Surgical treatment of lumbar spinal stenosis: Patients' postoperative disability and working capacity

Summary A total of 439 patients operated on for lumbar spinal stenosis during the period 1974–1987 was re-examinated and evaluated for working and functional capacity approximately 4 years after the decompressive surgery. The assessment of subjective disability was based on the Oswestry low-back pain questionnaire. The proportion of excellent-to-good outcomes was 62% (women 57%, men 65%). The ability to work before or after the operation and a history of no prior back surgery were variables predictive of a good outcome. Before the operation 86 patients were working, 223 patients were on sick leave, and 130 patients were retired. After the operation 52 of the employed patients and 70 of the unemployed patients returned to work. None of the retired patients returned to work. In logistic regression analysis the ability to work preoperatively, age under 50 years at the time of operation and the absence of prior back surgery predicted a postoperative ability to work. Our results suggest that more attention should be focussed on the diagnosis of spinal stenosis and on the timing of the operative intervention.     

Painful internal disc derangements of the lumbosacral spine: discographic diagnosis and treatment by posterior lumbar interbody fusion.

Results of surgical or non-surgical treatment of patients with chronic persistent low back pain, but without clearly demonstrable diagnosis of disc herniation, spinal stenosis, or spinal instability, range between 50% to 80% of success rates in the literature. Between 1984 and 1988, the authors reviewed 25 consecutive cases of internal derangements of the lumbar disc treated by subtotal disc excision and interbody fusion. All patients had chronic, persistent, or frequently recurring low back pain resistant to active nonoperative treatments for a minimum of 3 months (mean: 16); no evidence of disc herniation, stenosis, or instability; no previous operation; single level of the pathologic condition in L-S spine; and diagnosis made by clinical information, CT, MRI, and/or discography. Ages ranged from 25 to 51 (mean: 38 to 40). Average follow up was 2 years (range: 13 to 57 months). In addition, 20 patients (32 discographics) who had available information of discography, MRI, and CT scan of the L-S spine, were reviewed for the relationship between disc morphology, pressure, volume, and pain response during discography. Overall clinical results for the 25 patients were: 58% excellent (15 of 26), 31% good (8 of 26), and 11% fair (3 of 26). No patients were in the "poor" category. The successful fusion rate was 95%.     

Clinical instability of the lumbar spine after microdiscectomy

Summary A total of 190 patients treated micorsurgically for a virgin single level lumbar disc herniation were examined physically after a mean follow-up period of 3 years (range 21–68 months). Included were 99 (52%) men and 91 (48%) women with a mean age of 42 years. During the observation period, sciatica had completely recovered or markedly diminished in 172 (90%) patients, and 142 (75%) patients had returned to work. However, as many as 29% of the patients occasionally suffered from low back pain.Clinical examination revealed various signs and symptoms of segmental instability of the lumbar spine in 22% of the surgical patients. There was a significant association between postoperative instability and unsatisfactory long-term outcome: of the 42 patients with instability, 62% suffered from low back pain and 45% were on sick leave or retired because of the back, while the corresponding numbers for those patients without instability were 20% and 8%, respectively (p<0.0001). Moreover, the mean value of the Oswestry index in instability patients was as high as 34% (SD 12), indicating moderate disability, whereas a significantly (p=0.0001) lower Oswestry Index 16% (SD 13), indicating minimal disability, was detected in patients without instability.     

腰椎间盘突出症再手术患者的MRI表现

目的：探讨ＭＲＩ在腰橙是盘突出症手术失败病例诊治过程中的应用价值。方法：分析８３例腰椎间盘同症再手术患者的ＭＲＩ表现。其中男性５６例,女性２７例。年龄２７～７１岁,平均４３．４岁。距初次手术时间８个～６年。结果;椎间盘突出２４例,椎管狭窄４３例,假性脊膜突出３例,硬膜纤维化神经周围瘢痕形成１１例,腰椎不稳２例。结论：ＭＲＩ对于引起腰椎手术失败的多数在均有诊断,尤其适用于未作内固定的病例。     

Low back pain in hospital outpatients in Lomé (Togo)

