Epidemiology of Low Back Pain in Enugu, Nigeria

Background: Low back pain (LBP) is one of the most frequently reported chronic health problems affecting the adult population. It is the most prevalent musculoskeletal condition in Orthopaedic practice. It is generally assumed that LBP prevalence in Africa is comparatively lower than in developed countries; but recent findings suggest that the prevalence among Africans is rising and is of concern. These inform the need for this study in a regional Orthopaedic and trauma centre in Nigeria which has a catchment area covering 14 states of the 36 states of the federation. The aim of the study is to determine the pattern of LBP in Enugu, the common etiologic factors and the predisposing factors.Materials and Methods: A retrospective study was done in which the records of 3200 patients newly diagnosed for LBP over a period of five years were analyzed and the following data extracted: demographic indices, duration of symptoms before presentation, predisposing factors, diagnosis and spinal level of involved vertebrae. Patients with vertebral fractures and spinal cord injuries in the lumber region were excluded.Results: Three thousand two hundred patients' records met the inclusion criteria. The mean age was 45 years, peak age incidence was 31 40 years; while the age range is 8 to 82 years. The male to female ratio is 1: 1.5. Twenty percent of the patients presented as acute LBP, 6.9% as sub acute whereas 73.1% presented as chronic LBP. The most commonly affected occupational groups are Petty traders, 720 (22.5%), and Civil Servants 580 (18.1%). The most common predisposing factor to LBP were trauma to the low back 420 (13.1%), and lifting of heavy objects 340 (10.6%). Eighty percent had mechanical LBP with lumbosacral spondylosis being the commonest cause 1060 (33.1%). The most affected spinal segments in our series are L4/L5 and L5/S1 segments.Conclusion: Sedentary life style appears to play a significant role in the development of LBP in Enugu and environs while trauma, lifting of heavy objects, obesity and pregnancy are the other common factors. Mechanical LBP in the form of spondylosis, chronic disc prolapsed and spondylolisthesis are the common causes. The most affected spinal motion segments are L4/L5 and L5/S1.Key Words: Low back pain, epidemiology, etiology, Enugu, Nigeria