Quantification of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the workplace. Pat II. Occurrence and magnitude of overload injuries in exposed cohorts

Paul Brinckmann, W Frobin, M Biggemann, Malcolm Tillotson, Anthony Burton, C. Burke, C. Dickinson, H. Krause, R. Pangert, U. Pfeifer, H. Römer, M. Rysanek, D. Weiß, T. Wilson, V. Zarach, G. Zerlett

Research output: Contribution to journalArticle

Abstract

Objective: Quantitative documentation of primary mechanical overload injury to lumbar vertebrae and discs caused by long-term exposure to heavy physical exertions or whole-body vibration at the workplace.

Study design: A cross sectional study measuring vertebral height, sagittal plane displacement and disc height from lateral radiographic views of exposed cohorts and comparing the results with a normative database complied from radiographs of unexposed, healthy subjects.

Background: Current guidelines on health and safety during manual handling and lifting as well as under conditions of whole-body vibration are aimed at minimising potential risks specifically to the lumbar spine. Such regulations affect a large percentage of the labour force, and their enforcement constitutes a major economic factor. Up to now, however, the prevalence of work-related primary mechanical overload damage to lumbar vertebrae and discs has not been quantified and the effectiveness of the guidelines in preventing overload damage has not been proven.

Methods: Overload damage to the lumbar spine is expected to result potentially in (i) fractures effecting a decrease in vertebral height or a wedge shape of vertebral bodies, (ii) a derangement of the sagittal plane alignment of lumbar vertebrae, resulting in dorso-ventral displacement, or (iii) primary injury to intervertebral discs or fracture of vertebral endplates, resulting in a decrease in disc height. To assess the occurrence and magnitude of such damage, archive lateral radiographic views and work histories of 355 subjects with long-term exposure to heavy physical exertions or whole-body vibration at the workplace were collected from 8 cohorts in the steel, mining and oil industries as well as from public services. Vertebral height, sagittal plane displacement and disc height were measured, employing advanced methods of image analysis compensating for distortion in central projection as well as for variation in radiographic technique, patient posture and stature. The measured data were compared with age-appropriate data of normative databases, previously compiled from radiographs of healthy, male, unexposed subjects (n=737) in the age range between 17 and 57 years.

Results: Comparison with normative databases demonstrates that in the cohorts under study (save for a cohort performing a specialised task in a forward bent posture and a cohort of miners with mean age close to 60 y) neither exposure to very heavy physical exertions in manual labour nor exposure to whole-body vibration or shock loading resulted in a height decrease or wedge-shape deformation of lumbar vertebrae. Heavy spinal loading or whole-body vibration did not lead to increased sagittal plane (dorso-ventral) displacement of lumbar vertebrae. Lifting and handling very heavy objects, specifically when working in confined spaces or on uneven ground, lead to a noticeable and significant decrease in the height of lumbar discs. While exposure to vibration on damped machine operators' seats did not lead to a reduction in disc height, vibration and shock loading transmitted from unsprung seats on (in some cases) unsprung machines resulted in a noticeable and significant decrease in lumbar disc height.

Conclusions: This study demonstrates, for the first time, objectively and quantitatively that spinal loading in certain industrial workplaces can result in damage to lumbar discs. Heights of vertebral bodies and sagittal plane displacement were generally unaffected. Any workplaces with characteristics similar to those identified here as detrimental are in urgent need of ergonomic redesign. That ergonomic redesign can be effective in reducing spinal overload damage is starkly demonstrated by comparing the results from vibration-exposed cohorts of machine operators using damped as opposed to unsprung seats. The question of whether heavy work is related to the prevalence of symptoms and/or resultant disability remains to be determined, but the results here suggest that existing ergonomic guidelines are justified to reduce the risk of irreversible spinal damage.
Original languageEnglish
Pages (from-to)S1-S36
Number of pages36
JournalClinical Biomechanics
Volume13 Suppl. 2
DOIs
Publication statusPublished - 1 Nov 1998

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Physical Exertion
Vibration
Workplace
Spine
Lumbar Vertebrae
Wounds and Injuries
Human Engineering
Databases
Guidelines
Posture
Shock
Confined Spaces
Body Height
Intervertebral Disc
Steel
Documentation
Healthy Volunteers
Industry
Oils
Cohort Studies