OBJECTIVE: To determine the patterns of low back pain and the conditions associated with this symptom in outpatients attending the rheumatology unit of the Lomé Teaching Hospital. METHODS: Medical records of patients seen over 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 were as follows: degenerative spinal disease, N = 3,054 (95.32%); spinal infections, N = 79 (2.47%); spondyloarthropathies, N = 44 (1.37%); and tumors, N = 27 (0.84%). The patterns of degenerative spinal disease included low back 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 pain and claudication suggestive of lumbar spinal stenosis (N = 411, 12.83%). Sch?ber's index was abnormal in 831 of the 1,408 patients (59%) with acute pain or disk herniation. Most patients with lumbar spinal stenosis were women (72.26%) and were aged 35 to 64 years. Findings suggestive of tuberculosis were present in 62 of the 79 patients with lumbar spinal infection. Among the 44 patients with spondyloarthropathies, 15 had ankylosing spondylitis and 11 had infection with the human immunodeficiency virus (HIV). Multiple myeloma was present in ten patients and metastatic tumors in eight. CONCLUSION: Low back pain seems to be as common in sub-Saharan Africa as in occidental countries, with a prevalence of one-third among rheumatology outpatients. Lumbar spinal stenosis seems more common than in the occident and is mainly observed in woman. Sch?ber's index is not useful for measuring forward bending of the lumbar spine in Africans. The epidemiology of spondyloarthropathies in sub-Saharan Africa has been changed by the expanding HIV epidemic, despite the low prevalence of the HLA B27 phenotype.     

Pain following operations of the lumbar spine. The "failed back surgery syndrome"

This is a follow up study of 61 patients with a 'failed back surgery syndrome' (FBSS). The mean follow up time is 5.4 years after the first operation on the lumbar spine. The diagnosis before the first operation was in 35 patients an entrapment disease (disc herniation or stenosis of the spinal canal), in 25 patients a segmental instability and once a deformity. The reason for the development of a 'failed back surgery syndrome' was in 18% a perioperative complication, in 24% a late unhappy consequence of the operation, in 40% an assessment- or treatment error. In 18% we were not able to figure out any reason for the failure. The correlating diagnosis were: postoperative infections 3, hematoma 1, disc herniation or instability on a second level 12, a second disc herniation at the same level 3, scarring or arachnoiditis 2, instability 18, lateral spinal stenosis 10. We emphasize the importance to distinguish between a clinical relevant and irrelevant diagnosis and to use special tests for this differentiation.     

TLIF入路椎体间单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症并腰椎不稳

目的 评价经椎间孔腰椎体间融合术（TLIF）入路椎体间单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症并腰椎不稳的疗效。方法 自2007-01-2012-12采用TLIF入路椎管减压、GSS或SINO内固定装置复位内固定、椎体间混合植骨、单枚cage应用治疗31例多节段腰椎管狭窄症并腰椎不稳,分析术后症状、体征改善情况。结果31例获得0.5-5年,平均1.5年的随访。按侯树勋等制定的疗效评定标准评定疗效：优26例,良5例。按JOA下腰痛疾患疗效评定标准,改善率达90%-98%。结论 应用TLIF入路椎体间单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症并腰椎不稳具有减压彻底、微创植骨易融合、神经副损伤少等优点,是治疗多节段腰椎管狭窄症及腰椎不稳的理想方法。     

扩张式椎间融合器在腰椎融合术中的应用

目的探讨扩张式椎间融合器（expanding cage,EC）在腰椎融合术中应用的适应性、技术要点和疗效。方法本组47例患者,均行后路扩张式椎间融合术（PELIC）。术前分别诊断为腰椎管狭窄、腰椎间盘突出、腰椎滑脱和退变性腰椎不稳,经非手术治疗无效后,以手术对椎管及神经根管减压,用EC融合固定并植骨。术前、术后对患者的腰疼情况进行视觉痛觉自我评定尺（VAS）评分。结果所有患者术前症状消失,术中未发生神经损伤,随访最长时间为61个月,最短53个月,平均57．3个月,无假关节形成,无明显椎体塌陷。结论EC在腰椎融合术应用中具有融合可靠、症状改善明显等优点。     

退行性腰椎滑脱伴腰椎管狭症的手术治疗

目的探讨退变性腰椎滑脱伴椎管狭窄症的手术治疗。方法回顾性分析 84例退变性腰椎滑脱伴腰椎管狭窄症的手术治疗结果。其中男性 33例 ,女 5 1例 ;年龄 4 3～ 79岁 ,平均 5 6 .1岁 ;包括Ⅰ°滑脱 5 1例 ,Ⅱ°滑脱 33例。33例接受单侧或双侧椎板开窗减压术 ,5 1例接受全椎板切除减压、植骨融合椎弓根螺钉内固定术。结果 84例经过平均 5年 3个月的随访 ,两种手术方法疗效优良率分别是 90 .90 %、84 .2 7% ,两种疗效无显著性差别 (P >0 .0 5 )。手术并发症发生率为 9.0 9%、17.6 4 % ,亦无显著性差异 (P >0 .0 5 )。结论对于腰椎管狭窄症伴腰椎滑脱症手术适应症和减压范围要掌握恰当 ,二种手术方式减压均可以取得满意疗效。     

Mini-open anterior spine surgery for anterior lumbar diseases

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified “mini-open anterior spine surgery” (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24–52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12–L1, 18 at L1–L2, 18 at L2–L3, 22 at L3–L4 and 11 at L4–L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62–124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4–26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.     

