A Survey Of The Orthopedic Surgeons’ Opinion On The Role Of Lumbosacral X-ray In The Management Of Patients With Low Back Pain

This study involved the orthopedic surgeons in Government Hospital in Enugu urban. The sampling technique used, being purposive sampling. A population of twenty (20) orthopedic surgeons was used and this included only senior registrars and consultant orthopedic surgeons. The source of data was primary, collected from orthopedic surgeons working at University of Nigeria Teaching Hospital (UNTH) and National Orthopedic Hospital (NOHE), Enugu. All data were from self administered semi-structured questionnaire. Descriptive statistics of frequency distribution and percentage were used to analyze the data.

Data collected showed that low back pain was one of the most frequent diagnoses in practice as it constituted about 50-70% of the clinical cases attended to by 55% of the orthopedic surgeons in a week on the average. The incidence of low back pain peaked at ages 41-50 and 55% of patients that presented with low back pain were within that range. The common radiographic finding was spondylosis as it constituted about 50% of the major cause of the low back pain cases. The diagnostic yield of lumbosacral x-ray was fairly reliable as 85% of the orthopedic surgeons sent patients that presented with low back pain for lumbosacral x-ray.  Lumbosacral x-ray was useful in the management of patients with LBP from the orthopedic surgeons’ opinion (100%). CT and MRI were found to be the other possible diagnostic alternative to lumbosacral x-ray from the orthopedic surgeons’ point of view.

Title page…………………………………………………………….i

Approval page………………………………………………………ii

Certification………………………………………………………….iii

Dedication………………………………………………………….iv

Acknowledgement…………………………………………………..v

Abstract…………………………………………………………….vi

Table of contents……………………………………………………..vii

CHAPTER 1

1.1 Background of study

1.2Imaging modalities for low back pain

1.3 Lumbosacral x-ray

1.4 Statement of problem

1.5 Objective of study

1.6 Significance of study

1.7 Scope of study

1.8 Literature review

CHAPTER 2

2.0 Anatomy of lumbosacral spine

2.1 The intervertebral disc

2.2 Intervertebral foramen

2.3 Nerves of the lumbosacral spine

2.4 Pathogenesis of low back pain

2.5 Factors predisposing to low back pain

2.6 Differentiation of low back pain

2.7 Common types of dysfunction and injury to the lower back

CHAPTER 3

3.0 Research methodology

3.1 Research design

3.2 Source of data

3.3 Method of data collection

3.4 Target population

3.5 Sample size

3.6 Sampling method

3.7 Data analysis and presentation

CHAPTER 4

4.0 Data presentation

4.1 Discussion

CHAPTER 5

5.0 Summary of findings

5.1 Recommendations

5.2 Limitation of study

5.3Areas of further research

REFERENCES

Table 1: Age and sex of respondents

Table 2: Respondents place of work

Table 3: % of low back pain cases attended to by the respondents 

Table 4: Major causes of low back pain

Table 5: Respondents answer on how often patients with low back pain are sent         for lumbosacral x-ray

Table 6: Respondents rating of this modality

Table 7: Diagnostic yield of lumbosacral x-ray

 

Figure 1:  usefulness of lumbosacral x-ray in the management of patients with low back pain from the respondent’s point of view.

 

Low back pain is a common musculoskeletal disorder affecting 80% of people at some point in their lives. Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning. Low back pain is one of the most significant health problems. [1]

Causes of lower back pain are varied. Most cases are believed to be due to a sprain or strain in the muscles and soft tissues of the back.[2] Overactivity of the muscles of the back can lead to an injured or torn ligament in the back which in turn leads to pain. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation). Due to aging, discs begin to diminish and shrink in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as one ages, leading to spondylolisthesis, which causes the vertebrae to move much more than they should. Pain is also generated through lumbar spinal stenosis, sciatica and scoliosis. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction which may be responsible for 22.6% of low back pain.[3] Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor[4] .

 Low back pain can be either acute, subacute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset. Low back pain may be classified by the duration of symptoms as acute (less than 4 weeks), sub acute (4–12 weeks), chronic (more than 12 weeks).[2]The majority of lower back pain stems from benign musculoskeletal problems, and are referred to as non specific low back pain; this type may be due to muscle or soft tissues sprain or strain, particularly in instances where pain arose suddenly during physical loading of the back, with the pain lateral to the spine. Over 99% of back pain instances fall within this category.[5] 

Most people with acute lower back pain recover completely over a few weeks regardless of treatments.[6] 60% of people recover after seven weeks, regardless of the treatments they receive.[7] Consistent with these statistics, a recent study found that almost 30% of patients did not recover from the presenting episode of low back pain within a year.[8]