Profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in Kwa-Zulu Natal

Abstract

Purpose: Low Back Pain (LBP) is a leading cause of activity limitation and absence from work globally, and the treatment is often complicated and multifactorial. There is little documentation about the types of conditions requiring lumbar spine surgery in the public health care sector in South Africa (SA). The aim of this study was to develop a profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in KwaZulu-Natal (KZN). Methods: This study utilised a descriptive, retrospective, clinical audit design. A total of 112 patient files meeting the study inclusion criteria were analysed and data was extracted and recorded on a data template. Permission to conduct the study was obtained from the KZN Department of Health, the Manager of the King Dinizulu Hospital and ethical approval was obtained from the Institutional Research Ethics committee. The data was analysed using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation). The data was described using means, standard deviations, percentages and count. Inferential statistical analysis was utilised to draw conclusions about populations from sample data. Chi-square and Fischer’s Exact test were used to compare categorical data with a statistical significance of p value ≤0.05. Results: The mean age of the patients was 41.7 years of age (range 3-76 years of age), with more females (55.4%, n = 62) than males (44.6%, n = 50) requiring surgery. More than half of the patients were Black Africans (55.4%, n = 62), with the majority (58%, n = 65) of all the patients being unemployed. Mechanical low back pain (MLBP) was the condition most often requiring surgical intervention (41.1%, n = 46) with lumbar stenosis being the most common diagnosis (17%, n = 19). This was followed by infective spondylitis (33.9%, n = 38). Frankel grading for neurological deficit was most often reported in patients with non-mechanical or infective causes of low back pain. Infective co-morbidity was (39.3%, n = 44) with 19.6% (n = 22) patients suffering from both tuberculosis (TB) and human immunodeficiency virus (HIV), 14.3% (n = 16) from TB alone and 5.4% (n = 6) with HIV/Acquired immunodeficiency syndrome alone. Most patients (91.1%, n = 102) received pre-surgical management consisting of medication either alone or in combination with other therapies such as physiotherapy, back braces, crutches and dietary intervention. The most common surgical procedure utilised was posterior spinal fusion (PSF) (43.8%, n = 49) either alone or in combination with other surgical procedures such as: decompression, biopsy and abscess drainage. This procedure alone was the favoured for non-mechanical LBP (NMLBP) (12.5%, n = 14), while PSF in combination with decompression was favoured the treatment for LBP of infective origin (15.2%, n = 17).

Post-surgical management included medication (96.4%, n = 108) and physiotherapy (17%, n = 19); these were administered either individually or in combination. There were only six post- surgical complications; two were metal ware failure and four were infections. Of the four post- surgical infections, all of the patients had HIV/AIDS as a co-morbid condition. The trends suggest that the MLBP patients were predominantly older i.e. 40-69 years (82.6%, n = 38) and from the Indian race group (25.9%, n = 29). This was in contrast to the other types of LBP which predominately affected younger populations (i.e. 10-39 years) and Blacks. There were no differences in gender distribution for both MLBP and NMLBP. However, with LBP of infective origin, females were twice as much affected than males. Conclusion: The profile of lumbar spine conditions requiring surgical intervention at a public hospital is varied and there is a high prevalence of surgery for mechanical and infective cases of lumbar spine pain. Effective management of these conditions may reduce morbidity. Future studies should investigate the economic impact of lumbar spine surgery on health expenditure in South Africa.