• Annekatrin Bergmann, Ulrich Bolm-Audorff, Dirk Ditchen, Rolf Ellegast, Joachim Grifka, Johannes Haerting, Friedrich Hofmann, Matthias Jäger, Oliver Linhardt, Alwin Luttmann, Hans Jörg Meisel, Martina Michaelis, Gabriela Petereit-Haack, Barbara Schumann, and Andreas Seidler.
• *Section of Occupational Medicine, Institute for Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany †Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany ‡Leibniz Research Centre for Working Environment and Human Factors at Dortmund University of Technology, Dortmund, Germany §Institute for Occupational Safety and Health of the German Social Accident Insurance - IFA, Sankt Augustin, Germany ¶Institute of Occupational Medicine, Frankfurt University, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany ||Orthopaedic Clinic, University of Regensburg, Bad Abbach, Germany **Research Center for Occupational and Social Medicine Freiburg, Freiburg, Germany ††Labor Inspection, Occupational Health Division, Regional Government of South Hesse, Wiesbaden, Germany ‡‡Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Carl-Gustav-Carus- University, Dresden, Germany §§Dep. of Applied Physiology, Occupational Medicine and Infectiology, University of Wuppertal, Wuppertal, Germany ¶¶Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
• Spine. 2017 Oct 15; 42 (20): E1204-E1211.

Study DesignA multicenter, population based, case-control study.ObjectiveThe aim of the present analysis is to clarify potential differences in the "occupational risk profiles" of structural lumbar disc diseases on the one hand, and low back pain (LBP) on the other hand.Summary Of Background DataPhysical workplace factors seem to play an important etiological role.MethodsWe recruited 901 patients with structural lumbar disc diseases (disc herniation or severe disc space narrowing) and 233 control subjects with "low-back-pain." Both groups were compared with 422 "low-back pain free" control subjects. Case history, pain data, neurological deficits, and movement restrictions were documented. LBP was recorded by the Nordic questionnaire on musculoskeletal symptoms. All magnetic resonance imaging, computed tomography, and X-rays were inspected by an independent study radiologist. The calculation of cumulative physical workload was based on a computer-assisted interview and a biomechanical analysis by 3-D-dynamic simulation tool. Occupational exposures were documented for the whole working life.ResultsWe found a positive dose-response relationship between cumulative lumbar load and LBP among men, but not among women. Physical occupational risks for structural lumbar disc diseases [odds ratio (OR) 3.7; 95% confidence interval (95% CI) 2.3-6.0] are higher than for LBP (OR 1.9; 95% CI 1.0-3.5).ConclusionOur finding points to potentially different etiological pathways in the heterogeneous disease group of LBP. Results suggest that not all of the structural disc damage arising from physical workload leads to LBP.Level Of Evidence4.

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