Exposure to whole-body vibration and hospitalization due to lumbar disc herniation

Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review

BACKGROUND

Lumbar disc herniation (LDH) with radiculopathy is associated with greater pain, disability, healthcare use, and costs compared with nonspecific low back pain. Reliable information about its incidence and risk factors were lacking.

QUESTIONS

(1) What is the incidence of lumbar disc herniation (LDH) with radiculopathy in adults? (2) What are the risk factors for LDH with radiculopathy in adults?

METHODS

Systematic review. We searched five electronic databases from 1970 to September 2023. Eligible cohort and case-control studies were identified and independently assessed for risk of bias. A qualitative best evidence synthesis of low and moderate risk of bias studies was conducted.

RESULTS

We critically reviewed 87 studies and synthesised data from 59 (68%) studies; 12 were of low and 47 of moderate risk of bias. The lower and upper bound limits of the 95% CIs of annual incidence estimates ranged from 0.3 to 2.7 per 1000 persons for surgical case definitions, from 0.04 to 1.5 per 1,000 persons for hospital-based case definitions, and from 0.1 to 298.3 per 1,000 persons for clinical case definitions. Factors associated with the development of LDH with radiculopathy included middle-age (30-50 years), smoking, higher BMI, presence of cardiovascular risk factors (in women), and greater cumulative occupational lumbar load by forward bending postures and manual materials handling, with effect sizes ranging from ranging from 1.1 (1.0-1.3) to 3.7 (2.3-6.0).

CONCLUSIONS

Incidence of LDH varies in different populations and according to case definition. Risk factors include individual, behavioural, and work-related variables. Our findings support the need to develop standardised case definitions that validly classify the clinical spectrum of LDH and for future low risk of bias studies examining causal relationships for LDH with radiculopathy in adults.

Primary Creep Characterization in Porcine Lumbar Spine Subject to Repeated Loading

Low back pain (LBP) is a common medical condition worldwide, though the etiology of injuries causing most LBP is unknown. Flexion and repeated compression increase lumbar injury risk, yet the complex viscoelastic behavior of the lumbar spine has not been characterized under this loading scheme. Characterizing the non-injurious primary creep behavior in the lumbar spine is necessary for understanding the biomechanical response preceding injury. Fifteen porcine lumbar spinal units were loaded in repeated flexion-compression with peak compressive stresses ranging from 1.41 to 4.68 MPa. Applied loading simulated real loading exposures experienced by high-speed watercraft occupants. The strain response in the primary creep region was modeled for all tests using a generalized Kelvin-Voigt model. A quasilinear viscoelastic (QLV) approach was used to separate time-dependent (creep) and stress-dependent (elastic) responses. Optimizations between the models and experimental data determined creep time constants, creep coefficients, and elastic constants associated with this tissue under repeated flexion-compression loading. Average R2 for all fifteen models was 0.997. Creep time constants optimized across all fifteen models were 24 s and 580 s and contributed to 20 ± 3% and 30 ± 3% of the overall strain response, respectively. The non-transient behavior contributed to 50 ± 0% of the overall response. Elastic behavior for this porcine population had an average standard deviation of 24.5% strain across the applied stress range. The presented primary creep characterization provides the response precursor to injurious behavior in the lumbar spine. Results from this study can further inform lumbar injury prediction and kinematic models.

Understanding the etiopathogenesis of lumbar intervertebral disc herniation: From clinical evidence to basic scientific research

Lumbar intervertebral disc herniation, as a leading cause of low back pain, productivity loss, and disability, is a common musculoskeletal disorder that results in significant socioeconomic burdens. Despite extensive clinical and basic scientific research efforts, herniation etiopathogenesis, particularly its initiation and progression, is not well understood. Understanding herniation etiopathogenesis is essential for developing effective preventive measures and therapeutic interventions. Thus, this review seeks to provide a thorough overview of the advances in herniation-oriented research, with a discussion on ongoing challenges and potential future directions for clinical, translational, and basic scientific investigations to facilitate innovative interdisciplinary research aimed at understanding herniation etiopathogenesis. Specifically, risk factors for herniation are identified and summarized, including familial predisposition, obesity, diabetes mellitus, smoking tobacco, selected cardiovascular diseases, disc degeneration, and occupational risks. Basic scientific experimental and computational research that aims to understand the link between excessive mechanical load, catabolic tissue remodeling due to inflammation or insufficient nutrient supply, and herniation, are also reviewed. Potential future directions to address the current challenges in herniation-oriented research are explored by combining known progressive development in existing research techniques with ongoing technological advances. More research on the relationship between occupational risk factors and herniation, as well as the relationship between degeneration and herniation, is needed to develop preventive measures for working-age individuals. Notably, researchers should explore using or modifying existing degeneration animal models to study herniation etiopathogenesis, as such models may allow for a better understanding of how to prevent mild-to-moderately degenerated discs from herniating.

