Spinal Disorders in Sub-Saharan Africa: A 10-Year Hospital Experience from Senegal ()
1. Introduction
The spine, or vertebral column, is a flexible bony structure extending from the base of the skull to the pelvis, serving as the axial support of the trunk and enclosing the spinal cord [1]-[6]. Its role in weight transmission and the accumulation of mechanical stress throughout life explain its vulnerability to acute, subacute, and chronic disorders. These conditions are multiple but are classically grouped into two main categories: degenerative and inflammatory pathologies [7] [8].
Vertebral pain is among the leading reasons for consultation in rheumatology, regardless of location (cervical, dorsal, lumbar). Globally, degenerative spinal disease remains the most common rheumatologic condition, while in Africa most available data derive from hospital-based epidemiological and clinical studies [9]-[12].
In Senegal, and specifically in the Rheumatology Department of Aristide Le Dantec University Hospital, the scarcity of dedicated research on spinal disorders has long limited precise estimation of their burden. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, and outcome characteristics of spinal pathologies recorded in a Senegalese rheumatology service.
2. Materials and Method
This was a retrospective, descriptive study conducted in the Rheumatology Department of Aristide Le Dantec University Hospital (Dakar, Senegal), over the period from January 2012 to December 2022. For each patient, demographic, diagnostic, therapeutic, and outcome data were analyzed.
Inclusion criteria: All records with a confirmed diagnosis of spinal pathology, based on the following:
Degenerative disorders: ACR (1986), Dougados, and Kellgren criteria.
Spondyloarthritis: Amor, ESSG, ASAS, and modified New York criteria.
Rheumatoid arthritis and Sjögren’s syndrome: ACR-EULAR (2010), American-European Consensus (2002), Vitali (2016).
Other spinal disorders (such as spondylolisthesis, osteoporotic vertebral fractures, congenital malformations) established using clinical, epidemiological, and paraclinical arguments.
Exclusion criteria:
Patients with uncertain or unconfirmed diagnosis still under investigation.
Patients with rheumatic diseases other than spinal involvement.
Patients lost to follow-up or with irregular follow-up.
Variables studied: sociodemographic data (age, sex, geographic origin, occupation, marital status); clinical and radiological data (onset pattern, diagnostic delay, spinal segments involved, family history, radiological lesions); paraclinical data (hematology, imaging, immunology, infectious serologies); therapeutic data (analgesics, NSAIDs, corticosteroids, DMARDs, biologics, infiltrations, physiotherapy, surgery); and outcome/functional scores (Lequesne, EIFFEL, NHP, SF-36, BASDAI, ASDAS, BASFI).
Statistical analysis: Data were entered using Word and Excel 2019, then analyzed with Sphinx software. Frequencies and means were calculated. Comparisons of functional scores were performed using the paired Student’s t-test for normally distributed variables and the Wilcoxon test for non-normally distributed variables.
3. Results
Epidemiological data: During the study period (2012-2022), a total of 11,359 records were collected, of which 10,189 were usable. We retained 6196 cases of spinal disorders, corresponding to a hospital prevalence of 60.8%. There were 2102 men (33.9%) and 4094 women (66.1%), with a sex ratio of 0.51. The mean age was 60.3 years (range: 25 - 93 years). The most represented age group was 60 - 69 years (30.3%), followed by 50 - 59 years (21.3%).
Reasons for consultation: All patients consulted for spinal pain. Low back pain accounted for 44.5%, buttock pain 12.6%, lumboradiculalgia 15.6%, dorsal pain 8.1%, and neck pain 19.2%. Onset was progressive in 72.1% of cases, insidious in 18.1%, and abrupt in 9.8%. The mean diagnostic delay was 8 years.
Axial involvement: As shown in Table 2, the distribution of spinal pain by anatomical region highlights the predominance of lumbar disorders, followed by cervical and dorsal locations. Lumbar involvement was the most frequent (57.8%), followed by cervical (23.6%) and dorsal (12.1%). Mixed forms represented 6.5%.
