Low back pain in hospital outpatients in Lome (Togo)

Objective. To determine the patterns of low back pain and the conditions as sociated with this symptom in outpatients attending the rheumatology unit o f the Lome Teaching Hospital. Methods. Medical records of patients seen ove r a ten-year period were studied retrospectively. Results. Among the 9,065 patients seen during the study period, 3,204 (35.34%; 1,850 women and 1,354 men) had low back pain. Mean age at onset was 41 years, and mean duration of low back pain was three years. Diseases associated with low back pain we re as follows: degenerative spinal disease, N = 3,054 (95.32%); spinal infe ctions, N = 79 (2.47%); spondyloarthropathies, N = 44 (1.37%); and tumors, N = 27 (0.84%). The patterns of degenerative spinal disease included low ba ck pain (N = 1,535, 47.91%), low back pain with nerve root pain suggestive of disk herniation (N = 1,108, 34.58%), and low back pain with nerve root p ain and claudication suggestive of lumbar spinal stenosis (N = 411, 12.83%) . Schober's index was abnormal in 831 of the 1,408 patients (59%) with acut e pain or disk herniation, Most patients with lumbar spinal stenosis were w omen (72.26%) and were aged 35 to 64 years. Findings suggestive of tubercul osis were present in 62 of the 79 patients with lumbar spinal infection. Am ong the 44 patients with spondyloarthropathies, 15 had ankylosing spondylit is and 11 had infection with the human immunodeficiency Virus (HIV), Multip le myeloma was present in ten patients and metastatic tumors in eight. Conc lusion. Low back pain seems to be as common in sub-Saharan Africa as in occ idental countries, with a prevalence of one-third among rheumatology outpat ients. Lumbar spinal stenosis seems more common than in the occident and is mainly observed in woman. Schober's index is not useful for measuring forw ard bending of the lumbar spine in Africans. The epidemiology of spondyloar thropathies in sub-Saharan Africa has been changed by the expanding HIV epi demic, despite the low prevalence of the HLA B27 phenotype. (C) 2000 Editio ns scientifiques et medicales Elsevier SAS.