Work health determinants in employees without sickness absence.

BACKGROUND: Working ability is known to be related to good physical condition, clear work tasks, positive feedback and other occupational, organizational and psychosocial factors. In Sweden, high levels of sickness absence are due to stress-related disorders and musculoskeletal pain. AIMS: To identify work health characteristics in a working population with a large variety of professional skills and occupational tasks. METHODS: Employers' data on occupation, sickness absence, age and gender in a working population of 11 occupational groups and questionnaire responses regarding work-organization, environment, work stress, pain, health, and socio-demographic factors were collected. Employees with no history of sick-leave were compared with those with a history of sick-leave (1-182 days, mean 25 days). RESULTS: Of 2641 employees, 1961 participated. Those with no history of sick-leave reported less work-related pain, work-related stress, sleep disturbances, worry about their health, 'sick-presenteeism', monotonous work, bent and twisted working positions and exposure to disturbing noise than those with a history of sick-leave (P < 0.001). They also reported better health, support from superiors, having influence on their working hours and evening and week-end working, longer working hours per week (P < 0.001) and more regular physical training (P < 0.01). Socio-demographic factors were less important than gender, and differences in responses between occupational groups were also found. CONCLUSIONS: Workers without a history of sick-leave experienced less stress, sleep disturbances, worry about their own health and less neck, shoulder and back pain and more support from their superiors and influence on their working hours.

Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity.

The aim of this study is to evaluate possible benefits of hyperbaric oxygen (HBO) therapy in the treatment of deep postoperative infections in six high risk paediatric patients with neuromuscular spine deformity. The study involved review of medical records including radiology, office visits, and telephone contacts for six patients, referred for postoperative HBO therapy in 2003-2005. Infection control and healing without removal of implants or major revision surgery with a minimum of 2-year follow-up after index surgery were considered to represent success. All infections were resolved. Median time for wound healing, normalisation of blood tests and antibiotic weaning were 3 months. Radiological bony fusion, intact implants without any signs of radiolucent zones were seen in all cases at a mean follow-up of 54 months (37-72). Side effects of HBO treatment were minor. HBO is a safe and potentially useful adjuvance in the treatment of early deep postoperative infections in complex situations with spinal implants in high risk paediatric patients.

Radiographic measurement of the lumbar spine. A clinical and experimental study in man.

The accuracy of radiographic measurements of lumbosacral lordosis, vertebral size, spondylolisthesis, and disc height were studied. Errors caused by lateral tilt or longitudinal axis rotation of the lumbosacral spine were assessed in an experimental study on 12 cadavers. In a series of 170 normal individuals, the distribution of radiographic variables describing lumbosacral lordosis, size of vertebrae, and disc height was investigated. The interobserver measurement variation was studied with respect to all measured variables. The differences between radiographs of 125 spondylolytic patients in the recumbent and standing positions were analyzed with respect to vertebral slipping and lumbosacral lordosis. There were only minor projectional and interobserver measurement errors in the variables describing vertebral size and lumbosacral lordosis, which make these variables suitable for radiographic assessment at repeated examination. The absolute measurements of disc height were too inaccurate to be used as a basis for conclusions. A semiquantitative approach is more reliable, and can be recommended for the comparison of radiographic assessments of disc height. In adults, the radiographic evaluation of vertebral slipping and lumbosacral lordosis is equally reliable in the recumbent and standing positions.

Upper body movement during walking in children with lumbo-sacral myelomeningocele.

Eight children with lumbo-sacral myelomeningocele (MMC) underwent three-dimensional movement analysis to determine whether or not differing levels of lower extremity strength affected the extent of shoulder, trunk and pelvis movement during independent walking when wearing orthoses. Fourteen control children were also investigated. The patterns of upper body movements in all MMC children were well defined and consistent, showing small standard deviations from the mean. In the frontal and transverse planes, segment displacements of the MMC children assigned into Group II (hip extensor and abductor muscle strength grade 0-2) were almost twice that of the MMC children in Group I (hip extensor and abductor muscle strength grade 3-4). All segment displacements in the frontal, transverse and sagittal planes for Group I and Group II children were significantly greater than those for the controls. In the frontal plane these differences were approximately 4-10 times greater, with the Group II children having the largest peak-to-peak displacements. These results indicate that the motion amplitudes of the upper body segments are related to the degree of muscle weakness of the lower limbs. No significant differences were found when comparing segment motions during walking with either the Ferrari type knee-ankle-foot or ankle-foot orthoses.

