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ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1199-1204
Radiographic lumbar spondylosis: Gender and age group prevalence in Nigeria


Department of Radiology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

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Date of Web Publication6-Nov-2017
 

   Abstract 


Background: Lumbar spondylosis (LS) increases with, and is perhaps an inevitable concomitant of age, and is a major cause of low back pain and disability in the elderly. The prevalence in Nigeria is poorly documented, and its knowledge will assist in patient management. Objective: The aim is to study the gender and age group prevalence of LS in Nigeria. Materials and Methods: This is a retrospective review of 368 anteroposterior and lateral lumbosacral spine spondylotic radiographs of patients of both genders. Data analysis was performed with IBM SPSS Statistics 20.0 (New York, USA). The value of P < 0.05 was considered statistically significant. Results: The age range was 17–90 years, mean (standard deviation) was 51.96 (13.49) years. The majority (201 [55%]) were aged 45–64 years. The males (217 [59%]) were aged 17–90 years, and the mean (standard deviation) was 52.28 (14.49) years, whereas the females (151 [41%]) were aged 17–80 years, and the mean (standard deviation) was 51.51 (11.95) years. The mean ages showed no significant gender difference (P = 0.429). Male: female ratio was 1.4:1. LS prevalence increased with age, peaked at 45–54 years in females, 55–64 years in males, and steadily declined to zero, in females after 80 years, and in males after 90 years. Conclusion: LS prevalence started as early as 17 years of life, increased with age, peaked at 45–54 years in females, 55–64 years in males, and steadily declined to zero, in females after 80 years, and in males after 90 years. Sex ratio showed slight male preponderance.

Keywords: Age group prevalence, gender prevalence, lumbar spondylosis

How to cite this article:
Francis O O. Radiographic lumbar spondylosis: Gender and age group prevalence in Nigeria. Ann Trop Med Public Health 2017;10:1199-204

How to cite this URL:
Francis O O. Radiographic lumbar spondylosis: Gender and age group prevalence in Nigeria. Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 22];10:1199-204. Available from: http://www.atmph.org/text.asp?2017/10/5/1199/217531



   Introduction Top


The vertebral column, made up of vertebrae, is a complex bony structure with irregular contours, shapes, and multiple bony processes (projecting in various directions) and encloses the spinal canal which serves as a protective conduit for vital neural elements, the spinal cord and nerve roots.[1] Disease processes that disrupt or compress the neural structures, although not often fatal, are major causes of morbidity and disability.[1] One of those diseases at the lumbar vertebrae is spondylosis, a degenerative disc disorder, which though usually asymptomatic, is a common cause of low back pain (LBP).[1],[2] LBP area includes the space between T12/Lower ribs and the lower gluteal folds.[3]

Lumbar spondylosis (LS) describes bony overgrowths (osteophytes), especially at the anterior, lateral, and less commonly, posterior aspects of the superior and inferior margins of vertebral centra (bodies).[2]

Across the globe, there are several epidemiological data on LS.[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] About 27%–37% of the asymptomatic population has LS, and this can begin in persons as young as 20 years, and the prevalence increases with, and is perhaps an inevitable concomitant of age.[2],[11],[16] At 45–64 years, LS occurs in about 20% of men and 22% of females, whereas at 55–64 years, the incidence increases to about 30% of men and 28% of females.[2] Although variable, the sex ratio reports are essentially equal.[17],[18]

In the United States, about 3% of individuals aged 20–29 years have LS and this increased to about more than 80% of individuals older than 40 years.[2] In the United Kingdom (UK), in a population of 1180 people older than 50 years of age, a prevalence of 84% of LS in men and 74% in women was found.[11] In Japan, in a cohort of 2288 people older than 60 years of age, a prevalence of 75.8% was found for the presence of LS with or without the presence of loss of disc height.[4] The epidemiological data on LS in Nigeria is poorly documented. Knowledge of the gender and age group prevalence will assist in patient management, and this necessitated this study.