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain

Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.

Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis

OBJECTIVES

The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP.

METHODS

The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP).

RESULTS

Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP.

CONCLUSIONS

Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.

Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: a systematic review

OBJECTIVE

Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review.

METHODS

A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question.

RESULTS

A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8).

DISCUSSION

In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.

A Health-Impact Assessment of an Ergonomic Measure to Reduce the Risk of Work-Related Lower Back Pain, Lumbosacral Radicular Syndrome and Knee Osteoarthritis among Floor Layers in The Netherlands

Sand-cement-bound screed floor layers are at risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis, given their working technique of levelling screed with their trunk bent while mainly supported by their hands and knees. To reduce the physical demands of bending of the trunk and kneeling, a manually movable screed-levelling machine was developed for floor layers in the Netherlands. The aim of this paper is to estimate the potential health gains of working with a manually movable screed-levelling machine on the risk of lower back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to traditional working techniques. This potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF), combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk estimates was based on worksite observations among 28 floor layers. For LBP, 16/18 workers were at risk when using traditional working techniques, with a PAF = 38%, and for those using a manually movable screed-levelling machine, this was 6/10 with a PIF = 13%. For LRS, these data were 16/18 with a PAF = 55% and 14/18 with a PIF = 18%, and for KOA, 8/10 with a PAF = 35% and 2/10 with a PIF = 26%. A manually movable screed-levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands, and health-impact assessments are a feasible approach for assessing health gains in an efficient way.

Agreement between an expert-rated mini job exposure matrix of occupational biomechanical exposures to the lower body and technical measurements or observation: a method comparison study

OBJECTIVES

Investigating the agreement between an expert-rated mini job exposure matrix (JEM) of lower body exposures and technical measurements of worktime spent standing/walking and observation-based estimates of time spent kneeling/squatting and total load lifted per workday.

METHODS

We chose 16 job titles from the 121 job groups in the lower body JEM and included them in the mini JEM. New expert ratings for the mini JEM were performed by the same five occupational physicians who performed the ratings for the lower body JEM. For each job title and type of exposure, the exposure estimates were a mean of the five independent ratings. Technical measurements of standing/walking for all 16 job titles, and for 8 job titles workplace observations were performed of kneeling/squatting and total load lifted per workday. Data were collected from September to December 2015 and supplemented by data from the NOMAD and DPhacto studies collected between 2011 and 2013. All data were collected in Denmark. Agreement between expert-based and measured/observed lower body exposures by job titles was evaluated using Spearman's rank correlation, Bland-Altman plots evaluated systematic deviations and limits of agreement (LoA).

RESULTS

Standing/walking showed a rank correlation of 0.55, kneeling/squatting 0.83 and total load lifted per workday 0.71. The mini JEM estimates did not systematically deviate from the technical measurements/observations for time spent standing/walking (mean difference 0.20 hours/workday, LoA -1.63, 2.03 hours/workday) and kneeling/squatting (mean difference -0.35 hours/workday, LoA -1.21, 0.51 hours/workday). For total load lifted per workday, the mini JEM systematically overestimated the exposures compared with the observations (mean difference -909 kg/workday, LoA -3000, 1147 kg/workday).

CONCLUSIONS

There was moderate to very high agreement between an expert-rated mini JEM of standing/walking, kneeling/squatting, and lifting exposures and corresponding technical measurements/observations. This method comparison study supports the use of the expert-based lower body JEM in large-scale occupational epidemiological studies.

