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. 2001 Nov;58(11):735–746. doi: 10.1136/oem.58.11.735

The role of cumulative physical work load in lumbar spine disease: risk factors for lumbar osteochondrosis and spondylosis associated with chronic complaints

A Seidler 1, U Bolm-Audorff 1, H Heiskel 1, N Henkel 1, B Roth-Kuver 1, U Kaiser 1, R Bickeboller 1, W Willingstorfer 1, W Beck 1, G Elsner 1
PMCID: PMC1740072  PMID: 11600730

Abstract

OBJECTIVES—To investigate the relation with a case-control study between symptomatic osteochondrosis or spondylosis of the lumbar spine and cumulative occupational exposure to lifting or carrying and to working postures with extreme forward bending.
METHODS—From two practices and four clinics were recruited 229 male patients with radiographically confirmed osteochondrosis or spondylosis of the lumbar spine associated with chronic complaints. Of these 135 had additionally had acute lumbar disc herniation. A total of 197 control subjects was recruited: 107 subjects with anamnestic exclusion of lumbar spine disease were drawn as a random population control group and 90 patients admitted to hospital for urolithiasis who had no osteochondrosis or spondylosis of the lumbar spine radiographically were recruited as a hospital based control group. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and other diseases affecting the lumbar spine. To calculate cumulative forces to the lumbar spine over the entire working life, the Mainz-Dortmund dose model (MDD), which is based on an overproportional weighting of the lumbar disc compression force relative to the respective duration of the lifting process was applied with modifications: any objects weighing ⩾5 kg were included in the calculation and no minimum daily exposure limits were established. Calculation of forces to the lumbar spine was based on self reported estimates of occupational lifting, trunk flexion, and duration.
RESULTS—For a lumbar spine dose >9×106 Nh (Newton×hours), the risk of having radiographically confirmed osteochondrosis or spondylosis of the lumbar spine as measured by the odds ratio (OR) was 8.5 (95% confidence interval (95% CI) 4.1 to 17.5) compared with subjects with a load of 0 Nh. To avoid differential bias, forces to the lumbar spine were also calculated on the basis of an internal job exposure matrix based on the control subjects' exposure assessments for their respective job groups. Although ORs were lower with this approach, they remained significant.
CONCLUSIONS—The calculation of the sum of forces to the lumbar spine is a useful tool for risk assessment for symptomatic osteochondrosis or spondylosis of the lumbar spine. The results suggest that cumulative occupational exposure to lifting or carrying and extreme forward bending increases the risk for developing symptomatic osteochondrosis or spondylosis of the lumbar spine.


Keywords: case-control study; physical work load; lumbar osteochondrosis; lumbar spondylosis

