Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Osteochondrosis | Research article

Evaluation criteria for the assessment of occupational diseases of the lumbar spine - how reliable are they? -

Authors: Benjamin Ulmar, Julia Wölfle-Roos, Tugrul Kocak, Alexander Brunner

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

In 2005, the German Association of Occupational Accident Insurance Funds (DGUV) defined radiological evaluation criteria for the assessment of degenerative occupational diseases of the lumbar spine. These include the measurement of intervertebral osteochondrosis and classification of vertebral osteosclerosis, antero-lateral and posterior spondylosis, and spondyloarthritis via plain radiography. The measures currently remain in daily use for determining worker compensation among those with occupational diseases. Here, we aimed to evaluate the inter- and intra-observer reliability of these evaluation criteria.

Methods

We enrolled 100 patients with occupational degenerative diseases of the lumbar spine. Native antero-posterior and lateral radiographs of these patients were evaluated according to DGUV recommendations by 4 observers with different levels of clinical training. Evaluations were again conducted after 2 months to assess the intra-observer reliability.

Results

The measurement of intervertebral osteochondrosis showed good inter-observer reliability (ICC: 0.755) and excellent intra-observer reliability (ICC: 0.827). The classification of vertebral osteosclerosis exhibited moderate kappa values for inter-observer reliability (К: 0.426) and intra-observer reliability (К: 0.441); the remaining 3 criteria showed poor inter- and intra-observer reliabilities.