Whole Body Vibration Exposure Transmitted to Drivers of Heavy Equipment Vehicles: A Comparative Case According to the Short- and Long-Term Exposure Assessment Methodologies Defined in ISO 2631-1 and ISO 2631-5

The construction and transport sectors are the industries with the highest proportions of workers exposed to vibrations in the European Union. Heavy equipment vehicle (HEV) drivers often perform operations on different uneven surfaces and are exposed to whole body vibration (WBV) on a daily basis. Recently, a new version of ISO 2631-5 was published. However, since this new method required as input the individual exposure profile and the acceleration signals recorded on more surfaces, limited studies have been carried out to evaluate HEV operations according to this standard. The objectives of this study were to assess the WBV exposure using the methods defined in ISO 2631-1:1997 and ISO 2631-5:2018 and to compare the obtained health risk assessments between drivers with different anthropometric characteristics. For this purpose, two drivers were selected and a field measurement campaign was conducted. Regarding short-term assessment, results showed that VDV was the most restrictive method with exposure levels above the exposure action limit value, while SdA indicated that the same exposures were safe for the worker. With respect to long-term assessment, Risk Factor R^A showed that the driver with the highest body mass index was the only one who exceeded the low probability limit of adverse health effects.

Prediction of the natural frequencies of different degrees of degenerated human lumbar segments L2-L3 using dynamic finite element analysis

BACKGROUND AND OBJECTIVE

Chronic exposure to resonant environment may cause more serious injuries to human lumbar spine than other vibrations. On the condition that the natural frequency of human lumbar spine is known, excitation frequency from an external vibration source can be optimized to keep away from the natural frequency and thus avoid lumbar resonance. Therefore, this study aimed to present an approach to predict the natural frequency of the human lumbar spine.

METHODS

Four poroelastic finite element models of human L2-L3 spinal motion segments with different degrees of degeneration were established. Dynamic finite element analyses of these models during 1 h of vibration were then conducted. The mechanical parameters of these models under vibrations at different excitation frequencies were predicted. The excitation frequencies that resulted in the greatest changes in the lumbar mechanical parameters were identified as the natural frequencies of the established L2-L3 spinal motion segments.

RESULTS

Simulation results showed that the natural frequencies of the healthy and mildly degenerated L2-L3 spinal motion segments, moderately degenerated L2-L3 spinal motion segments, and seriously degenerated L2-L3 spinal motion segments were in the range of 5-7, 3-5, and 1-3 Hz, respectively.

CONCLUSIONS

The predicted results indicated that the natural frequencies of the human L2-L3 spinal motion segments gradually decreased with the severity of degeneration. These phenomena may be related to changes in the lumbar structures and materials because of degeneration. This study provided a feasible method to predict the lumbar natural frequencies for different populations, which may be helpful in optimizing external vibration sources to avoid lumbar resonance.

Effect of Osteoporosis on Adjacent Segmental Degeneration After Posterior Lumbar Interbody Fusion Under Whole Body Vibration

BACKGROUND

Adjacent segmental degeneration (ASD) is one of the common complications after posterior lumbar interbody fusion (PLIF). Both whole body vibration (WBV) and osteoporosis are important factors associated with the biomechanics of the lumbar spine. However, to the best of our knowledge, no studies have investigated the effects of osteoporosis on ASD after PLIF under WBV.

METHODS

In the present study, using one normal model, one PLIF model and one PLIF with osteoporosis model of the L1-S1 segment were developed. A 5-Hz, 40-N sinusoidal vertical load was imposed on the superior surface of L1 of each model to simulate WBV, and the dynamic responses and maximal values of intradiscal pressure, shear stress on annulus fibrosus, total deformation, and disc bulge were evaluated in the L1-L2, L2-L3, L3-L4, and L5-S1 segments.

RESULTS

At the L1-L2, L2-L3, and L3-L4 levels, the differences in the dynamic responses and maximal values in intradiscal pressure, shear stress, total deformation, and disc bulge between the PLIF and PLIF with osteoporosis models were slight. However, at the L5-S1 level, the dynamic response curves and maximal intradiscal pressure, shear stress, and disc bulge values in the PLIF with osteoporosis model were significantly lower than those in the PLIF model.

CONCLUSIONS

Osteoporosis can mitigate the development of ASD in the lower adjacent segment but has no obvious influence on the upper adjacent segments during WBV.

Analysis of the influence of species, intervertebral disc height and Pfirrmann classification on failure load of an injured disc using a novel disc herniation model

BACKGROUND CONTEXT

Annular repair devices offer a solution to recurrent disc herniations by closing an annular defect and lowering the risk of reherniation. Given the significant risk of neurologic injury from device failure it is imperative that a reliable preclinical model exists to demonstrate a high load to failure for the disc repair devices.