Bone and joint pathology in workers using hand-held vibrating tools. An overview.

A literature evaluation was made with regard to the radiological documentation of bone and joint pathology in the hands and arms of workers using vibrating tools. There is evidence that work with pneumatic percussive tools (such as chipping hammers and scalers) may cause premature elbow and wrist osteoarthrosis, although of very low prevalence. This work-related disorder is not specific to vibration exposure. Instead, it is likely to result from the strong dynamic and static joint loading (often in extreme positions of the joint) and the repetitive hand-arm movements (sometimes also repeated minor traumatization) typical for tool manipulation in any heavy labor. Exposure to low-frequency percussion may, however, play a particular etiologic role: damage to the joint cartilage by repeated shocks from the tool, additional articular load (and consequent strain) associated with a vibration-induced increase in the need for joint stabilization and higher gripping forces, the tonic vibration reflex (which increases muscle contraction), and a stronger grip induced when tactile sensibility is diminished by vibration. So far, no investigations have ventured into the great complexity of possible confounders and effect modifiers. -A constitutional susceptibility may be required to produce osteoarthrosis. -The allegation that hand-arm vibration exposure causes an excess prevalence of bone cysts, vacuoles, Kienböck's disease, or pseudarthrosis of the scaphoid has not been validly documented. -Exposure to vibration of higher frequencies (such as from rotating drills, grinders, and chain saws) does not seem to be associated with excess bone and joint pathology. -The observed large variation in the prevalence of skeletal disorders may be explained by biodynamic and ergonomic differences between various occupations.

Spondylolysis and spondylolisthesis.

Lysis is common and its causes are mainly constitutional. Most of slipping has already occurred when the patient comes for consultation. A further progress is often caused by disc pathology. Neurological deficits are rare. A high-degree olisthesis and L4 location are risk factors for future back pain. Asymptomatic lysis with or without olisthesis should not be treated. A posterolateral fusion in situ without instrumentation gives good results in adolescents and young adults, whereas old patients benefit from instrumentation. Reduction cannot be recommended as a routine method.

The effect of a device for transverse traction on vertebral rotation in surgery for scoliosis as studied by X-ray stereophotogrammetry.

The effect of a device for transverse traction (DTT) on vertebral rotation in surgery for scoliosis has been analysed with an X ray stereophoto-grammetric method in 17 patients. Six of them underwent conventional Harrington rod instrumentation and eleven patients received additional treatment with the DTT. The DTT exerted a positive effect on vertical rotation at the apex, and derotation average 10° as compared with 5° in the group in whom the device was not used.

The etiology of spondylolysis. A retrospective radiographic study.

One hundred and thirty-five patients with lysis in the fifth (lowest) lumbar vertebra and 24 patients with L4 lysis were compared retrospectively with respect to radiographic variables and the occurrence of trauma before symptom onset. Hypoplasia occurred only in the L5 lysis group, whereas trauma as a symptom-precipitating factor was frequent in the L4 group. These observations suggest the possibility of different etiologies: trauma may contribute to lysis in a normal L4 vertebra, and inherited hypoplasia of the lumbosacral junction may lead to L5 lysis.

Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis.

A clinical and radiological follow-up study with at least 20 years of observation was made of 255 spondylolysis and spondylolisthesis patients for examination of the clinical course and its possible correlation to radiographic findings. The progression of slipping was small and not correlated to age at diagnosis and initial degree of spondylolisthesis. Disc height reduction at the spondylolytic level occurred at an earlier age and was more severe than in a normal control group. Symptoms were correlated to radiographic pathology. Risk factors for low-back symptoms were greater than 25% slipping, low lumbar index in L5 spondylolysis, spondylolysis at the L4 level, and early disc degeneration.

Spondylolysis and pregnancy--a risk analysis.