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Selected References

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  1. Adams M. A., McNally D. S., Dolan P. 'Stress' distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br. 1996 Nov;78(6):965–972. doi: 10.1302/0301-620x78b6.1287. [DOI] [PubMed] [Google Scholar]
  2. Biering-Sørensen F., Hansen F. R., Schroll M., Runeborg O. The relation of spinal x-ray to low-back pain and physical activity among 60-year-old men and women. Spine (Phila Pa 1976) 1985 Jun;10(5):445–451. doi: 10.1097/00007632-198506000-00008. [DOI] [PubMed] [Google Scholar]
  3. Billenkamp G. Körperliche Belastung und Spondylosis deformans. Fortschr Geb Rontgenstr Nuklearmed. 1972 Feb;116(2):211–216. [PubMed] [Google Scholar]
  4. Burdorf A., Laan J. Comparison of methods for the assessment of postural load on the back. Scand J Work Environ Health. 1991 Dec;17(6):425–429. doi: 10.5271/sjweh.1679. [DOI] [PubMed] [Google Scholar]
  5. Burdorf A., Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health. 1997 Aug;23(4):243–256. doi: 10.5271/sjweh.217. [DOI] [PubMed] [Google Scholar]
  6. Burdorf A., van der Beek A. J. In musculoskeletal epidemiology are we asking the unanswerable in questionnaires on physical load? Scand J Work Environ Health. 1999 Apr;25(2):81–83. doi: 10.5271/sjweh.409. [DOI] [PubMed] [Google Scholar]
  7. Elsner G., Nienhaus A., Beck W. Berufsbedingte degenerative Diskopathien im Lendenwirbelsäulenbereich. Soz Praventivmed. 1997;42(3):144–154. doi: 10.1007/BF01300565. [DOI] [PubMed] [Google Scholar]
  8. Freemont A. J., Peacock T. E., Goupille P., Hoyland J. A., O'Brien J., Jayson M. I. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet. 1997 Jul 19;350(9072):178–181. doi: 10.1016/s0140-6736(97)02135-1. [DOI] [PubMed] [Google Scholar]
  9. Frymoyer J. W., Newberg A., Pope M. H., Wilder D. G., Clements J., MacPherson B. Spine radiographs in patients with low-back pain. An epidemiological study in men. J Bone Joint Surg Am. 1984 Sep;66(7):1048–1055. [PubMed] [Google Scholar]
  10. Gordon S. J., Yang K. H., Mayer P. J., Mace A. H., Jr, Kish V. L., Radin E. L. Mechanism of disc rupture. A preliminary report. Spine (Phila Pa 1976) 1991 Apr;16(4):450–456. doi: 10.1097/00007632-199104000-00011. [DOI] [PubMed] [Google Scholar]
  11. HULT L. Cervical, dorsal and lumbar spinal syndromes; a field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. Acta Orthop Scand Suppl. 1954;17:1–102. doi: 10.3109/ort.1954.25.suppl-17.01. [DOI] [PubMed] [Google Scholar]
  12. Handa T., Ishihara H., Ohshima H., Osada R., Tsuji H., Obata K. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine (Phila Pa 1976) 1997 May 15;22(10):1085–1091. doi: 10.1097/00007632-199705150-00006. [DOI] [PubMed] [Google Scholar]
  13. Hutton W. C., Toribatake Y., Elmer W. A., Ganey T. M., Tomita K., Whitesides T. E. The effect of compressive force applied to the intervertebral disc in vivo. A study of proteoglycans and collagen. Spine (Phila Pa 1976) 1998 Dec 1;23(23):2524–2537. doi: 10.1097/00007632-199812010-00007. [DOI] [PubMed] [Google Scholar]
  14. Iatridis J. C., Mente P. L., Stokes I. A., Aronsson D. D., Alini M. Compression-induced changes in intervertebral disc properties in a rat tail model. Spine (Phila Pa 1976) 1999 May 15;24(10):996–1002. doi: 10.1097/00007632-199905150-00013. [DOI] [PubMed] [Google Scholar]
  15. KELLGREN J. H., LAWRENCE J. S. Rheumatism in miners. II. X-ray study. Br J Ind Med. 1952 Jul;9(3):197–207. doi: 10.1136/oem.9.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kumar S. Perception of posture of short duration in the spatial and temporal domains. Appl Ergon. 1993 Oct;24(5):345–350. doi: 10.1016/0003-6870(93)90073-i. [DOI] [PubMed] [Google Scholar]
  17. Kuorinka I., Jonsson B., Kilbom A., Vinterberg H., Biering-Sørensen F., Andersson G., Jørgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987 Sep;18(3):233–237. doi: 10.1016/0003-6870(87)90010-x. [DOI] [PubMed] [Google Scholar]
  18. Köster M., Alfredsson L., Michélsen H., Vingård E., Kilbom A. Retrospective versus original information on physical and psychosocial exposure at work. Scand J Work Environ Health. 1999 Oct;25(5):410–414. doi: 10.5271/sjweh.453. [DOI] [PubMed] [Google Scholar]
  19. LAWRENCE J. S. Rheumatism in coal miners. III. Occupational factors. Br J Ind Med. 1955 Jul;12(3):249–261. doi: 10.1136/oem.12.3.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lawrence J. S. Disc degeneration. Its frequency and relationship to symptoms. Ann Rheum Dis. 1969 Mar;28(2):121–138. doi: 10.1136/ard.28.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mach J., Heitner H., Ziller R. Die Bedeutung der beruflichen Belastung für die Entstehung degenerativer Wirbelsäulenveränderungen. Z Gesamte Hyg. 1976 May;22(5):352–354. [PubMed] [Google Scholar]