General and extra-articular manifestations: Asthenia (23.9%), anorexia (21.2%), weight loss (10.5%). Digestive involvement predominated (14.2%), followed by endocrine (11.2%), neurological (2.1%), and cardiac (1.1%). Uveitis was present in 1.5% of cases.
Paraclinical data: A nonspecific inflammatory syndrome was found in 44.3% of patients. ESR was elevated in 25.2%, CRP in 15.8%. Anemia was noted in 23.6%, thrombocytopenia in 12.6%, thrombocytosis in 1.7%. In cases of Pott’s disease, Quantiferon was positive in 100%, TST in 70.8%, with GeneXpert confirmation in 2 cases.
Diagnostic data: As shown in Table 1, degenerative disorders were the leading diagnostic category, followed by inflammatory and traumatic causes. Degenerative disorders were dominated by lumbar osteoarthritis (1256 cases; 30.1%), followed by common lumboradiculalgia (781 cases; 18.7%) and herniated disc (17.6%). Inflammatory disorders were led by spondyloarthritis (970 cases; 48.1%) and rheumatoid arthritis with spinal involvement (26.8%). Traumatic pathology was rare (0.16%), represented by 5 cases of vertebral compression and 3 vertebral fractures. Rheumatoid arthritis associated with Sjögren’s syndrome was the most frequent comorbidity (98.9%).
Therapeutic management: As shown in Table 3, pharmacologic and non-pharmacologic therapies were distributed according to disease type and clinical presentation. Treatment included analgesics (step I–III), NSAIDs, corticosteroids, adjuvant analgesics. Patients also received DMARDs (sulfasalazine, methotrexate, leflunomide), biologics (anti-TNFα), antituberculosis drugs, physiotherapy, and surgery. As shown in Figure 2, pharmacologic and non-pharmacologic treatments were variably distributed according to disease type and patient profile.
Outcomes: As shown in Table 4, functional and quality-of-life indices demonstrated significant post-treatment improvement across patient groups. Evaluated with functional and quality-of-life indices. Lequesne, EIFFEL, NHP, and SF-36 scores showed improvement after management. In patients with spondyloarthritis, BASDAI and ASDAS scores confirmed therapeutic response. Overall, a statistically significant improvement (p < 0.05) in clinical and functional outcomes was observed in most cases. As shown in Figure 1, the mean post-treatment scores for pain, mobility, and overall quality of life improved significantly in most patients.
Table 1. Distribution of patients according to age and sex.
Tranche d’âge (ans) |
Hommes n (%) |
Femmes n (%) |
25 - 39 |
210 (10.0%) |
420 (10.3%) |
40 - 49 |
315 (15.0%) |
650 (15.9%) |
50 - 59 |
448 (21.3%) |
870 (21.3%) |
60 - 69 |
635 (30.2%) |
1240 (30.3%) |
70+ |
494 (23.5%) |
914 (22.2%) |
Table 2. Distribution of patients according to the reason for consultation.
Motif de consultation |
Effectifs (%) |
Lombalgies |
2754 (44.5%) |
Pygalgies |
781 (12.6%) |
Lomboradiculalgies |
969 (15.6%) |
Dorsalgies |
501 (8.1%) |
Cervicalgies |
1191 (19.2%) |
Table 3. Distribution of patients according to the type of axial injury.
Atteinte axiale |
Effectifs (%) |
Cervicale |
1 461 (23.6%) |
Dorsale |
753 (12.1%) |
Lombaire |
3 581 (57.8%) |
Mixte |
401 (6.5%) |
Table 4. Distribution of patients according to WOMAC score.
Domaines WOMAC |
Score moyen ± ET |
Douleur |
55.8 ± 14.3 |
Raideur |
50.2 ± 13.5 |
Fonction physique |
58.6 ± 15.1 |
Score global |
54.9 ± 13.9 |
Figure 1. SF-36 score (mean).
Figure 2. NHP score (mean).
Figure 3. Distribution of patients according to treatment.
Table 5. Frequency of spinal pathologies according to African literature.
