[Disk-related diseases of the lumbar spine as an example for the critical interaction between clinical diagnosis and occupational disease].
First an overview of the significance of musculoskeletal diseases in terms of national economy and social politics is given, and then the historical development of the occupational disease "disk-related spinal disorders" is outlined. The most important court decisions and the actual state of jurisprudence on this matter are summarized, emphasizing the questions which still have to be answered in the course of medical evaluation of a spinal occupational disease. Based on a joint research project on the spinal effects of whole-body vibrations, an analysis of lumbar X-rays is presented which aimed at detecting specific patterns of response corresponding to the respective extent of strain. In spite of a statistically significant relationship between the clinical diagnosis of a lumbar syndrome and the severity of the degenerative radiological changes on the one hand and vibration exposure on the other hand, the evaluation of the lumbar X-rays did not show any clear radiological pattern related to the exposure. Furthermore, starting points for prevention are discussed. With regard to whole-body vibration, the technical possibilities of reducing the amount of vibration load are still not completely exhausted. However, during preventive measures of occupational health usually carried out as medical screening examinations, the occupational health physician again will face some of the same problems which have already been met with respect to the medical evaluation. Thus, a suggestion is made to modify the traditional concepts of the Professional Industrial Associations on occupational diseases in order to take into account the peculiarities of disk-related spinal disorders.
Schwarze
S
S
Institut für Arbeitsmedizin und Sozialmedizin, Heinrich-Heine-Universität Düsseldorf, Germany. sieglinde.schwarze@uni-duesseldorf.de
Blome
O
O
Notbohm
G
G
D000062:Accidents, Occupational / Q000331:legislation & jurisprudence; D000328:Adult; D000375:Aging; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D003937:Diagnosis, Differential; D005260:Female; D005858:Germany; D006801:Humans; D007348:Insurance, Health; D007403:Intervertebral Disc; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D016272:Occupational Health / Q000331:legislation & jurisprudence*; D011379:Prognosis; D011859:Radiography; D013122:Spinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D013128:Spinal Osteophytosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D014732:Vibration / Q000009:adverse effects