Patterns of lumbar myelographic findings in patients with LBP a 5 years retrospective study at Yehuleshet Higher Clinic, Addis Ababa, Ethiopia.

Background: Low back pain (LBP) is usually defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). LBP is a common health problem and the imaging of which need carful clinical diagnostic triage. Most of us will experience at least one episode of LBP during our life. Despite its burden to the health facilities, more than 90% have no identifiable organic cause so their diagnosis is based on exclusion of other specific pathologies.

Objective: The study asses level of association of LBP and lumbar Myelographic findings in a higher clinic in Addis Ababa and provide baseline information of patterns of lumbar myelographic disease.

Patients And Methods: This is a retrospective record review of patients with LBP for whom lumbar myelography was done at Yehuleshet Higher Clinic. Data were collected from the clinics record, both hard and soft copy records were used a total of 1688 patients who had lumbar myelography study done for a complaint of LBP in the years from 2002-2008 are included in the study.

Results: Among the study subjects 895 (53%) were males and 793 (47%) were females. Mean age was 42.41 +/- 13.22. 1073 (63.6%) had abnormal myelographic findings and the rest 615 (36.4%) had normal lumbar myelography. The commonest abnormality is disc prolapse 36.7% with L4-L5 and L5-S1 being the commonest sites.

Conclusion: Even if lumbar myelography showed abnormal findings in 63.6% a significant number of the studies (36.4%) were normal indicating lack of optimal clinical triage. Overall in countries like ours, where the recommended primary imaging modality, i.e., MRI is inaccessible and expensive, the value of myelography is unquestionable.

Recommendation: But because of the invasive nature of the examination which also uses radiation, a diagnostic clinical triage should be taken first before subjecting patients to Myelographic procedures. Further studies to assess the positive predictive value of myelography with surgical confirmation are recommended.