Country |
Author |
Year |
Duration |
Frequency (%) |
Ref. |
Côte d’Ivoire/
Ivory Coast |
Diomandé |
2020 |
15 ans/15 years |
P. infectieuse (43.81); P. dégénératif (28.65); P. inflammatoire (8.04) |
[36] |
Burkina Faso |
Ouedraogo |
2014 |
5 ans/5 years |
P. dégénératif (79.63); P. métabolique (5.02); P. indéterminé (4.98) |
[9] |
Togo |
Mijiyawa |
1991 |
1 an/1 year |
P. dégénératif (53); P. abarticulaire (13.8); P. inflammatoire (1.4) |
[34] |
Bénin/Benin |
Zomaletho |
2014 |
14 ans/14 years |
P. dégénératif (66.6); P. inflammatoire (8.8) |
[39] |
Guinée/Guinea |
Kamissoko |
2018 |
1 an/1 year |
P. dégénératif (70.8); P. inflammatoire (24.27) |
[37] |
Sénégal/Senegal |
Notre étude/
Our study |
2012-2022 |
10 ans/10 years |
P. dégénératif (67.32%); P. inflammatoire (32.52%) |
[Notre étude/
Our study] |
Legend: Compilation of major African studies published on spinal pathologies.
4. Discussion
As shown in Table 5, our findings are consistent with other sub-Saharan African series, particularly those from Togo, Côte d’Ivoire, and Burkina Faso. To our knowledge, this is one of the largest hospital-based African series on spinal disorders, including 6196 patients over a 10-year period. Its strengths lie in the large sample size, diagnostic diversity, and systematic functional evaluation. However, some limitations must be acknowledged, particularly its retrospective and hospital-based design, which may limit generalizability to the overall population.
The hospital prevalence found (60.8%) is similar to that reported in Togo by Oniankitan et al. (57%) and higher than that observed in Benin (48%) [13]-[16]. Degenerative disorders predominated, in line with several African and international studies. The female predominance and mean age of 60 years confirm previous reports identifying aging, menopause, and metabolic factors as major determinants [17].
Our study also highlights the issue of a mean diagnostic delay of 8 years, consistent with findings in other chronic rheumatic diseases in Africa, particularly rheumatoid arthritis [18]-[26]. This reflects both limited access to specialized care and poor recognition of early warning signs.
As shown in Figure 3, pharmacologic treatments such as NSAIDs, corticosteroids, and DMARDs predominated, while non-pharmacologic modalities were less frequent, a distribution consistent with other African studies. From a therapeutic perspective, management relied mainly on analgesics, NSAIDs, DMARDs, and physiotherapy. The use of biologics remained marginal, not only because of their high cost but also due to the lack of specialized infrastructures and adapted national guidelines. This constraint is consistent with observations in other African countries [27]-[32].
Finally, the functional and socioeconomic burden is substantial. Although our study did not directly assess costs, impairment in quality-of-life scores (SF-36, NHP, WOMAC) reflects productivity loss and social integration challenges. Future studies should incorporate medico-economic assessments to complete these findings [33]-[39].
5. Conclusions
Spinal disorders represent a major reason for consultation in rheumatology in Senegal, with a high hospital prevalence and predominance of degenerative conditions. Advanced age, female sex, and mechanical and metabolic factors appear to be important determinants. The functional and quality-of-life impact is considerable, as revealed by the Lequesne, EIFFEL, NHP, SF-36, and WOMAC scores.
Management relies on a multidimensional approach combining pharmacological treatments, rehabilitation, and, in some cases, surgery. However, limited access to biologics remains a major challenge in our context. Strengthening diagnostic and therapeutic capacities, together with improved patient awareness, is needed to enhance outcomes. This large-scale study provides a strong foundation for developing adapted strategies and paves the way for prospective population-based research.
Declarations
Author Contributions
All authors contributed substantially to the design, data collection, analysis, and interpretation of results. All participated in drafting and critical revision of the manuscript and approved the final version.
Ethics Approval and Consent
The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The retrospective nature of the study and the anonymization of data did not require individual informed consent. Authorization was obtained from the department.