Academic journal article Scandinavian Journal of Work, Environment & Health

Professional Driving and Prolapsed Lumbar Intervertebral Disc Diagnosed by Magnetic Resonance Imaging: A Case-Control Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Professional Driving and Prolapsed Lumbar Intervertebral Disc Diagnosed by Magnetic Resonance Imaging: A Case-Control Study

Article excerpt

Objectives The aim of this study was to investigate whether whole-body vibration (WBV) is associated with prolapsed lumbar intervertebral disc (PID) and nerve root entrapment among patients with low-back pain (LBP) undergoing magnetic resonance imaging (MRI).

Methods A consecutive series of patients referred for lumbar MRI because of LBP were compared with controls X-rayed for other reasons. Subjects were questioned about occupational activities loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about LBP. Exposure to WBV was assessed by six measures, including weekly duration of professional driving, hours driven at a spell, and current 8-hour daily equivalent root-mean-square acceleration A(8). Cases were sub-classified according to whether or not PID/nerve root entrapment was present. Associations with WBV were examined separately for cases with and without these MRI findings, with adjustment for age, sex, and other potential confounders.

Results Altogether 237 cases and 820 controls were studied, including 1 83 professional drivers and 1 76 cases with PID and/or nerve root entrapment. Risks associated with WBV tended to be lower for LBP with PID/nerve root entrapment but somewhat higher for risks of LBP without these abnormalities. However, associations with the six metrics of exposure were all weak and not statistically significant. Neither exposure-response relationships nor increased risk of PID/nerve root entrapment from professional driving or exposure at an A(8) above the European Union daily exposure action level were found.

Conclusions WBV may be a cause of LBP but it was not associated with PID or nerve root entrapment in this study.

Key terms back pain; disc pathology; low-back pain; MRI; PID; whole-body vibration.

Many studies have found an association of whole-body vibration (WBV) with low-back pain (LBP) and sciatica, and some indicate an increased risk of prolapsed intervertebral disc (PID) specifically (1-9). However, the latter have seldom confirmed diagnosis beyond self-report, so it remains uncertain whether WBV is a cause of PID. The increased use of magnetic resonance imaging (MRI) offers new opportunities to distinguish cases with PID and nerve root entrapment. In the present paper, we report a case-control study of MRI-investigated LBP, which examines the association of PID and nerve root entrapment with occupational exposure to WBV.

Methods

The main methods have been described elsewhere (9). In brief, the study population comprised working-aged adults resident in the area served by a public hospital. Cases were a consecutive series referred to the radiology department at that hospital or to two local private hospitals for MRI of the lumbar spine during 2003-2006. Controls were investigated by radiography while attending the public hospital's emergency department over 20032006. They fulfilled the same residency requirement and were group-matched to cases by sex and age.

Participants completed a questionnaire on occupational history, work activities (digging, lifting, trunk bending/twisting), professional driving, and exposure to WBV (vehicle types, duration, intensity), demographic characteristics, somatizing tendency (10), low mood (11), consulting behavior (12), fear-avoidance beliefs (13), and beliefs regarding the work-relatedness of LBP. Cases were asked about their LBP symptoms and disability. Exposure to WBV in their latest job was assessed by six metrics: (i) professional driving (>1 hour/day); (ii) professional driving (>3 hours consecutively); (iii) weekly hours driven for the vehicle most used; (iv) weekly hours driven for all vehicles (none, <16, >16); (v) maximum root-mean-square (rms) acceleration of any vehicle (0, -0.5, >0.6 ms -2 rms) and (vi) A(8) rms (< or >0.5 ms2 rms [the action level in the European Union (EU) Physical Agents (vibration) Directive (14)]. …

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