PURPOSE

To establish a preclinical model for disc herniation and demonstrate how changes in species, intervertebral disc height and Pfirrmann classification impacts failure load on an injured disc. We hypothesized that: (1) The force required for disc herniation would be variable across disc morphologies and species, and (2) for human discs the force to herniation would inversely correlate with the degree of disc degeneration.

STUDY DESIGN

Animal and human cadaveric biomechanical model of disc herniation.

METHODS

We tested calf lumbar spines, bovine tail segments and human lumbar spines. We first divided individual lumbar or tail segments to include the vertebral bodies and disc. We then hydrated the specimens by placing them in a saline bath overnight. A magnetic resonance images were acquired from human specimens and a Pfirrmann classification was made. A stab incision measuring 25% of the diameter of the disc was then done to each specimen along the posterior intervertebral disc space. Each specimen was placed in custom test fixtures on a servo-hydraulic test frame (MTS, Eden Prarie, MN) such that the superior body was attached to a 10,000 lb load cell and the inferior body was supported on the piston. A compressive ramping load was placed on the specimen in load control at 4 MPa/sec stopping at 75% of the disc height. Load was recorded throughout the test and failure load calculated. Once the test was completed each specimen was sliced through the center of the disc and photos were taken of the cut surface.

RESULTS

Fifteen each of calf, human, and bovine tail segments were tested. The failure load varied significantly between specimens (p<.001) with human specimens having the highest average failure load (8154±2049 N). Disc height was higher for lumbar/bovine tail segments as compared to calf specimens (p<.001) with bovine tails having the highest disc height (7.1±1.7 mm). Similarly, human lumbar discs had a cross sectional area that was greater than both bovine tail/calf lumbar spines (p<.001). There was no correlation between disc height and failure load within each individual species (p>.05). Cross sectional area and failure load did not correlate with failure load for human lumbar spine and bovine tails (p>.05) but did correlate with calf spine (r=0.53, p=.04). There was a statistically significant inverse correlation between disc height and Pfirrmann classification for human lumbar spines (r=-0.84, p<.001). There was also a statistically significant inverse relationship between Pfirrmann classification and failure load (r=-0.58, p=.02).

CONCLUSIONS

We have established a model for disc herniation and have shown how results of this model vary between species, disc morphology, and Pfirrmann classification. Both hypotheses were accepted: The force required for disc herniation was variable across species, and the force to herniation for human spines was inversely correlated with the degree of disc degeneration. We recommend that models using human intervertebral discs should include data on Pfirrmann classification, while biomechanical models using calf spines should report cross sectional area. Failure loads do not vary based on dimensions for bovine tails.

CLINICAL SIGNIFICANCE

Our analysis of models for disc herniation will allow for quicker, reliable comparisons of failure forces required to induce a disc herniation. Future work with these models may facilitate rapid testing of devices to repair a torn/ruptured annulus.

Preventive action with a population of excavator drivers exposed to whole-body vibration

BACKGROUND:

Whole-body vibration is a major cause of lower back pain among employees, and the medical and preventive care teams of occupational health departments are often confronted with lower back pain problems among machine operators.

OBJECTIVES:

The objectives of this research are to determine the number of excavator drivers exposed to whole-body vibration levels above 0.5m/s², identify other exposure factors that may contribute to back pain, and propose corrective measures.

METHODS:

Vibration measurements were carried out on individual excavator drivers while they were observed carrying out working tasks, after which prevention advice is given. Factors which determine vibration levels are logged on to a database.

RESULTS:

The multivariate analysis of several determining factors shows vibration exposure levels vary depending on the varied work tasks being carried out.

CONCLUSION:

This study identifies exposed employees among excavator operators. For each workstation, the determining factors that could explain the high exposures to vibrations are identified. This work shows the important role of tasks on exposure levels. A better adaptation of the tools used to carry out work tasks would allow a decrease in the vibration level of this type of machine.