Conclusion

The measurement of intervertebral osteochondrosis and classification of vertebral osteosclerosis showed adequate inter- and intra-observer reliability in the assessment of occupational diseases of the lumbar spine, whereas the classification of antero-lateral and posterior spondylosis and spondyloarthritis stage exhibited insufficient reliability. Hence, we recommend the revision of the DGUV recommendations for the evaluation of occupational diseases of the lumbar spine.
Literature
1.
go back to reference Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl. 1998;281:28–31.CrossRef Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl. 1998;281:28–31.CrossRef
2.
go back to reference Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.CrossRef Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.CrossRef
3.
go back to reference Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can. 2004;25(1):13–21.PubMed Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can. 2004;25(1):13–21.PubMed
4.
go back to reference Chenot JF, Haupt C, Gerste B. In: Klauber J, Günster C, Gerste B, Robra BP, Schmacke N, editors. Zeitliche Trends bei der Versorgung von Rücken- schmerzpatienten. In: Versorgungs-Report 2013/2014: Stuttgart: Schattauer; 2014. p. 155–83. Chenot JF, Haupt C, Gerste B. In: Klauber J, Günster C, Gerste B, Robra BP, Schmacke N, editors. Zeitliche Trends bei der Versorgung von Rücken- schmerzpatienten. In: Versorgungs-Report 2013/2014: Stuttgart: Schattauer; 2014. p. 155–83.
5.
go back to reference Luoma K, Riihimaki H, Raininko R, Luukkonen R, Lamminen A, Viikari-Juntura E. Lumbar disc degeneration in relation to occupation. Scand J Work Environ Health. 1998;24(5):358–66.CrossRef Luoma K, Riihimaki H, Raininko R, Luukkonen R, Lamminen A, Viikari-Juntura E. Lumbar disc degeneration in relation to occupation. Scand J Work Environ Health. 1998;24(5):358–66.CrossRef
6.
go back to reference Martini L, Hoffmann F. Comorbidity of chronic back pain and depression in Germany: results from the GEDA study, 2009 and 2010. Z Evid Fortbild Qual Gesundhwes. 2018;137-138:62–8.CrossRef Martini L, Hoffmann F. Comorbidity of chronic back pain and depression in Germany: results from the GEDA study, 2009 and 2010. Z Evid Fortbild Qual Gesundhwes. 2018;137-138:62–8.CrossRef
7.
go back to reference Ohashi M, Watanabe K, Hirano T, Hasegawa K, Katsumi K, Shoji H, Tatsuki M, Endo N. Predicting Factors at Skeletal Maturity for Curve Progression and Low Back Pain in Adult Patients Treated Non-Operatively for Adolescent Idiopathic Scoliosis with Thoracolumbar/Lumbar Curves: A Mean 25-Year Follow-up. Spine (Phila Pa 1976); 2018. Ohashi M, Watanabe K, Hirano T, Hasegawa K, Katsumi K, Shoji H, Tatsuki M, Endo N. Predicting Factors at Skeletal Maturity for Curve Progression and Low Back Pain in Adult Patients Treated Non-Operatively for Adolescent Idiopathic Scoliosis with Thoracolumbar/Lumbar Curves: A Mean 25-Year Follow-up. Spine (Phila Pa 1976); 2018.
8.
go back to reference Seidler A, Bergmann A, Jager M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, et al. Cumulative occupational lumbar load and lumbar disc disease--results of a German multi-center case-control study (EPILIFT). BMC Musculoskelet Disord. 2009;10:48.CrossRef Seidler A, Bergmann A, Jager M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, et al. Cumulative occupational lumbar load and lumbar disc disease--results of a German multi-center case-control study (EPILIFT). BMC Musculoskelet Disord. 2009;10:48.CrossRef
9.
go back to reference Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.CrossRef Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.CrossRef
10.
go back to reference Bolm-Audorff U, Brandenburg S, Brüning T, Dupuis H, Ellegast R, Elsner G, Franz K, Grasshoff H, Hanisch L, Hartmann B, et al. Medizinische Beurteilungskriterien zu bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule. Konsensusempfehlungen zur Zusammenhangsbegutachtung der auf Anregung des HVBG eingerichteten interdisziplinären Arbeitsgruppe Trauma Berufskrankh. 2005;7:211–52. Bolm-Audorff U, Brandenburg S, Brüning T, Dupuis H, Ellegast R, Elsner G, Franz K, Grasshoff H, Hanisch L, Hartmann B, et al. Medizinische Beurteilungskriterien zu bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule. Konsensusempfehlungen zur Zusammenhangsbegutachtung der auf Anregung des HVBG eingerichteten interdisziplinären Arbeitsgruppe Trauma Berufskrankh. 2005;7:211–52.