Cite this

Brinckmann, Paul ; Frobin, W ; Biggemann, M ; Tillotson, Malcolm ; Burton, Anthony ; Burke, C. ; Dickinson, C. ; Krause, H. ; Pangert, R. ; Pfeifer, U. ; Römer, H. ; Rysanek, M. ; Weiß, D. ; Wilson, T. ; Zarach, V. ; Zerlett, G. / Quantification of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the workplace. Pat II. Occurrence and magnitude of overload injuries in exposed cohorts. In: Clinical Biomechanics. 1998 ; Vol. 13 Suppl. 2. pp. S1-S36.
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Brinckmann, P, Frobin, W, Biggemann, M, Tillotson, M, Burton, A, Burke, C, Dickinson, C, Krause, H, Pangert, R, Pfeifer, U, Römer, H, Rysanek, M, Weiß, D, Wilson, T, Zarach, V & Zerlett, G 1998, 'Quantification of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the workplace. Pat II. Occurrence and magnitude of overload injuries in exposed cohorts', Clinical Biomechanics, vol. 13 Suppl. 2, pp. S1-S36. https://doi.org/10.1016/S0268-0033(98)00050-3

Quantification of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the workplace. Pat II. Occurrence and magnitude of overload injuries in exposed cohorts. / Brinckmann, Paul; Frobin, W; Biggemann, M; Tillotson, Malcolm; Burton, Anthony; Burke, C.; Dickinson, C.; Krause, H.; Pangert, R.; Pfeifer, U.; Römer, H.; Rysanek, M.; Weiß, D.; Wilson, T.; Zarach, V.; Zerlett, G.

In: Clinical Biomechanics, Vol. 13 Suppl. 2, 01.11.1998, p. S1-S36.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quantification of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the workplace. Pat II. Occurrence and magnitude of overload injuries in exposed cohorts

AU - Brinckmann, Paul

AU - Frobin, W

AU - Biggemann, M

AU - Tillotson, Malcolm

AU - Burton, Anthony

AU - Burke, C.

AU - Dickinson, C.

AU - Krause, H.

AU - Pangert, R.

AU - Pfeifer, U.

AU - Römer, H.

AU - Rysanek, M.

AU - Weiß, D.

AU - Wilson, T.

AU - Zarach, V.

AU - Zerlett, G.

PY - 1998/11/1

Y1 - 1998/11/1

N2 - Objective: Quantitative documentation of primary mechanical overload injury to lumbar vertebrae and discs caused by long-term exposure to heavy physical exertions or whole-body vibration at the workplace.Study design: A cross sectional study measuring vertebral height, sagittal plane displacement and disc height from lateral radiographic views of exposed cohorts and comparing the results with a normative database complied from radiographs of unexposed, healthy subjects.Background: Current guidelines on health and safety during manual handling and lifting as well as under conditions of whole-body vibration are aimed at minimising potential risks specifically to the lumbar spine. Such regulations affect a large percentage of the labour force, and their enforcement constitutes a major economic factor. Up to now, however, the prevalence of work-related primary mechanical overload damage to lumbar vertebrae and discs has not been quantified and the effectiveness of the guidelines in preventing overload damage has not been proven.Methods: Overload damage to the lumbar spine is expected to result potentially in (i) fractures effecting a decrease in vertebral height or a wedge shape of vertebral bodies, (ii) a derangement of the sagittal plane alignment of lumbar vertebrae, resulting in dorso-ventral displacement, or (iii) primary injury to intervertebral discs or fracture of vertebral endplates, resulting in a decrease in disc height. To assess the occurrence and magnitude of such damage, archive lateral radiographic views and work histories of 355 subjects with long-term exposure to heavy physical exertions or whole-body vibration at the workplace were collected from 8 cohorts in the steel, mining and oil industries as well as from public services. Vertebral height, sagittal plane displacement and disc height were measured, employing advanced methods of image analysis compensating for distortion in central projection as well as for variation in radiographic technique, patient posture and stature. The measured data were compared with age-appropriate data of normative databases, previously compiled from radiographs of healthy, male, unexposed subjects (n=737) in the age range between 17 and 57 years.Results: Comparison with normative databases demonstrates that in the cohorts under study (save for a cohort performing a specialised task in a forward bent posture and a cohort of miners with mean age close to 60 y) neither exposure to very heavy physical exertions in manual labour nor exposure to whole-body vibration or shock loading resulted in a height decrease or wedge-shape deformation of lumbar vertebrae. Heavy spinal loading or whole-body vibration did not lead to increased sagittal plane (dorso-ventral) displacement of lumbar vertebrae. Lifting and handling very heavy objects, specifically when working in confined spaces or on uneven ground, lead to a noticeable and significant decrease in the height of lumbar discs. While exposure to vibration on damped machine operators' seats did not lead to a reduction in disc height, vibration and shock loading transmitted from unsprung seats on (in some cases) unsprung machines resulted in a noticeable and significant decrease in lumbar disc height.Conclusions: This study demonstrates, for the first time, objectively and quantitatively that spinal loading in certain industrial workplaces can result in damage to lumbar discs. Heights of vertebral bodies and sagittal plane displacement were generally unaffected. Any workplaces with characteristics similar to those identified here as detrimental are in urgent need of ergonomic redesign. That ergonomic redesign can be effective in reducing spinal overload damage is starkly demonstrated by comparing the results from vibration-exposed cohorts of machine operators using damped as opposed to unsprung seats. The question of whether heavy work is related to the prevalence of symptoms and/or resultant disability remains to be determined, but the results here suggest that existing ergonomic guidelines are justified to reduce the risk of irreversible spinal damage.

