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Figure 3. T2W Sag image of normal cervical spine.

Figure 4. T2W Sag image of normal lumbar spine.

Figure 5. T2W Sag image showing degenerative disc disease at L4-L5 and L5-S1 (arrows).

Figure 6. T2W Sag of discal hernia at L5-S1 level (arrow).

(a) (b)

Figure 7. Lumbar T1W Sag (a) and T2 W Sag (b) showing spondylitis of L3-L4 and L4-L5 (arrows).

4.2. Indications

Spinal pain (48.6%) was the frequent indication for MRI examination in our study. This is in accordance with other published studies [10] [11]. According to Brochard and Loembe, spinal pain is the major symptom that leads patients to consult in almost 90% of cases [12] [13]. Pain is only a symptom and not a disease; as such it can cover many etiologies and in the majority it results from degenerative changes in the spine, involving the intervertebral discs, facet joints and soft tissues, less common causes of pseudoradicular pain include infections, non-infectious inflammation, tumours and metabolic disease (e.g. osteoporosis) [14]. Sensory and motor disorders (11.3%) and traumatism (8.1%) were also frequent as indication. At the cervical segment, the indications found in our study is similar to those of Hari which reports in his study that cervico-brachial neuralgia is frequently found [12]. At the dorsal level, the main indication was suspicion of spinal cord compression with 2.3%. In the lumbar segment, our observation corroborates the findings of Tchuindjang, who found that more than 72.4% of patients received in neurosurgical consultation for suspicion of herniated disc of the lumbar region had lumbosciatic pain [15]. The whole spine was explored mainly in the case of sensory and motor disorders. In other studies, the whole spine was explored when vertebral tuberculosis was suspected [16].

Neurosurgeon (33.6%), neurologist (23.1%) and rheumatologist (13.6%) were the main referring physicians. They are specialists of neurological pathologies and are in the front line in the management of patients suffering from or suspected of having neurological disorders and articular pain.

4.3. MRI Results

As results, 78.6% of MRI exams were pathological. Discal hernia (46.6%), arthrosis (31.3%) and degenerative disc disease (25.5%) were the main observed lesion. Kalichman and al and Hicks and al in a similar study found discal hernia in 63.9% and 49% respectively followed by posterior inter-apophyseal arthrosis [17] [18]. These lesions were sitting preferentially at the level of the last lumbar stages, observation made by Cheung et al. who mentioned in their study a relatively high-frequency discal hernia at L4-L5 and L5-S1 stages [19]. Kanayama and al had also notified it in agreement with VanRijn and al who estimated the frequency of herniated discs at both last lumbar stages at 90% [20] [21]. Indeed degenerative pathology is a process of aging that happens spontaneously with age.

Hyposignal of intervertebral disc in degenerative disc disease on T2 weighted images is the witness of the dehydration of the disc but can also translate the production sometimes anarchic collagen fibers [14]. Morphological modifications of discs are responsible of almost all root conflicts [22].

Tuberculous spinal infections are not exceptional. Their Clinical presentation is often non specific, and may result in lumbosciatica. In our series, the infectious pathology was represented mainly by spondylitis (5%). The typical appearance of spondylitis reported in MRI regardless of its etiology associates a hypersignal T2 discal, a hyposignal T1 and T2 hypersignal of the 2 adjacent vertebrae, and thickening of the soft parts paravertebral and/or intra-ductal. Our results corroborate those of Mijiyawa who reported 54 (2.3%) cases of spondylitis for a population of 2358 patients at Tokoin Teaching Hospital in Lomé [23].

We observed 9 (4%) metastasis. Amiel et al. reported a case of sciatica revealing pleural mesothelioma and non-Hodgkin lymphoma (NHL) by metastasis of the fifth lumbar vertebra [24] and Bahri and al four sciatic observations revealing metastases of a uterine cancer [25]. As soon as it is found a metastasis must make search of the primitive tumor.

Spondylolisthesis (8.6%) was the most common traumatic pathology. Spinal trauma is a common pathology affecting about 10,000 subjects per year in France [26]. They are complicated in 10% - 20% of the cases of medullary injury. The association with polytrauma is frequent: 70% of traumatized spine have a life-threatening lesion in the short term and 10% of those with multiple trauma have traumatic spinal injury. Spinal injuries mainly affect young adults, male, with a peak frequency between 15 and 24 years. The most common cause are road accidents, followed by accidents at work and sports accidents according to Hu et al. [27].

In our study the concordance between the clinic and MRI results was 78.63% for degenerative pathology. In agreement with Abdoulaye and al in their study on the contribution of MRI in the exploration of low back pain at Fann University Hospital Center (Dakar-Senegal) found a concordance between the clinic and MRI of 73.1% [28].

Most of patients (60.4%) had no previous examination. 45 (20.4%) patients underwent X-ray, 41 (18.6%) CT scan and one a myelogram. Through its wide variety of pulse sequences, MRI provide superior contrast resolution to allow different soft tissues to be distinguished with ease. It is generally performed in second or third intention after a conventional X-ray or CT scan.

21.3% of MRI were normal. This rate of normal exams raises the problem of justification of this exam which should not be asked in first line in a context where accessibility to this exam is not within the reach of everyone and there is no referral guideline to help clinicians to choose the most appropriate imaging investigation for specific clinical diagnostic problems.

However, some limitations were encountered in this study, including the lack of therapeutic aspects and the follow-up of these patients, thus we cannot present the results of the treatment nor the complications.

5. Conclusion

MRI allows an accurate assessment of spinal and spinal cord pathologies without exposing patients to radiation. It helped to confirm or refute the diagnosis suspected by clinics with a high level of concordance between the clinic and the results of the MRI. Discal hernia, arthrosis and degenerative disc disease were the main observed lesions. However, its availability is limited in our country.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

Cite this paper

Guena, M.N., Zilbinkai, F.A., Djougnye, A., Etoundi, R.G.N., Ngadjere, E.V., Wankie, E.M., Nana, N.N., Nguemgne, C., Vanina, W.W.L. and Gonsu, J.F. (2019) Magnetic Resonance Imaging of the Spine at the Douala General Hospital (Cameroon). Open Journal of Modern Neurosurgery, 9, 237-247.


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