  22. Nachemson A. L. Disc pressure measurements. Spine (Phila Pa 1976) 1981 Jan-Feb;6(1):93–97. doi: 10.1097/00007632-198101000-00020. [DOI] [PubMed] [Google Scholar]
  23. Pope D. P., Silman A. J., Cherry N. M., Pritchard C., Macfarlane G. J. Validity of a self-completed questionnaire measuring the physical demands of work. Scand J Work Environ Health. 1998 Oct;24(5):376–385. doi: 10.5271/sjweh.358. [DOI] [PubMed] [Google Scholar]
  24. Riihimäki H. Back pain and heavy physical work: a comparative study of concrete reinforcement workers and maintenance house painters. Br J Ind Med. 1985 Apr;42(4):226–232. [PMC free article] [PubMed] [Google Scholar]
  25. Riihimäki H. Low-back pain, its origin and risk indicators. Scand J Work Environ Health. 1991 Apr;17(2):81–90. [PubMed] [Google Scholar]
  26. Riihimäki H., Wickström G., Hänninen K., Mattsson T., Waris P., Zitting A. Radiographically detectable lumbar degenerative changes as risk indicators of back pain. A cross-sectional epidemiologic study of concrete reinforcement workers and house painters. Scand J Work Environ Health. 1989 Aug;15(4):280–285. doi: 10.5271/sjweh.1855. [DOI] [PubMed] [Google Scholar]
  27. SCHROTER G., SCHLOMKA G. Uber die Bedeutung der beruflichen Belastung für die Entstehung der degenerativen Gelenkleiden. II. Z Gesamte Inn Med. 1954 Oct 15;9(19-20):1031–1037. [PubMed] [Google Scholar]
  28. Sairanen E., Brüshaber L., Kaskinen M. Felling work, low-back pain and osteoarthritis. Scand J Work Environ Health. 1981 Mar;7(1):18–30. doi: 10.5271/sjweh.2572. [DOI] [PubMed] [Google Scholar]
  29. Torgén M., Winkel J., Alfredsson L., Kilbom A. Evaluation of questionnaire-based information on previous physical work loads. Stockholm MUSIC 1 Study Group. Musculoskeletal Intervention Center. Scand J Work Environ Health. 1999 Jun;25(3):246–254. doi: 10.5271/sjweh.431. [DOI] [PubMed] [Google Scholar]
  30. Van der Beek A. J., Braam I. T., Douwes M., Bongers P. M., Frings-Dresen M. H., Verbeek J. H., Luyts S. Validity of a diary estimating exposure to tasks, activities, and postures of the trunk. Int Arch Occup Environ Health. 1994;66(3):173–178. doi: 10.1007/BF00380776. [DOI] [PubMed] [Google Scholar]
  31. Viikari-Juntura E., Rauas S., Martikainen R., Kuosma E., Riihimäki H., Takala E. P., Saarenmaa K. Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders. Scand J Work Environ Health. 1996 Aug;22(4):251–259. doi: 10.5271/sjweh.139. [DOI] [PubMed] [Google Scholar]
  32. Wickström G., Niskanen T., Riihimäki H. Strain on the back in concrete reinforcement work. Br J Ind Med. 1985 Apr;42(4):233–239. doi: 10.1136/oem.42.4.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wickström G., Nummi J., Nurminen M. Restriction and pain during forward bending in concrete reinforcement workers. Scand J Work Environ Health. 1978;4 (Suppl 1):29–38. doi: 10.5271/sjweh.2766. [DOI] [PubMed] [Google Scholar]
  34. Wiikeri M., Nummi J., Riihimäki H., Wickström Radiologically detectable lumbar disc degeneration in concrete reinforcement workers. Scand J Work Environ Health. 1978;4 (Suppl 1):47–53. doi: 10.5271/sjweh.2758. [DOI] [PubMed] [Google Scholar]
  35. Wiktorin C., Karlqvist L., Winkel J. Validity of self-reported exposures to work postures and manual materials handling. Stockholm MUSIC I Study Group. Scand J Work Environ Health. 1993 Jun;19(3):208–214. doi: 10.5271/sjweh.1481. [DOI] [PubMed] [Google Scholar]
  36. Wiktorin C., Selin K., Ekenvall L., Kilbom A., Alfredsson L. Evaluation of perceived and self-reported manual forces exerted in occupational materials handling. Appl Ergon. 1996 Aug;27(4):231–239. doi: 10.1016/0003-6870(96)00006-3. [DOI] [PubMed] [Google Scholar]
  37. Wilke H. J., Neef P., Caimi M., Hoogland T., Claes L. E. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine (Phila Pa 1976) 1999 Apr 15;24(8):755–762. doi: 10.1097/00007632-199904150-00005. [DOI] [PubMed] [Google Scholar]
  38. Witt I., Vestergaard A., Rosenklint A. A comparative analysis of x-ray findings of the lumbar spine in patients with and without lumbar pain. Spine (Phila Pa 1976) 1984 Apr;9(3):298–300. doi: 10.1097/00007632-198404000-00014. [DOI] [PubMed] [Google Scholar]
  39. van der Beek A. J., Frings-Dresen M. H. Assessment of mechanical exposure in ergonomic epidemiology. Occup Environ Med. 1998 May;55(5):291–299. doi: 10.1136/oem.55.5.291. [DOI] [PMC free article] [PubMed] [Google Scholar]

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