Assessment of Comfort Variation among Different Types of Driving Agricultural Tractors: Traditional, Satellite-Assisted and Semi-Automatic

Over the past years, in the agricultural field, geo-localization has been introduced in order to develop specific farming processes, optimize resources, and reduce environmental pollution. Researchers have found alternative driving methods to traditional ones, such as assisted and semi-automatic driving. The aim of this study was to monitor the musculoskeletal efforts necessary to carry out different kinds of driving. The muscular strain was assessed using surface electromyographic devices, the distribution of the pressure exerted by the operator’s body on the seat was observed by using two barometric pads applied on the seat back and on the seat, respectively, while the body movements and postures were analyzed through a Microsoft Kinect Camera 3D acquisition system. Results showed a significantly greater muscular activation during manual and assisted driving conditions. The pressure exerted by the operator on the barometric pads was significantly higher in manual and semi-automatic driving modes than in the assisted one. A remarkable increase in the average swinging speed of examined joints was also detected, as well as the distances run by the joints in semi-automatic driving. From our study, assisted driving seems to be the best driving mode both in terms of joint economy and from the efficiency of agricultural processes.

Comparison of dynamic response of three TLIF techniques on the fused and adjacent segments under vibration

To explore which TLIF techniques are advantageous in reducing the risk of complications and conducive to bone fusion under the vibration. The L1-L5 finite element lumbar model was modified to simulate three different TLIF techniques (a unilateral standard cage, a crescent-shaped cage, and bilateral standard cages). The results showed that the crescent-shaped cage may reduce the risk of subsidence and provide a more stable and suitable environment for vertebral cell growth under the vibration compared to the other TLIF techniques. Unilateral cage may increase the risk of adjacent segment disease and cage failure including fatigue failure under vibration.

Comparison of biomechanical studies of disc repair devices based on a systematic review

BACKGROUND CONTEXT

A variety of solutions have been suggested as candidates for the repair of the annulus fibrosis (AF), with the ability to withstand physiological loads of paramount importance.

PURPOSE

The objective of our study was to capture the scope of biomechanical test models of AF repairs. We hypothesized that common test parameters would emerge.

STUDY DESIGN

Systematic Review METHODS: PubMed and EMBASE databases were searched for studies in English including the keywords "disc repair AND animal models," "disc repair AND cadaver spines," "intervertebral disc AND biomechanics," and "disc repair AND biomechanics." This list was further limited to those studies which included biomechanical results from annular repair in animal or human spinal segments from the cervical, thoracic, lumbar and/or coccygeal (tail) segments. For each study, the method used to measure the biomechanical property and biomechanical test results were documented.

RESULTS

A total of 2,607 articles were included within our initial analysis. Twenty-two articles met our inclusion criteria. Significant variability in terms of species tested, measurements used to quantify annular repair strength, and the method/direction/magnitude that forces were applied to a repaired annulus were found. Bovine intervertebral disc was most commonly used model (6 of 22 studies) and the most common mechanical property reported was the force required for failure of the disc repair device (15 tests).

CONCLUSIONS

Our hypothesis was rejected; no common features were identified across AF biomechanical models and as a result it was not possible to compare results of preclinical testing of annular repair devices. Our analysis suggests that a standardized biomechanical model that can be repeatably executed across multiple laboratories is required for the mechanical screening of candidates for AF repair.

CLINICAL SIGNIFICANCE

This literature review provides a summary of preclinical testing of annular repair devices for clinicians to properly evaluate the safety/efficacy of developing technology designed to repair annular defects after disc herniations.

Hospital admission and associated factors among individuals presenting to healthcare facilities for low back pain in Ethiopia

AIM

The aim of this paper is to analyze hospital admission and associated factors following presentation to healthcare facilities for low back pain (LBP) in Ethiopia.

METHODS

A population-based cross-sectional study was conducted between June and November 2018 in South-west Shewa zone of Oromia regional state. Data were collected by face-to-face interviews of adults (≥18 years) with self-reported LBP using a newly developed and validated instrument. All the statistical analyses of (n = 543) individuals with a 1-year history of presentation to healthcare facilities for LBP were performed using R version 3.5.1. The log-binomial regression model was fitted and prevalence ratios with 95% confidence intervals (CIs) were calculated to identify factors associated with hospitalization and the significance level was considered at the P value of ≤ .05.

RESULTS

The proportion of hospital admissions following presentation to healthcare facilities for LBP was 14.4%, 95% CI 11.4-17.3, with an average length of stay (LOS) 7.4 days, 95% CI 6.4-8.8. The admission rate was 18.5%, 95% CI 13.4-23.3 in females and 11.4%, 95% CI 8.0-15.1 in males. Multiple factors, such as gender, age, living conditions, residential environment, alcohol consumption status, intensity of pain, and presence of additional spinal pain, were found to be independently associated with hospitalization for LBP.