11.
go back to reference Bolm-Audorff U, Ellegast R, Grifka J, Haerting J, Hering-von Diepenbroik V, Hofmann F, Jäger M, Seidler A. Design der deutschen Wirbelsäulenstudie (DWS). In: Arbeitsmedizin im Gesundheitsdienst. Volume 17, edn. Edited by Hofmann F, Reschauer G, Stössel U. FFAS: Freiburg; 2004. Bolm-Audorff U, Ellegast R, Grifka J, Haerting J, Hering-von Diepenbroik V, Hofmann F, Jäger M, Seidler A. Design der deutschen Wirbelsäulenstudie (DWS). In: Arbeitsmedizin im Gesundheitsdienst. Volume 17, edn. Edited by Hofmann F, Reschauer G, Stössel U. FFAS: Freiburg; 2004.
12.
go back to reference Hartung E, Schäfer K, Jäger M, Luffmann A, Bolm-Audorff U, Kuhn S, Paul R, Francks HP. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108: Part 2: Suggestion for appraisal of the working technique prerequisites in procedure to establish occupational diseases. Arbeitsmed Sozialmed Umweltmed. 1999;34:112–43. Hartung E, Schäfer K, Jäger M, Luffmann A, Bolm-Audorff U, Kuhn S, Paul R, Francks HP. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108: Part 2: Suggestion for appraisal of the working technique prerequisites in procedure to establish occupational diseases. Arbeitsmed Sozialmed Umweltmed. 1999;34:112–43.
13.
go back to reference Jäger M, Luttmann A, Bolm-Audorff U, Schäfer K, Hartung E, Kuhn S, Paul R, Francks HP. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108: Part 1: Retrospective determination of strain in work associates with risk. Arbeitsmed Sozialmed Umweltmed. 1999;34:101–11. Jäger M, Luttmann A, Bolm-Audorff U, Schäfer K, Hartung E, Kuhn S, Paul R, Francks HP. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108: Part 1: Retrospective determination of strain in work associates with risk. Arbeitsmed Sozialmed Umweltmed. 1999;34:101–11.
14.
go back to reference Schäfer K, Hartung E. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108 Part 3: Suggestion for appraisal of the working technique prerequisites in procedures to establish occupational diseases in combined exposure to wholebody oscillation. Arbeitsmed Sozialmed Umweltmed. 1999;34:143–7. Schäfer K, Hartung E. The Mainz-Dortmund Dose Model (MDD) for appraisal of stress to the lumbar spine from lifting or carrying heavy loads or by working postures with highly inclined trunk in suspicion of occupational disease no. 2108 Part 3: Suggestion for appraisal of the working technique prerequisites in procedures to establish occupational diseases in combined exposure to wholebody oscillation. Arbeitsmed Sozialmed Umweltmed. 1999;34:143–7.
15.
go back to reference Roberts N, Gratin C, Whitehouse GH. MRI analysis of lumbar intervertebral disc height in young and older populations. J Magn Reson Imaging. 1997;7(5):880–6.CrossRef Roberts N, Gratin C, Whitehouse GH. MRI analysis of lumbar intervertebral disc height in young and older populations. J Magn Reson Imaging. 1997;7(5):880–6.CrossRef
16.
go back to reference Hurxthal LM. Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Therapy, Nucl Med. 1968;103(3):635–44.CrossRef Hurxthal LM. Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Therapy, Nucl Med. 1968;103(3):635–44.CrossRef
17.
go back to reference Cohen J. A coefficient of agreement for nominal scales. Educ Psycho Meas. 1960;20:37–46.CrossRef Cohen J. A coefficient of agreement for nominal scales. Educ Psycho Meas. 1960;20:37–46.CrossRef
18.
go back to reference Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRef Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRef
19.
go back to reference Andersson GB, Schultz A, Nathan A, Irstam L. Roentgenographic measurement of lumbar intervertebral disc height. Spine (Phila Pa 1976). 1981;6(2):154–8.CrossRef Andersson GB, Schultz A, Nathan A, Irstam L. Roentgenographic measurement of lumbar intervertebral disc height. Spine (Phila Pa 1976). 1981;6(2):154–8.CrossRef
20.
go back to reference Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K: Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon) 1997, 12 Suppl 1:S1-S63.CrossRef Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K: Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon) 1997, 12 Suppl 1:S1-S63.CrossRef
21.
go back to reference Brinckmann P, Biggemann M, Hilweg D: Fatigue fracture of human lumbar vertebrae. Clin Biomech (Bristol, Avon) 1988, 3 Suppl 1:i-S23.CrossRef Brinckmann P, Biggemann M, Hilweg D: Fatigue fracture of human lumbar vertebrae. Clin Biomech (Bristol, Avon) 1988, 3 Suppl 1:i-S23.CrossRef
