| Summer 2010
Degenerative Disc Disease: Is It Work-Related?
By N. F. Tsourmas, M.D., Medical Director, Texas Mutual Insurance Company
As recently as the 1990s, sneezing, picking up a pencil or bending were thought to be sufficient trauma to aggravate, exacerbate or accelerate degenerative disc disease. Nowadays, that concept seems unsupportable.
Dr. Eugene Carragee followed 300 patients over five years during a cohort study. Activities of daily life and other “minor traumatic events,” including those that might cause work-related injuries, did not change imaging studies that were obtained the day the study was initiated.
Additionally, when some of the patients were involved in minor car accidents, slips and falls, or lifting events of 30 pounds or less, there was no change in their imaging studies.
Trained university staff evaluated the back pain complaints and found other explanations, such as psychiatric illness and/or the concept of fault, to be statistically more credible.
Twin studies published in 2009 suggest identical and fraternal twins that had different lifestyles and vocational histories had identical imaging studies and clinical complaints. Whether one twin was a heavy-labor worker and one twin was a clerical worker seemed not to impact clinical presentation, and certainly did not impact imaging studies.
MRIs of the lumbar spines were almost identical, mirror images, to the point that the same level or the same side experienced early and similar degenerative changes.
A recent symposium sponsored by the American Academy of Orthopaedic Surgeons research committee called for further education and research of internal disc derangement. The participating groups were the AAOS, NASS, NIH and the ORS.
According to their consensus conclusions, published in “AAOS Bulletin Vol. 54 #1; Feb 2006,” everyone has evidence of disc degeneration on MRI images by age 50. Disc degeneration starts early and is present in more than one-third of people in their 20s. The causes of disc degeneration are uncertain.
There is a strong association between increasing age and progressive deterioration. Occupational factors were previously thought to play the major role, but recent studies indicate the importance of heredity. Environmental factors such as smoking also influence prevalence. In general, degenerative disc changes are not by themselves symptom-producing.
Finally, screening processes put forth in the general health care of Scandinavian countries reinforce the concept of heredity being the main discerning factor of degenerative disc disease.
With the advent and improvement of hardware/software and the power of magnets and MRIs, some 20 percent of 13-year-old children in a school screening process were found to have abnormalities on these MRIs.
Our capacity to diagnose degenerative disc disease is increasing every day. Our ability to treat degenerative disc disease remains unchanged. Whether degenerative disc disease is symptomatic in and of itself is arguable. However, whether degenerative disc disease is caused or aggravated by a work event seems clearer now than ever. They simply are not related.
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Degenerative Disc Disease: Is It Work-Related?
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