La lombalgie en consultation hospitalière à Lomé (Togo)

Objective. To determine the patterns of low back pain and the conditions associated with this symptom in outpatients attending the rheumatology unit of the Lomé teaching hospital. Methods. Medical records of patients seen over a ten-year period were studied retrospectively. Results. Among the 9065 patients seen, 3204 (35.34%; 1850 women and 1354 men) had low back pain. Mean age at onset was 41 years, and mean duration of low back pain was 3 years. Diseases associated with low back pain were as follows: degenerative spinal disease, n= 3054 (95.32 %); spinal infections, n=79 (2.47 %) ; spondyloarthropathies, n=44 (1.37 %) ; and tumors, n=27 (0.84 %). The features of degenerative spinal disease included back pain (n=1535, 47.91 %), lumbar and radicular pain suggestive of disc herniation (n=1108, 34.58 %), and lumbar and radicular pain with claudication suggestive of lumbar spinal stenosis (n=411, 12.83 %). Schöber’s test was abnormal in 831 of the 1408 patients (59 %) with acute pain or disc herniation. Most patients with lumbar spinal stenosis were women (72.26 %) and were aged 35 to 64 years. Findings suggestive of tuberculosis were present in 62 of the 79 patients with lumbar spinal infection. Among the 44 patients with spondyloarthropathies, 15 had ankylosing spondylitis and 11 had infection with the human immunodeficiency virus (HIV). Multiple myeloma was present in 10 patients and metastatic tumors in eight. Conclusion. Low back pain seems to be as common in sub-Saharan Africa as in occidental countries, with a prevalence of one-third among rheumatology outpatients. Lumbar spinal stenosis seems more common than in the Occident and is mainly observed in woman.  Schöber’s test is not useful for measuring lumbar flexion in Africans. The epidemiology of spondyloarthropathies in sub-Saharan Africa has been changed by the expanding HIV epidemic, despite the low prevalence of HLA B27.     

Coexistence of cervical and lumbar disc disease

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.     

腰椎间盘突出症术后失稳的手术治疗

目的：探讨椎间植骨融合、椎弓根内固定系统在腰椎间盘切除术后脊柱失稳再手术中的应用和临床效果。方法：回顾总结1997年5月～2002年8月收治的采用后路椎管减压、腰椎间盘髓核摘除治疗爱椎间盘突出症导致的腰椎失稳再手术病例23例，男14例，女9例；年龄28～64岁，平48．5岁。再手术距初次手术时间2～10年，平均5年8个月。病程6个月～3年，平均1年6个月。单节段病变17例，双节段病变6例。所有患者初次手术行椎间盘切除术，根据手术后症状和影像学检查评估脊柱失稳程度以确定再手术治疗。结果：手术时间120～210min，平均180min；术中出血550～800ml，平均650ml；术后随访1～6．4年，平均3．6年。疗效应用MPQ问卷和下腰痛及功能不利评分评定，临床成功率86.9%，患者满意率82．6％。螺钉断裂2枚，松动1枚。5例出现神经根刺激症状，23周后恢复。3例硬膜撕裂。3例植骨未融合，其中2例行后外侧融合术。结论：腰椎间盘突出术后脊柱失稳再手术时应行腰椎融合术，同时应用内固定，促进植骨融合并以维持椎间隙稳定，疗效满意，无严重并发症发生。     

Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study

STUDY DESIGN: A prospective cohort study of patients with lumbar spinal stenosis recruited from the practices of orthopedic surgeons and neurosurgeons throughout Maine. OBJECTIVE: To assess 4-year outcomes for patients with lumbar spinal stenosis treated surgically or nonsurgically. SUMMARY OF BACKGROUND DATA: Surgery for lumbar spinal stenosis has increased dramatically despite the lack of randomized trials comparing surgical with nonsurgical treatments. Long-term evaluation of surgical series has documented deterioration in initial symptomatic improvement, but few studies have compared long-term outcomes of surgical and nonsurgical treatment. METHODS: Eligible, consenting patients had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months, then annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, and satisfaction. RESULTS: Of 148 patients with lumbar spinal stenosis initially enrolled, 4-year outcomes were available on 119 patients (80.4%): 67 of 81 (83%) treated surgically and 52 of 67 (78%) treated nonsurgically. The surgically treated patients had more severe symptoms and worse functional status at baseline and better outcomes at 4-year evaluation than the nonsurgically treated patients. After 4 years, 70% of the surgically treated and 52% of the nonsurgically treated patients reported that their predominant symptom, either leg or back pain, was better (P = 0.05). Satisfaction of patients with their current state at 4 years was reported by 63% of the surgically treated and 42% of the nonsurgically treated patients (P = 0.04). Surgical treatment remained a significant determinant of 4-year satisfaction, even after adjustment for other independent predictors (P = 0.001). For the nonsurgically treated patients, there was no significant change in outcomes over 4 years, whereas the initial improvement seen in the surgically treated patients modestly decreased over the subsequent 4 years. CONCLUSIONS: For the patients with severe lumbar spinal stenosis, surgical treatment was associated with greater improvement in patient-reported outcomes than nonsurgical treatment at 4-year evaluation, even after adjustment for differences in baseline characteristics among treatment groups. The relative benefit of surgery declined over time but remained superior to nonsurgical treatment. Outcomes for the nonsurgically treated patients improved modestly and remained stable over 4 years. Determining whether outcomes continue to converge will require longer-term evaluation.     

Results of surgery for spinal stenosis adjacent to previous lumbar fusion

The literature provides little data to guide surgical management of spinal stenosis adjacent to previous lumbar fusion. Thirty-three consecutive patients who had surgical decompression for spinal stenosis at the lumbar segments adjacent to a previous lumbar fusion were studied. The mean interval between fusion and the adjacent segment surgery was 94 months. Of the 33 patients, 26 were followed for 3-14 years (mean: 5 years) after adjacent segment surgery and were clinically evaluated and independently completed an outcome questionnaire. Of the 26 patients, 15 rated their outcome as completely satisfactory, 6 were neutral toward the surgery, and 5 considered their surgery a failure. The surgery was generally effective at improving or relieving lower extremity neurogenic claudication. The strongest independent predictive factor of patient dissatisfaction was ongoing postoperative low back pain (r = 0.7, p = 0.001). A higher back pain score at follow-up was associated with continued narcotic use (p = 0.001) and decreased ability to perform activities of daily living (p = 0.05). Six patients required further lumbar surgery during the follow-up period. This study provides the longest published follow-up data of surgical results for symptomatic spinal stenosis adjacent to a previously asymptomatic lumbar fusion.     

Clinical and radiological characteristics of spinal epidural lipomatosis: A retrospective review of 90 consecutive patients

BackgroundThe epidemiology and clinical characteristics of spinal epidural lipomatosis (SEL) have been well-reported in the literature. However, few studies investigated the concomitant spinal pathologies that were present in patients with SEL. Therefore, we aimed to summarize the clinical and radiological characteristics of patients with SEL diagnosed on spinal imaging.MethodsPatients who were diagnosed with SEL on magnetic resonance imaging from January 2018 to October 2020 at our institution were included in the study. Clinical data was collected using a standardized data collection form. SEL was graded using a modified version of the Borré grading system. Factors associated with moderate or severe SEL were determined using multiple logistic regression.ResultsA total of 90 patients were included in the analysis. The mean (±SD) age was 59.3 (±17.1) years, and 62 patients (68.9%) were male. 61 patients (67.8%) had moderate or severe SEL. Most patients were overweight or obese (57 patients, 63.3%). The most common presenting symptoms was back pain (57 patients, 63.3%). SEL was diagnosed incidentally in 42 patients (46.7%). The lumbar spine was the most common site of SEL (35 patients, 38.9%). The most common concomitant spinal pathologies were disc bulge (83 patients, 92.2%) and flavum hypertrophy (60 patients, 66.7%). Moderate or severe SEL was associated with WHO Obesity Class, back pain or radicular leg pain at first presentation, and SEL that was worst at the lumbar or lumbosacral spinal level.ConclusionsModerate or severe SEL were independently associated with WHO Obesity Class, back pain, radicular leg pain, and SEL that was worst at the lumbar or lumbosacral spinal level. Future studies should prospectively evaluate whether weight loss therapy is warranted in patients with SEL.     

