Achilles' tendon, the heel, the sole of the foot when suffering from
SI).These sensitivity disorders were also found by Deshayes in 25% of cases and
by El Azhari in 42% of cases [25, 32].
Study of motricity
Segmental motricity function was evaluated in all patients in
this series. Eighty-one patients (50.6%) had no motor deficit, 35 patients
(21.9%) had paresis and 34 patients (21.3%) had complete paralysis. Our results
are in agreement with the observations of Dheshayes who reported paralytic
sciatica in 9.1% and paresiant sciatica in 23.9% [25]. Similarly Guieu reported
paralyzing sciatic in 10% and paresiant in 14% [33]. As for Brement, he had
reported 5.8% of paralytic sciatica and 10.8% of parasiant sciatica [34].
Clinical forms of common sciatica
Hyperalgic sciatica
It prohibits any spinal mobilization. The pain is
excruciating, not relieved by the decubitus. After radiological assessment and
when this pain does not give way under medical treatment, it can impose a
surgical intervention. In our series, hyperalgic sciatica was found in 80
patients (50% of all patients). Our results are close to those of the study of
Davis who found in his series 76% of hyperalgic forms [21].Nevertheless, our
observations were in contradiction with the data of Brement which had found a
frequency of 24, 16% [34]. Barhourhe, on a sample of 266patients? , found a
frequency of 25.93% [24]. This high rate of the hyperalgesic form explained why
nearly 50% of patients had an admission time of around 17.5 days.
Paralyzing forms
This form was observed in 19 patients (11.9%) of this series.
In general, paralytic sciatica presents itself first as a common or hyperalgic
sciatica and then, the pain disappears, leaving room for a brutal or sub-acute
motor deficit. This most often concerns the antero-external compartment of the
leg. In some cases, electromyography can quantify the motor impairment and
follow its evolution. Our observations are consistent with those of Guieu [33]
and Deshayes [34] who reported a frequency of 10% and 9.1% respectively.
Barhoure [24] had a frequency of 14.27%.
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