AB - Objective: Quantitative documentation of primary mechanical overload injury to lumbar vertebrae and discs caused by long-term exposure to heavy physical exertions or whole-body vibration at the workplace.Study design: A cross sectional study measuring vertebral height, sagittal plane displacement and disc height from lateral radiographic views of exposed cohorts and comparing the results with a normative database complied from radiographs of unexposed, healthy subjects.Background: Current guidelines on health and safety during manual handling and lifting as well as under conditions of whole-body vibration are aimed at minimising potential risks specifically to the lumbar spine. Such regulations affect a large percentage of the labour force, and their enforcement constitutes a major economic factor. Up to now, however, the prevalence of work-related primary mechanical overload damage to lumbar vertebrae and discs has not been quantified and the effectiveness of the guidelines in preventing overload damage has not been proven.Methods: Overload damage to the lumbar spine is expected to result potentially in (i) fractures effecting a decrease in vertebral height or a wedge shape of vertebral bodies, (ii) a derangement of the sagittal plane alignment of lumbar vertebrae, resulting in dorso-ventral displacement, or (iii) primary injury to intervertebral discs or fracture of vertebral endplates, resulting in a decrease in disc height. To assess the occurrence and magnitude of such damage, archive lateral radiographic views and work histories of 355 subjects with long-term exposure to heavy physical exertions or whole-body vibration at the workplace were collected from 8 cohorts in the steel, mining and oil industries as well as from public services. Vertebral height, sagittal plane displacement and disc height were measured, employing advanced methods of image analysis compensating for distortion in central projection as well as for variation in radiographic technique, patient posture and stature. The measured data were compared with age-appropriate data of normative databases, previously compiled from radiographs of healthy, male, unexposed subjects (n=737) in the age range between 17 and 57 years.Results: Comparison with normative databases demonstrates that in the cohorts under study (save for a cohort performing a specialised task in a forward bent posture and a cohort of miners with mean age close to 60 y) neither exposure to very heavy physical exertions in manual labour nor exposure to whole-body vibration or shock loading resulted in a height decrease or wedge-shape deformation of lumbar vertebrae. Heavy spinal loading or whole-body vibration did not lead to increased sagittal plane (dorso-ventral) displacement of lumbar vertebrae. Lifting and handling very heavy objects, specifically when working in confined spaces or on uneven ground, lead to a noticeable and significant decrease in the height of lumbar discs. While exposure to vibration on damped machine operators' seats did not lead to a reduction in disc height, vibration and shock loading transmitted from unsprung seats on (in some cases) unsprung machines resulted in a noticeable and significant decrease in lumbar disc height.Conclusions: This study demonstrates, for the first time, objectively and quantitatively that spinal loading in certain industrial workplaces can result in damage to lumbar discs. Heights of vertebral bodies and sagittal plane displacement were generally unaffected. Any workplaces with characteristics similar to those identified here as detrimental are in urgent need of ergonomic redesign. That ergonomic redesign can be effective in reducing spinal overload damage is starkly demonstrated by comparing the results from vibration-exposed cohorts of machine operators using damped as opposed to unsprung seats. The question of whether heavy work is related to the prevalence of symptoms and/or resultant disability remains to be determined, but the results here suggest that existing ergonomic guidelines are justified to reduce the risk of irreversible spinal damage.

KW - disc

KW - ergonomics

KW - heavy work

KW - injury

KW - lumbar

KW - manual labour

KW - occupation

KW - radiology

KW - spinal loading

KW - spine vertebra

KW - whole-body vibration

U2 - 10.1016/S0268-0033(98)00050-3

DO - 10.1016/S0268-0033(98)00050-3

M3 - Article

VL - 13 Suppl. 2

SP - S1-S36

JO - Clinical Biomechanics

JF - Clinical Biomechanics

SN - 0268-0033

ER -