老年退行性腰椎管狭窄症手术治疗的疗效分析

目的探讨老年退行性腰椎管狭窄症患者手术治疗的疗效。方法1994年1月~2006年11月收治的247例65岁以上退行性腰椎管狭窄症患者中168例获得0.5~5年随访;把病例分为非固定组111例(全椎板切除减压或 横突间植骨、小开窗切除或半椎板减压)和固定组57例两组。将两组中各种术式的疗效进行回顾性分析。结果无死亡病例。发生并发症者30例。JOA评分优良率,非固定组为92.1%,固定组为94.3%。结论对于老年退行性腰椎管狭窄症的患者,没有明确证据证明腰椎不稳时,治疗以单纯减压为主,双侧小开窗或单侧小开窗 对侧半椎板减压可以满足绝大多数患者的要求,手术方法应人而异。内固定组与非固定组疗效经标准化处理无明显差异。但非固定组的治疗费用远远低于内固定组。     

The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study

BACKGROUND: In 1989, a group of sixty-seven asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Twenty-one subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects. METHODS: A questionnaire concerning the development and duration of low-back pain over a seven-year period was sent to the sixty-seven asymptomatic individuals from the 1989 study. A total of fifty subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for thirty-one of these subjects. Two neuroradiologists and one orthopaedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information. At each disc level, any radiographic abnormality, including bulging or degeneration of the disc, was identified. Radiographic progression was defined as increasing severity of an abnormality at a specific disc level or the involvement of additional levels. RESULTS: Of the fifty subjects who returned the questionnaire, twenty-nine (58%) had no back pain. Low-back pain developed in twenty-one subjects during the seven-year study period. The 1989 scans of these subjects demonstrated normal findings in twelve, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four of them had had normal findings on the original scans, two had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans. CONCLUSIONS: The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.     

La lombalgie en consultation hospitalière à Lomé (Togo)Low back pain in hospital outpatients in Lomé (Togo).

Objective. To determine the patterns of low back pain and the conditions associated with this symptom in outpatients attending the rheumatology unit of the Lomé teaching hospital. Methods. Medical records of patients seen over a ten-year period were studied retrospectively. Results. Among the 9065 patients seen, 3204 (35.34%; 1850 women and 1354 men) had low back pain. Mean age at onset was 41 years, and mean duration of low back pain was 3 years. Diseases associated with low back pain were as follows: degenerative spinal disease, N= 3054 (95.32 %); spinal infections, N=79 (2.47 %) ; spondyloarthropathies, N=44 (1.37 %) ; and tumors, N=27 (0.84 %). The features of degenerative spinal disease included back pain (n=1535, 47.91 %), lumbar and radicular pain suggestive of disc herniation (n=1108, 34.58 %), and lumbar and radicular pain with claudication suggestive of lumbar spinal stenosis (n=411, 12.83 %). Schöber’s test was abnormal in 831 of the 1408 patients (59 %) with acute pain or disc herniation. Most patients with lumbar spinal stenosis were women (72.26 %) and were aged 35 to 64 years. Findings suggestive of tuberculosis were present in 62 of the 79 patients with lumbar spinal infection. Among the 44 patients with spondyloarthropathies, 15 had ankylosing spondylitis and 11 had infection with the human immunodeficiency virus (HIV). Multiple myeloma was present in 10 patients and metastatic tumors in eight. Conclusion. Low back pain seems to be as common in sub-Saharan Africa as in occidental countries, with a prevalence of one-third among rheumatology outpatients. Lumbar spinal stenosis seems more common than in the Occident and is mainly observed in woman.  Schöber’s test is not useful for measuring lumbar flexion in Africans. The epidemiology of spondyloarthropathies in sub-Saharan Africa has been changed by the expanding HIV epidemic, despite the low prevalence of HLA B27.     

Stabilization of the lumbar spine using the dynamic neutralization system

The records of 68 patients (42 men and 26 women) who underwent spine stabilization with a dynamic neutralization system were reviewed. Mean patient age at operation was 42.8 years. The primary indication for surgery was degenerative spine disease and instability with neurogenic or radicular pain and/or chronic back pain. Forty-one (60.2%) patients had degenerative diskopathy or disk herniation, and 27 (39.8%) patients had lumbar spine stenosis. One-motion segment spine stabilization was performed in 30 patients, 2-motion segment spine stabilization in 32 patients, and 3-motion segment spine stabilization in 6 patients. Within a mean follow-up of 36.2 months (range, 12.9-75.3 months), there were 2 re-operations, and 3 patients with screw loosening. Re-operations were for a deep infection in 1 patient and left leg pain in another patient. Both patients were managed with early implant removal and spinal arthrodesis. Self-assessment questionnaires showed improvement of patients' clinical and functional status. The Oswestry Disability Index and the Roland-Morris Disability Questionnaire score improved from a mean preoperative score of 55.4% (severe disability) and 52% respectively to a mean postoperative score of 22.9% (moderate disability) and 35% respectively. The overall results of this study are highly comparable to fusion procedures. The dynamic neutralization system can be a safe and effective alternative technique to spine arthrodesis in selected cases of degenerative lumbar spine instability.