A possible interference of various musculo-skeletal anomalies with pregnancy is often discussed by obstetricians. Pregnancy as a risk factor for progression of spondylolisthesis, olisthesis as a risk factor for pregnancy complications, and pregnancy in women with spondylolysis as the cause of increased low-back symptoms, are questions hitherto not analysed. In the present study, a comparison between men, non-pregnant women, and women who had been pregnant, was made with respect to the degree of spondylolisthesis and its subsequent progression over an observation period of at least 20 years. Occurrence and intensity of low-back symptoms, and functional impairment due to low-back symptoms (such as change of work, sick-leave, sick-pension, limitation in non-occupational activities, and treatment) during this long observation time were also analysed. The mean values for the group of women who had been pregnant did not differ from those of the other groups as regards any of these variables. On the basis of these results, it is concluded that pregnancy does not constitute a risk for progression of spondylolisthesis, or for increased low-back symptoms in a woman with spondylolysis. Nor is spondylolysis, with or without olisthesis, a risk factor for pregnancy complications.

Symptoms in relation to the level of spondylolysis.

Spondylolysis usually occurs in the fifth lumbar vertebra, which with the rest of the lumbosacral junction may be hypoplastic. About 10% of spondylolysis occurs in the fourth lumbar vertebra which is usually normal radiologically. The present work studies the hitherto unknown prognostic value of the lysis level in relation to symptoms. A comparison was made between 213 patients with lysis at L5 and 42 patients with lysis at L4. The frequency and intensity of low back pain, the need for treatment, change of work, sickleave, and sick pension caused by low-back symptoms were noted during a period of more than 20 years. Pain frequency and intensity and functional impairment were consistently higher in the L4 group. The differences were particularly evident between the two subgroups when there was a marked vertebral slip. It is concluded that the level of spondylolysis is of significance in the occurrence of low-back symptoms.

The correlation of arthrography with the results of treatment in late diagnosed congenital dislocation of the hip.

The aim of this study was to assess the value of arthrography of the hip in the investigation of late diagnosed congenital dislocation. The results of the treatment of 109 hips were related to the findings at arthrography. The hip radiographs at follow-up were normal in all cases where the arthrogram had demonstrated a congruent reduction (86). When the arthrogram had indicated a block in reduction the results were less favourable, and dysplasia or subluxation was present at follow-up in 19 cases, despite repeated conservative or operative treatment. Four hips appeared normal after operation. Arthrography gave valuable information and showed good correlation with the results of treatment.

Life conditions of persons with and without low-back pain.

A comparison of life conditions (such as dwelling, health, leisure-time activities, education, occupation, and work characteristics) was made between age- and sex-stratified groups of persons with and without low-back pain (BP). The primary data were collected from a random, geographically standardized 1:1,000 sample of the Swedish population including 2,872 citizens aged 30-59 years. There were no differences with respect to dwelling, height, weight, habits of physical exercise, other non-occupational activities, and frequency of unemployment. In the group of 50-59 year old persons, the males with BP smoked more than those without. In the same age-group of females, and in the younger male groups there were no differences in smoking habits. Physically heavy, monotonous, and repetitive work was more frequent among the subjects with BP. The relative number of highschool-educated was lower among males--in the youngest age group--with BP. The back-healthy persons evaluated their state of health as better and their need of medical care as less than the persons with BP.

Vertebral resection and fusion for paralytic kyphosis. 9 patients followed up for 6 (2-14) years.

Nine patients with a thoracolumbar, progressing, paralytic kyphosis, pressure sores from gibbus, an inability to lie on the back, and deterioration of the sitting balance were operated on with resection of two to three vertebrae and a thoracolumbar fusion. One child died from intracranial bleeding caused by a halo screw. There were no implant loosenings or non-unions. Pressure sores healed, sitting improved, and lying on the back became possible. A mild scoliosis above the fusion level developed in 2 patients, but neither of them needed any treatment.

Stereophotogrammetry in the evaluation of the treatment of scoliosis.

