Povezanost stepena degeneracije intervertebralnih diskusa i radnih aktivnosti kod bolesnika sa lumbalnom diskus hernijom

  • 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
DOI: https://doi.org/10.2298/VSP151112306P
Ključne reči: lumbosacral region||, ||lumbosakralni predeo, inervertebral disc degeneration||, ||diskus degeneracija, occupational exposure||, ||profesionalna izloženost, intervertebral disc displacement||, ||hernija diskusa,

Sažetak


Uvod/Cilj. Degeneracija intervertebralnog diskusa (DID) nastaje kao posledica udruženog dejstva genetskih, starosnih faktora kao i faktora iz životne i radne sredine. Lumbalna diskus hernija (LDH) je najčešće posledica DID. Cilj rada bio je da se istraži da li je učestalost LDH viša na nivou najizraženijih degenerativnih promena intervertebralnog diskusa i da li kategorija fizičkog opterećenja na radnom mestu ima uticaj na stepen DID na nivou L3-L4, L4-L5 i L5-S1 pojedinačno. Metode. Istraživanjem je obuhvaćeno 60 bolesnika u stalnom radnom odnosu, hospitalizovanih zbog LDH. Stepen DID utvrđen je na osnovu preoperativnog nalaza pregleda lumbosakralne kičme magnetnom rezonancom (MRI) prema Firmanovom MRI sistemu klasifikacije. Profesionalni faktori su određeni pomoću specifičnog upitnika. Rezultati. Od 60 bolesnika koji su učestvovali u istraživanju, 33.3% obavljalo je lak fizički rad, 23% srednje težak, a 43% bolesnika težak fizički rad. Hernijacija diskusa na nivou L3-L4 nađena je kod 8,3%, na nivou L4-L5 kod 46,7%, a na nivou L5-S1 kod 45% bolesnika. Simptomatski diskusi na nivou L5-S1, su pokazali statistički značajno veću učestalost degenerativnih promena IV i V stepena. Rezultati binarne logističke regresije pokazali su da je fizičko opterećenje najjači prediktor stepena DID na svim ispitivanim nivoima. Pozitivna veza između fizičkog opterećenja i stepena DID je uočena u svim slučajevima. Viši stepen DID je verovatniji kod bolesnika sa dužim radnim stažom i teškim fizičkim opterećenjem (OR 2.011) na nivou L3-L4. Na nivoima L4-L5 i L5-S1 viši stepen DID je verovatniji kod žena koje obavljaju težak fizički rad (OR 1,978 i 2,433 respektivno). Zaključak. Simptomatski diskusi imaju veću učestalost degenerativnih promena višeg stepena, ali se hernijacija ne dešava isljučivo na nivou diskusa sa najizraženijim degenerativnim promenama. Rezultati ukazuju na značaj interaktivnog uticaja kategorije fizičkog opterećenja i dužine radnog staža kao i interakcije kategorije fizičkog opterećenja i pola, na degeneraciju lumbalnih diskusa.

Reference

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: http://www.medradanis.rs/docs/kniga_medicina_rada.pdf (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.

Objavljeno
2018/08/23
Broj časopisa
Vol. 74 Br. 12 (2017)
Rubrika
Originalni članak