CONCLUSIONS

The burden on the individuals and the Ethiopian healthcare system as a result of LBP is evident by the rate of hospital admissions. Further evidence on LBP case referral procedures is needed to allow health policy makers to develop appropriate management strategies capable of dealing with the increasing epidemiology of LBP.

Occupational lifting predicts hospital admission due to low back pain in a cohort of airport baggage handlers

Purpose

To examine if occupational lifting assessed as cumulative years as a baggage handler is associated with first-time hospital diagnosis or treatment for low back disorders.

Methods

This study is based on the Copenhagen Airport Cohort consisting of male baggage handlers performing heavy lifting every day and a reference group of unskilled men from the greater Copenhagen area during the period 1990–2012. We followed the cohort in the National Patient Register and Civil Registration System to obtain information on diagnoses, surgery, mortality, and migration. The outcomes were first-time hospital diagnosis or surgery for (1) lumbar disc herniation or (2) low back pain (LBP).

Results

Baggage handlers (N = 3473) had a higher incidence rate of LBP, but not of lumbar disc herniation, compared to the reference group (N = 65,702). Baggage handlers with longer employment had a higher incidence of LBP compared to baggage handlers with shorter employment. The linear association of cumulative years as a baggage handler on LBP was significantly increased with an incidence rate ratio of 1.16 (95% CI 1.07–1.25) for a 5-year increase of employment as baggage handler.

Conclusions

In this large cohort study, we found an increased incidence of LBP among baggage handlers compared to the reference group with indications of a dose–response relationship between years of employment and the outcome. For baggage handlers working on the apron, the incidence was particularly increased before introduction of technical lifting equipment, suggesting that preventive measures to reduce cumulative work load may have a positive effect.

Creep experimental study on the lumbar intervertebral disk under vibration compression load

The intervertebral disk cushions the load generated by human activity and absorbs energy to keep the spine moving steadily. Vibration condition is one of the important causes of disk degeneration. Creep experiments using the sheep lumbar intervertebral disk were carried out under vibration compression. Regularities of the strain of the disk with time were obtained and compared with those of static load. The influence of vibration frequency and time on the creep properties of the intervertebral disk was analyzed. An intervertebral disk three-parameter solid creep constitutive model considering vibration factors was established and the parameters in the model were identified. The results show that the strain of the lumbar intervertebral disk exhibits an exponential relationship with time and is unrelated to static compression or vibration load. Under the same vibration amplitude, the creep increases with vibration frequency and the relationship between them is nonlinear. The vibration frequency has a significant effect on the strain. The creep rate decreases gradually with time and is obviously influenced by vibration frequency at low vibration amplitudes. The creep prediction results obtained using the constitutive model with the time-varying material parameters are in good agreement with the experimental results. The two elastic moduli in the model decrease with time and the viscosity coefficient increases with time.

Presentation of an Approach on Determination of the Natural Frequency of Human Lumbar Spine Using Dynamic Finite Element Analysis

Occurring resonance may negatively affect the health of the human lumbar spine. Hence, vibration generated in working and living environments should be optimized to avoid resonance when identifying the natural frequency of the human lumbar spine. The range of the natural frequency of the human lumbar spine has been investigated, but its specific numerical value has not been determined yet. This study aimed at presenting an approach based on resonance for predicting the specific numerical value of the natural frequency of the human lumbar spine. The changes in the numerical fluctuation amplitudes and the cycles of lumbar mechanical parameters during resonance are greater than those during nonresonant vibration. Given that the range of the natural frequency has been identified, vibrations at different excitation frequencies within this range can be applied in a human lumbar finite element model for dynamic finite element analysis. When the excitation frequency is close to the natural frequency, resonance occurs, causing great changes in the numerical fluctuation amplitudes and the cycles of lumbar mechanical parameters. Therefore, the natural frequency of the lumbar finite element model could be back-calculated. Results showed that the natural frequency of the established model was 3.5 Hz. Meanwhile, the closer the excitation frequency was to the natural frequency, the greater the changes in the numerical fluctuation amplitudes and cycles in the parameters would be. This study presented an approach for predicting the specific numerical value of the natural frequency of the human lumbar spine. Identifying the natural frequency assists in finding preventive measures for lumbar injury caused by vibration and in designing the vibration source in working and living environments to avoid approximating to the natural frequency of the human lumbar spine.