Relation between grades of intervertebral disc degeneration and occupational activities of patients with lumbar disc herniation

  • Monika Papić Department for occupational health, Health center Novi Sad, Novi Sad, Serbia
  • Vladimir Papić Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Faculty of Sciences,Novi Sad, Serbia
  • Milena Kresoja University of Novi Sad, Department of Mathematics and Informatics, Novi Sad, Serbia
  • Valerija Munteanu Health Center Novi Sad, Center of Radiology, Novi Sad, Serbia
  • Ivan Mikov Clinical Center of Vojvodina, Outpatient Department, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine Novi Sad, Serbia
  • Tomislav Cigić Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Faculty of Sciences,Novi Sad, Serbia
Keywords: lumbosacral region, inervertebral disc degeneration, occupational exposure, intervertebral disc displacement,


Background/Aim. Intervertebral disc degeneration (IDD) occurs as consequence of combined effects of genetic, age-related, environmental and occupational factors. Lumbar disc herniation (LDH) develops mostly due to IDD. The aim of this study was to investigate whether the frequency of LDH is higher at the level of the most pronounced IDD, and whether a category of physical workload influences higher IDD on level L3-L4, L4-L5 and L5-S1 separately. Methods. The research included 60 patients with permanent employment, hospitalized due to LDH. A grade of IDD was assessed by lumbosacral preoperative magnetic resonance imaging (MRI), according to Pfirmann's MRI classification system. Occupational factors were determined by a specific questionnaire. Results. Out of the 60 patients participating in the study, 33.3% had jobs with easy workload, 23% had moderate workload, while 43% had heavy workload. Herniated discs were found at level L3-L4 in 8.3%, at level L4-L5 in 46.7% and at level L5-S1 in 45% patients. The symptomatic discs at level L5-S1 showed statistically significant frequency of degenerative changes of grades IV and V. Binary logistic regression results showed that the strongest predictor of IDD grade for examined levels was physical workload. Positive association of physical workload and IDD grade was observed in all cases. Higher grades of IDD are more likely for patients with both higher TE and heavier physical workload (OR 2.011) at level L3-L4. At levels L4-L5 and L5-S1 higher degree of IDD was more likely for females with heavier physical workload (OR 1.978 and 2.433 respectively). Conclusion. Symptomatic discs show higher frequency of higher grades of IDD but herniation does not occur solely at the disc of the most prominent degenerative changes. The results suggest importance of inter-influence of physical workload and the years of employment and the inter-influence of physical workload and gender, on degeneration of lumbar discs.


Bawa M, Boden DS. The Epidemiology and economics of inter-vertebral disc disease. In: Wachinger M, Lauryssen C, editors. The lumbar intervertebral disc. New York: Thieme Medical Publishers, Inc; 2010. p. 3−9.

Kraemer J. Intervertebral disk diseases causes, diagnosis, treat-ment, and prophylaxis. New York: Thieme Medical Publishers, Inc; 2009.

Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc de-generation. Spine 2000; 25(4): 487−92.

Borjanović S, Jovičić S. In: Load. Borjanović S. Method for assess-ment of risks in the workplace and work environment. Beo-grad: Eko Centar; 2008. p. 131−7. (Serbian)

Wadell G, Burton AK. Occupational health guidelines for the management of low back pain at work: Evidence review. Oc-cup Med (Lond) 2001; 51(2): 124−35.

Aranđelović M, Jovanović J. Occupational medicine. Niš: Faculty of Medicine, Unversity of Nis; 2009. Available from: (Serbian)

Jandrić S, Antić B. Low back pain and degenerative disc disease. Med Pregl 2006; 59(9−10): 456−61. (Serbian)

Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, et al. Cumulative occupational lumbar load and lumbar disc dis-ease: Results of a German multi-center case-control study (EP-ILIFT). BMC Musculoskelet Disord 2009; 10(1): 48.

Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degenera-tion. Spine 2001; 26(17): 1873−8.

Schroeder DG, Guyre AC, Vaccaro RA. The epidemiology and pathophysiology of lumbar disc herniations. Semin Spine Surg 2016; 28(1): 2−7.

Cigić T, Jajić Đ. Diseases and injuries of the spine. In: Vulekovic P, Cigić T, Kojadinović Ž, editors. Fundamentals of neurosurgery. Novi Sad: Faculty of Medicine, University of Novi Sad; 2012. p. 177−255. (Serbian)

Kitze K, Winkler D, Günther L, Angermeyer MC. Preoperative predictors for the return to work of herniated disc patients. Zentralbl Neurochir 2008; 69(1): 7−13.

Lama P, le Maitre CL, Dolan P, Tariton JF, Harding IJ, Adams MA. Do intervertebral disc degenerate before they herniated, or after. Bone Joint J 2013; 95-B(8): 1127−33.

Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenera-tive disk disease. Radiology 1988; 168(1): 177−86.

Jacob M, Akoko LO, Kazema RR. Lumbar disc degenerative dis-ease: Magnetic resonance imaging findings in patients with low back pain in Dar Es Salaam. East Cent Afr J Surg 2015; 20(1)1: 122−31.

Vardhan H, Raychaudhari C, Vinod D, Patel VV, Shah DS. A cross-sectional prevalence study of disc degeneration in a rural population and its relation with age, body mass index and back pain. Int J Med Health Res 2015; 1(1): 1−13.

Adams MA, McNally DS, Dolan P. 'Stress' distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br 1996; 78(6): 965−72.

Handa T, Ishihara H, Ohshima H, Osada R, Tsuji H, Obata K. Ef-fects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar interverte-bral disc. Spine (Phila Pa 1976) 1997; 22(10): 1085−91.

Hutton WC, Toribatake Y, Elmer WA, Ganey TM, Tomita K, Whitesides TE. The effect of compressive force applied to the intervertebral disc in vivo. A study of proteoglycans and colla-gen. Spine (Phila Pa 1976) 1998; 23(23): 2524−37.

Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N. Risk factors for lumbar disc degeneration: A 5-year prospec-tive MRI study in asymptomatic individuals. Spine (Phila Pa 1976) 2002; 27(2): 125−34.

Mariconda M, Galasso O, Imbimbo L, Lotti G, Milano C. Relation-ship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. Eur Spine J 2007; 16(2): 255−66.

Hung YJ, Shih TT, Chen BB, Hwang YH, Ma LP, Huang WC, et al. The dose-response relationship between cumulative lifting load and lumbar disk degeneration based on magnetic reso-nance imaging findings. Phys Ther 2014; 94(11): 1582−93.

Schenk P, Läubli T, Hodler J, Klipstein A. Magnetic resonance imaging of the lumbar spine: Findings in female subjects from administrative and nursing professions. Spine (Phila Pa 1976) 2006; 31(23): 2701−6.

Evans W, Jobe W, Seibert C. A cross-sectional prevalence study of lumbar disc degeneration in a working population. Spine (Phila Pa 1976) 1989; 14(1): 60−4.

Claus A, Hides J, Moseley GL, Hodges P. Sitting versus standing: Does the intradiscal pressure cause disc degeneration or low back pain. J Electromyogr Kinesiol 2008; 18(4): 550−8.

Johanning E. Evaluation and management of occupational low back disorders. Am J Ind Med 2000; 37(1): 94−111.

Original Paper