22.
go back to reference Boos N, Wallin A, Aebi M, Boesch C. A new magnetic resonance imaging analysis method for the measurement of disc height variations. Spine (Phila Pa 1976). 1996;21(5):563–70.CrossRef Boos N, Wallin A, Aebi M, Boesch C. A new magnetic resonance imaging analysis method for the measurement of disc height variations. Spine (Phila Pa 1976). 1996;21(5):563–70.CrossRef
23.
go back to reference Frymoyer JW, Phillips RB, Newberg AH, MacPherson BV. A comparative analysis of the interpretations of lumbar spinal radiographs by chiropractors and medical doctors. Spine (Phila Pa 1976). 1986;11(10):1020–3.CrossRef Frymoyer JW, Phillips RB, Newberg AH, MacPherson BV. A comparative analysis of the interpretations of lumbar spinal radiographs by chiropractors and medical doctors. Spine (Phila Pa 1976). 1986;11(10):1020–3.CrossRef
24.
go back to reference Fyllos AH, Arvanitis DL, Karantanas AH, Varitimidis SE. Hantes M. Magnetic resonance morphometry of the adult normal lumbar intervertebral space. Surg Radiol Anat: Zibis AH; 2018. Fyllos AH, Arvanitis DL, Karantanas AH, Varitimidis SE. Hantes M. Magnetic resonance morphometry of the adult normal lumbar intervertebral space. Surg Radiol Anat: Zibis AH; 2018.
25.
go back to reference Sobczak S, Dugailly PM, Gilbert KK, Hooper TL, Sizer PS Jr, James CR, Poortmans B, Matthijs OC, Brismee JM. Reliability and validation of in vitro lumbar spine height measurements using musculoskeletal ultrasound: a preliminary investigation. J Back Musculoskelet Rehabil. 2016;29(1):171–82.CrossRef Sobczak S, Dugailly PM, Gilbert KK, Hooper TL, Sizer PS Jr, James CR, Poortmans B, Matthijs OC, Brismee JM. Reliability and validation of in vitro lumbar spine height measurements using musculoskeletal ultrasound: a preliminary investigation. J Back Musculoskelet Rehabil. 2016;29(1):171–82.CrossRef
26.
go back to reference Babinska A, Wawrzynek W, Czech E, Skupinski J, Szczygiel J, Labuz-Roszak B. No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain. Neurol Neurochir Pol. 2019;53(1):74–82.PubMed Babinska A, Wawrzynek W, Czech E, Skupinski J, Szczygiel J, Labuz-Roszak B. No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain. Neurol Neurochir Pol. 2019;53(1):74–82.PubMed
27.
go back to reference Nemoto O, Kitada A, Naitou S, Tsuda Y, Matsukawa K, Ukegawa Y. A longitudinal study for incidence of low back pain and radiological changes of lumbar spine in asymptomatic Japanese military young adults. Eur Spine J. 2013;22(2):453–8.CrossRef Nemoto O, Kitada A, Naitou S, Tsuda Y, Matsukawa K, Ukegawa Y. A longitudinal study for incidence of low back pain and radiological changes of lumbar spine in asymptomatic Japanese military young adults. Eur Spine J. 2013;22(2):453–8.CrossRef
28.
go back to reference Lehman VT, Diehn FE, Broski SM, Nathan MA, Kemp BJ, Larson NB, Shelerud RA, Brault JS, Halasy MP, Maus TP. Comparison of [(18) F] FDG-PET/MRI and clinical findings for assessment of suspected lumbar facet joint pain: a prospective study to characterize candidate nonanatomic imaging biomarkers and potential impact on management. AJNR Am J Neuroradiol. 2019. Lehman VT, Diehn FE, Broski SM, Nathan MA, Kemp BJ, Larson NB, Shelerud RA, Brault JS, Halasy MP, Maus TP. Comparison of [(18) F] FDG-PET/MRI and clinical findings for assessment of suspected lumbar facet joint pain: a prospective study to characterize candidate nonanatomic imaging biomarkers and potential impact on management. AJNR Am J Neuroradiol. 2019.
29.
go back to reference Tu Y, Jung M, Gollub RL, Napadow V, Gerber J, Ortiz A, Lang C, Mawla I, Shen W, Chan ST, et al. Abnormal medial prefrontal cortex functional connectivity and its association with clinical symptoms in chronic low back pain. Pain. 2019;160(6):1308–18.CrossRef Tu Y, Jung M, Gollub RL, Napadow V, Gerber J, Ortiz A, Lang C, Mawla I, Shen W, Chan ST, et al. Abnormal medial prefrontal cortex functional connectivity and its association with clinical symptoms in chronic low back pain. Pain. 2019;160(6):1308–18.CrossRef
Metadata
Title
Evaluation criteria for the assessment of occupational diseases of the lumbar spine - how reliable are they? -
Authors
Benjamin Ulmar
Julia Wölfle-Roos
Tugrul Kocak
Alexander Brunner
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2878-4

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue