Radiological lumbar spine anatomical changes in chronic low back pain and its social impact in western Kenya

Abstract

Chronic low back pain (CLBP) is defined as pain that lasts for a period of twelve weeks or more and can develop later even after the associated cause of the acute low back pain has been managed and remarkably resolved. It is the commonest musculoskeletal complaint that most patients present with in the outpatient department accounting for 77-85% of the cases globally and the leading cause of disability with both adverse psychosocial and economic implications. Diagnostic techniques with low specificity in various health institutions have created many gaps in understanding the nature and anatomical structures implicated in chronic low back pain. Proper understanding of the anatomical structures associated with chronic low back pain can lead to early diagnosis and proper management of the condition. Therefore, the aim of this study was to establish radiological lumbar spine anatomical changes in chronic low back pain of adult patients and its social impact at Kakamega County General and Referral Hospital which had the largest number of patients presenting with chronic low back pain. The study specifically ;(i) determined radiological changes in the lumbar spine of adults presenting with chronic low back pain, (ii) assessed the social impact of chronic low back pain in adult patients at Kakamega and (iii) determined the association between the severity of chronic low back pain with the socio demographic profiles of these patients. A target case group of patients with CLBP in the outpatient and emergency departments including those on follow up for pain management clinic was used with a sample size of 144 patients as per Yamane Taro formula. Purposive sampling of lumbar spine Magnetic resonance imaging scans was used to obtain data. Personal and societal impact of patients with chronic low back pain was assessed using Oswetry modified questionnaire. Data analysis was done using SPSS version 22.0. and descriptive data such as frequencies, mean, mode and median were presented into tables and graphs. It was established that females were more prone to chronic low back pain as compared to males. Patients with weight above 75kg were more likely to develop chronic low back pain. Osteophytes were the most pathological changes affecting both casual laborers, professionals and business people while fractures were the least common. Most of the social activities were affected with moderate pain. It can be concluded that osteophytic changes of vertebra, desiccation and spinal narrowing can predispose one to chronic low back pain. Pain impacts the emotional wellbeing and work productivity of an individual. Individuals weighing >75kg are more predisposed to lumbar spine changes that cause chronic low back pain. The study therefore recommends early screening and treatment to avert pain and weight reduction to lessen the mechanical damage on the lumbar column.