A previously existing X-ray stereophotogrammetric method which allows the measurement of simultaneous changes in all components of a scoliotic deformity was developed without the use of invasive methods or skeletal markers. In order to evaluate the changes in rotation and lateral deviation of the scoliotic curve following treatment with the Boston brace, this method was applied to 31 patients suffering from idiopathic scoliosis. The derotational effect of the brace averaged 14 degrees (0-38 degrees) in 21 patients remaining after rejection of those whose radiographs were of inadequate quality. The accuracy, however, was not acceptable because of frequent gross errors due to the poor quality of the radiographs. Image interpretation may be improved by a suggested technique of enhancement based upon a computer program for figure restauration and border detection.

The effect of a device for transverse traction on vertebral rotation in surgery for scoliosis as studied by X-ray stereophotogrammetry.

The effect of a device for transverse traction (DTT) on vertebral rotation in surgery for scoliosis has been analysed with an X ray stereophotogrammetric method in 17 patients. Six of them underwent conventional Harrington rod instrumentation and eleven patients received additional treatment with the DTT. The DTT exerted a positive effect on vertical rotation at the apex, and derotation average 10 degrees as compared with 5 degrees in the group in whom the device was not used.

Factors influencing ambulation in myelomeningocele: a cross-sectional study.

A consecutive series of 53 children with myelomeningocele (mean age 7.6, range 3.2 to 11.4 years) was assessed in order to see if the children with motor paresis of the lower limbs achieved the expected level of ambulation, and if not, to identify possible causative factors. Methods used were clinical examination of orthopaedic and neurological status, information from medical reports, and documentation of orthoses use. Functional skills were documented and energy expenditure was examined. Thirty-one of 53 children had reached the expected ambulation considered possible according to their motor paresis, whereas 22 of the 53 performed worse than expected. Balance disturbances, occurrence of spasticity in knee and hip joints, and number of shunt revisions made differed significantly between the groups that achieved and did not achieve expected ambulation. Functional skills of mobility differed significantly between two muscle-function levels in children who had walking ability. Energy expenditure was higher in the non-achieving group than in the group who achieved expected ambulation in each of the muscle-function levels. Results show that children with similar muscle paresis exhibit different ambulatory function. This indicates the importance of a close analysis of other factors which may cause ambulation to deteriorate in order to predict future ambulation in children with myelomeningocele.

Anterior fusion insufficient for scoliosis in myelomeningocele. 8 children 2-6 years after the Zielke operation.

8 children with a mean age of 13 years with paralytic scoliosis due to myelomeningocele (MMC) were operated on according to Zielke with anterior fusion and instrumentation. There were no infections. All fusions healed. The postoperative mean follow-up was 4 years. The average correction of the primary curve was 62 degrees. In 5 cases proximal curve progression required reoperation; posterior fusion with Harrington rods was also done. Our last 2 patients, primarily operated on with both an anterior and posterior fusion, had no postoperative progression. Anterior fusion according to Zielke as the only procedure cannot be recommended in the treatment of severe paralytic scoliosis due to MMC. We advise a combined anterior and posterior approach in these cases.

Heart rate and walking velocity during independent walking in children with low and midlumbar myelomeningocele.

PURPOSE: The purpose of this study was to examine the heart rate and walking velocity of children with low and midlumbar myelomeningocele (MMC) using two types of orthoses. METHODS: Eight children with low and midlumbar myelomeningocele (mean age = 10.7 years) participated in the study. A clinical examination of muscle strength in the lower limbs was performed, and level of functional ambulation was defined. Weight and height were documented, and body mass index was calculated. Heart rate was recorded by a transmitter detecting heart beats, and walking time was registered as the children walked as far as possible along a straight corridor of 102 meters at a self-selected velocity. Two orthosis types were tested, each three times. RESULTS: All children showed higher heart rate than peers who were nondisabled. No steady-state heart rate level that could be used as a basis for calculating physiological cost index was achieved in any subject. In this study group, no difference was seen in heart rate trends with respect to the two tested orthoses. The children who were household ambulators, all with weaker hip abductors and hip extensors, walked with lower velocity than those who were community ambulators (all with stronger hip muscles). The children in the former group also walked significantly shorter distances, however, with similar heart rate. CONCLUSIONS: Pausing when the heart rate reaches a strenuous activity level is interpreted as a solution to maintain functional walking by keeping the heart rate and thus the energy expenditure at a comfortable level.