Value of preplacement examination of the lumbar spine.

Abstract

There is no single condition where skilled labor is involved that causes more loss of man-hours than low back symptoms (Runge). Coulter found that 79 per cent of back strains were in the lumbosacral area, as compared with only one-third of fractures. He believes that the lumbosacral spine is especially vulnerable to injury for two reasons: first, it is least protected by supporting structures in the region; second, it is more often subjected to excessive strain in lifting and bending than are other sections of the vertebral column. To be considered also is the fact that the lumbosacral region is more frequently the site of anomalies than any other part of the body. Colcher and Hursch point out that pain and disability could be and often are consistent with the anomalous findings. For these reasons, preplacement roentgen examinations of the lumbosacral spine have passed the stage of innovation. Cushway and Maier reported on routine examination of the spine for industrial employees in March of 1929.In their series of 931 examinations, 414 men were found to have a total of 510 anomalies and abnormalities. The necessity for preplacement examinations has been further emphasized by the steady increase in the number of so-called “industrial backs” in the recent past. Becker reported that from 1940 to 1950 Ohio had an increase of 31 per cent in employment and that during that period there was a 132 per cent increase in back injuries. In the same decade, with an increase of only 7 per cent in the industrial force of New York, back injuries increased 43 per cent. Becker also cites the experience of Minnesota, with a 57 per cent increase in its industrial force and 80 per cent increase in back injuries. The monetary significance of these observations is illustrated by a year's experience in the Commonwealth of Pennsylvania, with over 6,900 back injuries reported and nearly $1,500,000 in related compensation payments. According to Carney, these conditions cost the American railroads 29 million dollars in claims in 1941. In 1951 and each year thereafter, over 100 million dollars have been paid out, even though accidents were reduced. Any traumatic cause of backache, superimposed upon a pre-existing low back affection, causes a difficult medical problem, from the point of view of both patient and physician. The greatest difficulty is the estimation of the actual significance of the patient's complaints as compared with the physical signs of injury and its effect on the pre-existing low back condition. As Flaxman has pointed out, many patients with low back affections work and carryon a normal life until trauma aggravates a pre-existing lesion. It may be that the complaint of backache is so common that hardly anyone gives it much attention until an injury aggravates the pain.