Artikel
Occupational risks factors for lumbar disc herniation and disc narrowing (German Spine Study EPILIFT)
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Autoren
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Anne Katrin Bergmann
- Institute of Occupational Medicine, Martin-Luther University Halle-Wittenberg, Germany
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Bodo-Christian Kern
- Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany
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H. J. Meisel
- Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany
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U. Bolm-Audorff
- Labor inspection, Occupational Health Division, Regional Government of South Hesse, Wiesbaden, Germany
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A. Seidler
- Federal Institute for Occupational Safety and Health, Berlin, Germany
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M. Jäger
- Leibniz Research Centre for Working Evironment and Human Factors, Dortmund, Germany
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EPILIFT Study Group
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: In the etiology of lumbar disc disease physical workload factors seem to play an important role but there are open questions in pathogenetics, influence of special workload factors and dose-response relationship between workload and lumbar disc diseases. The dose model for cumulative lumbar load (Mainz-Dortmunder Dosismodell MDD) and threshold levels as recognition criteria for occupational diseases (BK 2108) are discussed.
Methods: In a multicenter case-control study all patients (25–70 years) with symptomatic lumbar disc herniation (286 males, 278 females) and severe disc narrowing (145 males, 206 females) treated in a hospital or a special orthopaedic or neurosurgical practice were prospectively recruited. Population control subjects (453 males, 448 females) were randomly selected from local registration offices. Participating physicians documented anamnesis, pain data and neurological deficits. On the base of standardized criteria all MRI, CT and X-ray pictures were evaluated by an independent study radiologist. In a detailed semi-standardized interview technical experts documented frequency and duration of manual handling of loads above 5 kg, postures with trunk inclination of 20° and more and other working postures. Quantification of cumulative lumbar load based on several dose models. Odds ratios and 95% confidence intervals were calculated separately for men and women and for lumbar disc herniation and disc narrowing. We adjusted for age, region, and social life data.
Results: We found a positive dose-response relationship between cumulative lumbar load and lumbar disc herniation or disc narrowing among men as well as among women. There was an association between whole body vibration and disc narrowing but not with lumbar herniation (analysis only for men). The best dose models are characterised by lowered thresholds for lumbar disc compression in comparison with the original MDD and a missing shift-dose threshold.
Conclusions: Our study results point to an etiologic role of cumulative physical workload in the multifactorial genesis of lumbar disc diseases. In women this association was shown for the first time in an epidemiological study. The currently applied MDD does not belong to the best fitting dose models for explaining the dose-response relationship between occupational exposure and lumbar disc diseases, mainly because its minimum thresholds limits appear too high.
Bergmann AK and Meisel HJ contributed equally.
