Annekatrin Bergmann, Ulrich Bolm-Audorff, Dirk Ditchen, Rolf Ellegast, Joachim Grifka, Johannes Haerting, Friedrich Hofmann, Matthias Jäger, Oliver Linhardt, Alwin Luttmann, Hans Jörg Meisel, Martina Michaelis, Gabriela Petereit-Haack, Barbara Schumann, Andreas Seidler

A multicentre population based case-control study. The aim of the present analysis is to clarify potential differences in the "occupational risk profiles" of structural lumbar disc diseases on the one hand, and low back pain (LBP) on the other hand. Physical workplace factors seem to play an important aetiological role. We recruited 901 patients with structural lumbar disc diseases (disc herniation or severe disc space narrowing) and 233 control subjects with "low-back-pain". Both groups were compared with 422 "low-back pain free" control subjects. Case history, pain data, neurological deficits and movement restrictions were documented. Low back pain was recorded by the Nordic questionnaire on musculoskeletal symptoms. All MRI, CT and X-rays were inspected by an independent study radiologist. The calculation of cumulative physical workload was based on a computer-assisted interview and a biomechanical analysis by 3-D-dynamic simulation tool. Occupational exposures were documented for the whole working life. We found a positive dose-response relationship between cumulative lumbar load and low back pain among men, but not among women. Physical occupational risks for structural lumbar disc diseases (OR 3.7; CI 2.3-6.0) are higher than for low back pain (OR 1.9; 95% CI 1.0-3.5). Our finding points to potentially different aetiological pathways in the heterogeneous disease group of LBP. Results suggest that not all of the structural disc damage arising from physical workload leads to low back pain. 4.