Diagnostic Value of Plain Radiographs in Patients with Low Back Pain of Non-traumatic Origin at a National Teaching and Referal Hospitalin Kenya.|
Ole-moko, P L.; Sitati, F C. & Gakuu, L N.
Background: Low back pain is a commonly recognized problem worldwide. Plain
radiography is used in many of these patients as an initial investigative and evaluative tool.
However, it was not known how truly useful this investigation was in making definitive
diagnosis for non traumatic low back pain. The main objective of the study was to
determine the value of plain radiographs in patients presenting with low back pain that is
of non-traumatic origin.
Methods: A prospective study 102 consecutive patients with low back pain was conducted
at the Kenyatta National Hospital (KNH) from 1st February 2013 to 30th May 2013. Data was
collected using a structured questionnaire and analyzed. Plain radiograph films were
reviewed by two qualified radiologists.
Results: The mean age of patients presenting with low back pain was 50.9years, with a
male to female ratio of 1:2.4. Majority of the patient had chronic low back pain. There was a
high rate of positive radiological findings (98%). The most common findings included
muscle spasm, osteoporosis, reduced lumbar lordosis, spondylosis, disc degenerative
disease and osteophytes.
Assessment of inter-rater variability showed good level of agreement on presence of
spondylolisthesis and vacuum phenomenon (k=0.71), moderate agreement on reduced disc
space, reduced lumbar lordosis, spondylosis (k=0.42-0.56) and poor agreement on film
quality, infections, tumor metastasis, osteophytes, prolapsed intervertebral disease (PID),
osteoporosis, scoliosis, muscle spasm and sacroilitis (k=0.13-0.21)
Conclusion: Most of the patients presenting to KNH with low back pain have a chronic type
and therefore have increased probability of having positive radiological findings. There
was a poor ability to diagnose infectious causes, inflammatory conditions, transitional
vertebrae and tumor metastasis. In such cases, more advanced imaging such as CT scan
and MRI may be required.