   Materials and Methods Top


The studied radiographs spanned a period of 10 years, 2003–2012, and were from the archives of two tertiary health institutions in the Southeastern part of Nigeria. These were the National Orthopaedic Hospital Enugu, and the Federal Teaching Hospital Abakaliki (Former Federal Medical Centre Abakaliki); ethical clearance was from the latter.

In this study, the anteroposterior and lateral radiographs of individuals with primary LS (i.e., LS without any other associated lumbar vertebral pathology) were reviewed retrospectively. A constant inclusion criterion was vertebral body osteophytosis.[2] The osteophytosis may be the only finding,[19] may be associated with normal or slightly decreased intervertebral disc (IVD),[20] or be found in combination with progressive degenerative disc disease, including decreased IVD height and subarticular sclerosis [4],[21],[22],[23],[24],[25],[26],[27],[28],[29] [Figure 1]. Radiographs of individuals of all ages were reviewed.
Figure 1: Lateral radiographs of (a) normal and (b) spondylotic lumbosacral spines

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Exclusion criteria were radiographs showing (a) Additional pathologies other than the radiographic lumbar spondylotic signs mentioned above, (b) normal appearances.

For each patient, the radiographs, request form, and sometimes, the radiological report was contained in a film jacket. The request form had such information such as patient's name, age, sex, address, and clinical information. From the request form, the patient's age, sex and Nigerian citizenship were noted. Although some of the radiographs were filed with their radiological reports, the author still reviewed all to ensure that they were those of primary LS. The radiographs (anteroposterior and lateral) of each individual were studied by mounting them on a viewing screen with good illumination. The data were analyzed with IBM SPSS Statistics 20.0 (New York, USA), and P < 0.05 was considered statistically significant. The statistical methods employed included frequency distribution curve, mean, and standard deviation, test of significance, and confidence interval.


   Results Top


The age range of the 368 patients whose anteroposterior and lateral lumbosacral spine radiographs were studied was 17–90 years, mean (standard deviation) was 51.96 (13.49) years, 99 (26.9%) were between 45 and 54 years, 102 (27.7%) were between 55 and 64 years, 201 (54.6%) were between 45 and 64 years and 9 (2.4%) (comprising 7 males, 2 females) were aged 17 years [Table 1] and [Figure 2]. The males (217 [59%]) were aged 17–90 years, and the mean (standard deviation) was 52.28 (14.49) years, whereas the females (151 [41%]) were aged 17–80 years, and the mean (standard deviation) was 51.51 (11.95) years [Table 2]. There was no significant difference between the mean ages of the males and females (P = 0.429) [Table 2]. In all the agegroups, more males have LS [Table 3] and [Figure 3]. In general, the male: female ratio was 1.4:1 [Table 3].{Table 1}
Figure 2: Total Age-groups showing percentage of each age-group

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{Table 2}{Table 3}{Figure 3}

Prevalence of LS increased with age, peaked at 45–64 years and then steadily declined. The females peaked at 45–54 years, and the males a decade later at 55–64 years; thereafter, the prevalence steadily declined to zero, in the females after 80 years, and in the males, after 90 years [Table 2] and [Figure 3].


   Discussion Top


Like in humans, LS occurs in animals with an upright posture (e.g., chimpanzees) and possibly, in some domestic animals.[30] It is usually asymptomatic, with no diagnostic or prognostic significance. The prognostic value of imaging is confounded by the high prevalence of morphologic changes in the asymptomatic population. It is present in 27%–37% of the asymptomatic population.[2],[31] When symptomatic, it is a major cause of LBP and disability in elderly people.[4] LBP affects approximately 60%–85% of adults during some point in their lives.[32],[33],[34] Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks.[35] Chronic LBP, defined as pain symptoms persisting beyond 3 months, affects an estimated 15%–45% of the population.[36] For the minority with intractable symptoms, the impact on quality of life and economic implications are considerable.[25],[37]

In this study, the increased prevalence of LS with age is in agreement with literature reports.[2],[11],[16] [Table 1], [Table 3] and [Figure 3]. However, unlike in the literature reports that suggested progressive increase in prevalence with age, in this study, the increased prevalence of LS peaked at 45–54 years in the females, and a decade later in the males at 55–64 years, and thereafter, steadily declined to zero, in the females after 80 years, and in the males after 90 years. This finding is indeed remarkable because it suggests that LS prevalence has a peak age-group after which it progressively declined, even to zero. The reason for this is unclear but may not be unconnected with the fact that given the low life expectancy in our geographic area, increasing number of people will not be alive after 65 years, and more of those who reach 80–90 years will be very reluctant to go to hospital just because of low backache, as this health issue would generally be attributed to old age. However, this finding needs to be investigated in other geographic areas and is, therefore, being suggested as an area of further research. According to 2015 World Health Organization report, as at 2013, the life expectancy at birth in Nigeria was 54/55 years (male/female) while that in the UK and the United States of America (USA) were, respectively, 79/83 and 76/81. Furthermore, while the life expectancy at the age of 60 years in Nigeria was 15/16 years (male/female), those of the UK and USA were 22/25 and 22/24 years, respectively.[38]

The sex ratio reports for LS have been variable but are essentially equal.[2] The male: female ratio of LS prevalence of 1.4: 1.0 obtained in this study has only a slight male preponderance and is thus in agreement with the literature report [Table 3]. In all age-groups in this study, LS has more prevalence in males than in females [Table 3] and [Figure 3]. This agrees with some literature report that the prevalence of spondylosis is more frequently found in males compared with females.[11],[16]

The age range of the 368 patients whose anteroposterior and lateral lumbosacral spine radiographs were studied was 17–90 years, mean (standard deviation) was 51.96 (13.49) years. The majority (201 [55%]) were between 45 and 64 years, and 9 (2.4%; Comprising of 7 males, 2 females) were aged 17 years [Table 1] and [Figure 2]. The literature report that globally, LS can begin in persons as young as 20 years [2] is contrary to the finding in this study that 2.4% of the studied population was 17 years old. Therefore, this study has shown that LS can begin in persons as young as 17 years, the period the development of lumbar lordosis stops. Lumbar lordosis is the anterior convexity of the lumbar spine in the mid-sagittal plane;[39] its development begins as an infant starts to stand, usually between 12 and 18 months of age, and it continues to develop until the completion of spinal growth, normally between 13 and 18 years.[40]

The mean age (standard deviation) of the studied individuals in this study was 51.96 (13.49) years, and there was no significant difference between the males and females (P = 0.429) [Table 1] and [Table 2]. This finding is consistent with literature report that by the age of 50 years, 85%–95% of adults show evidence of degenerative disk disease at autopsy.[41] Furthermore, the mean age of 51.96 (13.49) years obtained in this study is about 5 years less than the mean age of 57.0 (13.0) years reported in 2011 by Suri et al. in their study (P = 0.000 or, 0.001).[9] [Table 2] Suri et al. had conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population in Framingham, Massachusetts, United States. Although the reason for this slight difference is unclear, LS appears to be a nonspecific aging phenomenon. Most studies suggest no relationship to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption, or reproductive history. Adiposity is seen as a risk factor in British populations, but not in Japanese populations. The effects of heavy physical activity are controversial, as is a purported relationship to disk degeneration.[6],[18],[42] Spinal osteophytosis in postmenopausal Japanese women correlated with the CC genotype of the transforming growth factor β1 gene.[17]

A limitation of this study is that radiographs of individuals in the early stage of spondylosis (when the osteophytes have not formed, and the IVDs heights are still normal, or very slightly decreased) could have been passed as normal and therefore, excluded in the study; however, their very small number makes them statistically irrelevant.


   Conclusion Top


In both genders, LS prevalence started as early as 17 years of age (the period when spinal maturity and lumbar lordosis development stop). It increased with age, reached a peak, the females at early middle age, and the males, a decade later, and then, steadily declined, even to zero, in the females after the 7th decade, and in the males, a decade later. Sex ratio showed slight male preponderance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
O Okpala Francis
Department of Radiology, Federal Teaching Hospital, P. M. B 102, Abakaliki, Ebonyi State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_442_16

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