Spondylolisthesis is the slippage of one vertebral body, with its pedicles, transverse and superior articular processes with respect to the adjacent vertebral body [1]. It may remain asymptomatic and only diagnosed accidentally, but often, it causes excruciating low back pain by fatigue and sciatica [1]. Sometimes, there may be lumbosacral radiculopathy syndrome and spinal stenosis in long term [1]. Conventional radiography is the first-line investigative approach in diagnosing degenerated discopathy since it is easy to do, cost less, and provides valuable information [2]. Spondylolisthesis is common, affecting 3% to 5% of the world population [2]. Degenerative lumbar spondylolisthesis is a common cause of low back pain, affecting about 11.5% of the United States population [3]. The prevalence is 6% in France, with the black population being affected the most [4]. There are limited published studies on spondylolisthesis in Africa despite the importance of the pathology. In Togo, spondylolisthesis is a risk factor for lumbar spinal stenosis in 3.2% of the cases [5]. This study was undertaken to add to the limited published local data on lumbar spondylolisthesis. The primary purpose of this study was to determine the frequency, the clinical and radiographic features of lumbar spondylolisthesis in Togolese patients.

A cross-sectional study conducted on the medical records of patients with symptomatic spondylolisthesis with radiographic confirmation diagnosed between January 1997 and December 2019 in the Rheumatology department of the Sylvanus Olympio Teaching Hospital and at the Clinic Autel d’Elie, in Lome, Togo. All out-patients and in-patients at admission in the rheumatology department who suffered from non-specific low back pain and had performed x-ray showing spondylolisthesis during the study period were included. All patients suffering from non-specific low back pain without radiography; and patients with radiography and who were unable to perform the new digital radiography at Clinic Autel d’Elie were excluded. The medical records were reviewed for patients’ clinic identification and telephone numbers, demographics, date of symptom onset, date of initial presentation, pain characteristics, and physical examination findings, and radiography features (forms, types, grades, and presence of isthmic lysis and discopathy).

Firstly, a total of 450 patients with non-specific low back with or without spondylolisthesis on plain x-ray were selected. Of the 450 patients only patients, only 350 patients had available telephone contact and were called to participate in the study. Secondly (fundraisings), project work requests for financial support were duly drafted and sent to the various state companies in the country. Of the 350 patients contacted by telephone, only 118 (33.71%) were finally studied. The 118 patients were asked to undergo digital radiography within three months in the Clinic Autel d’Elie a private clinic specialized in medical imaging and located 14 miles from the Sylvanus Olympio Teaching Hospital. The same radiologist reviewed all images to ensure uniformity in interpretation. The study covered all expenses. The Meyerding classification system was used for grading [6] [7]. The data was collected using Epi info7.0, and statistical analysis was performed using STATA/IC 11.0.

This research was approved by the ethics committee affiliated to the teaching hospitals and the Director of the Sylvanus Olympio teaching hospital. Patients’ verbal consent was required before the publication.

In this study, we described the clinical and radiological semiology features of lumbar spondylolisthesis in 118 Togolese patients. Similar studies are scanty in Sub-Saharan Africa. In this study, there was a female predominance (sex ratio 0.13), and the mean age of the patients was 54.24 years. The main symptom was radicular pain (92.4%), and the average duration of the pain was 4.56 years. Spondylolisthesis predominated at the L4 - L5 level (77.97%). Most patients (89.83%) presented with antero-listhesis, and 110 (91.53%) patients had Grade I slip. The isthmic lysis was seen in 40 patients (33.9%). One hundred and ten patients (93.2%) had spondylosis on digital radiography.

This study was limited to patients seen in the department of rheumatology of the Sylvanus Olympio teaching hospital; and who underwent radiography. This study population does not represent all patients seen in other rheumatology departments in Togo, nor patients who may be found with spondylolisthesis accidentally on radiography. Moreover, the response rate of 33.71% was low making the findings of this study not generalizable to the entire population of patients with spondylosis in Togo.

This study shows that spondylolisthesis is a common pathology in rheumatological practice in Lomé and is most often responsible of radicular pain. Its clinical features were noted in the fifties years and affected most females. Spondylolisthesis is mainly located in the L4 - L5 stage with a predominance of Grade I. The isthmic lysis, commonly found at the fourth lumbar vertebra is rare with spondylolisthesis.

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

Tagbor, C.K., Koffi-Tessio, V.E.S., Houzou, P., Fianyo, E., Kakpovi, K., Amegan-Aho, K.H., Oniankitan, S., Atake, A.-E., Adjenou, V., Oniankitan, O. and Mijiyawa, M. (2022) Lumbar Spondylolisthesis in Rheumatological Practice in Lome (Togo): Frequency and Semiological Profile. Open Journal of Rheumatology and Autoimmune Diseases, 12, 21-28. https://doi.org/10.4236/ojra.2022.121003