Academic journal article Central European Journal of Public Health

Level of Education as a Risk Factor for Extensive Prevalence of Cervical Intervertebral Disc Degenerative Changes and Chronic Neck Pain

Academic journal article Central European Journal of Public Health

Level of Education as a Risk Factor for Extensive Prevalence of Cervical Intervertebral Disc Degenerative Changes and Chronic Neck Pain

Article excerpt

INTRODUCTION

A sedentary lifestyle can include office-related tasks, academic assignments that require prolonged sitting, physical inactivity, and long car rides, which are considered important factors that cause mechanical disorders of the cervical spine structures (CSS) (1). Likewise, sudden movements and poor posture (2) concomitant with weak biomechanical characteristics of the CSS may also lead to the development of cervical disc degenerative changes and subsequent neck pain (1, 2). The functional units of the CSS, called vertebral dynamic segments, represent key components in the structure of the cervical spine, commonly affected by degenerative changes of the cervical spine (1). These units consist of two adjacent vertebrae, an intervertebral disc, intervertebral joints, intervertebral apertures (which the blood vessels and nerves pass through), transverse and spinous processes, a spinal canal and ligaments, tendons, connective tissue, and paravertebral muscles (3). Any change in the structure of these components can compromise the function of the intervertebral discs, leading the nucleus to become more compact and stiffer as a consequence of loss in the liquid component, and subsequently to develop fissures and ruptures within the annulus (4-8). Over time, these loads may accumulate and contribute to the development of degenerative changes in the intervertebral discs, resulting in the development of painful neck conditions in the general population (7). For example, extensive degenerative changes may promote ankylosis of the dynamic segment that may cause neck pain (1, 6, 9).

Chronic neck pain and degenerative changes of intervertebral discs of the cervical spine could be defined as part of the condition known in the literature as 'DDD', which stands for degenerative disc disease. This condition affects young adults and middle-aged people who are active and otherwise in good health, although it could be speculated that some populations might be more susceptible to the development ofDDD than others (8, 10, 19). Also, errors in the classifications or subjective mistakes of magnetic resonance imaging (MRI) readings are common among radiologists (11-13), probably due to various classification methods and diagnosis of degenerative intervertebral discs changes used in the past to determine the degree of degenerative intervertebral discs alterations. Pfirrmann et al. (15) published MRI classification guidelines in 2001 in order to overcome on-going classification debate among medical professionals. Indeed, they published a five-item scale to classify the degree of degenerative changes in the intervertebral discs of the lumbar and later of the cervical spine, dependent on different MRI findings of the disc. They reported modest intra- and interobserver kappa coefficients ranging from 0.69 to 90, respectively, while the overall agreement of the questionnaire items and MRI scan was 84% in common variance. Thus, the scale was shown to be both valid and sensitive to classify the degree of degenerative disk changes, and it is used in clinical practice (14, 15).

A recent article (8) suggests that the prevalence of chronic neck pain tends to increase in the general population; meanwhile, data on degenerative changes of the cervical spine remain scarce. Bogduk et al. (16) suggest that degenerative changes of intervertebral discs originate from poor posture (i.e. straining position of the entire spine is sitting with mild anteflexion) during academic assignments such as reading, writing, or working on the computer. Weidenbaum et al. (17) re-confirmed these findings by documenting images of lesions and pathological and physiological changes of the intervertebral discs using the gold standard, MRI of the spine. According to the applied research of Movahhed et al. (19) chronic neck pain was moderately prevalent (by 41.8%) among recently graduated dentists and dental students in Iran, mainly due to extensive practical work coupled with the requirement of longterm standing. …

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