Ann Rehabil Med.  2017 Oct;41(5):808-815. 10.5535/arm.2017.41.5.808.

Clinical Usefulness of X-Ray Findings for Non-specific Low Back Pain in Korean Farmers: FARM Study

• Kang EK
• Park HW
• Kim SH
• Baek S

• KMID: 2440808
• DOI: http://doi.org/10.5535/arm.2017.41.5.808

Abstract

OBJECTIVE
To elucidate the association between non-specific low back pain (NSLBP) and spinal X-ray findings in Korean farmers: Farmers' Cohort for Agricultural Work-Related Musculoskeletal disorders (FARM) study.
METHODS
A total of 835 farmers (391 males, 444 females; mean age, 56.6±7.4 years) without red-flag signs of specific LBP were recruited. Presence of LBP more than one week or once a month with more than moderate degree of pain severity during the last year was assessed with a binary questionnaire (yes or no). Spinal degenerative changes were classified into disc height change (DHC) of L4-5 and L5-S1 (grade 0-5) and osteophyte formation of L5 (grade 0-5) by a radiologist based on X-ray findings. Additionally, spondylolisthesis, scoliosis and spondylolysis were assessed.
RESULTS
General prevalence of NSLBP was 40.7%, revealing a higher incidence of NSLBP in female and younger farmers compared to male and older farmers (χ²=23.3, p<0.001; χ²=4.54, p<05, respectively). Among X-ray findings, DHC (L5-S1) grade 4 revealed significantly higher relative risk of NSLBP compared to grade 0 (odds ratio, 5.00; 95% confidence interval, 2.05-12.20) after adjusting age and sex, while other X-ray findings were not associated with NSLBP.
CONCLUSION
The NSLBP of Korean farmers was significantly related to lumbar disc degenerative changes, suggesting clinical usefulness of X-ray findings in assessing LBP in farmers.

Keyword

Agriculture; Low back pain; Radiography; Osteoarthritis; Spine

MeSH Terms

Agriculture*
Cohort Studies
Farmers*
Female
Humans
Incidence
Low Back Pain*
Male
Osteoarthritis
Osteophyte
Prevalence
Radiography
Scoliosis
Spine
Spondylolisthesis
Spondylolysis

Figure

• 

  Fig. 1 Inclusion flowchart.

Reference

1. Osborne A, Blake C, Fullen BM, Meredith D, Phelan J, McNamara J, et al. Prevalence of musculoskeletal disorders among farmers: a systematic review. Am J Ind Med. 2012; 55:143–158. PMID: 22069159.

2. Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012; 379:482–491. PMID: 21982256.

3. Min D, Baek S, Park HW, Lee SA, Moon J, Yang JE, et al. Prevalence and characteristics of musculoskeletal pain in Korean farmers. Ann Rehabil Med. 2016; 40:1–13. PMID: 26949663.

4. Greenhalgh S, Selfe J. A qualitative investigation of Red Flags for serious spinal pathology. Physiotherapy. 2009; 95:224–227. PMID: 19635343.

5. de Schepper EI, Damen J, van Meurs JB, Ginai AZ, Popham M, Hofman A, et al. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976). 2010; 35:531–536. PMID: 20147869.

6. Cho NH, Jung YO, Lim SH, Chung CK, Kim HA. The prevalence and risk factors of low back pain in rural community residents of Korea. Spine (Phila Pa 1976). 2012; 37:2001–2010. PMID: 22588379.

7. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain: a systematic review of observational studies. Spine (Phila Pa 1976). 1997; 22:427–434. PMID: 9055372.

8. Jo H, Baek S, Park HW, Lee SA, Moon J, Yang JE, et al. Farmers' Cohort for Agricultural Work-Related Musculoskeletal Disorders (FARM) study: study design, methods, and baseline characteristics of enrolled subjects. J Epidemiol. 2016; 26:50–56. PMID: 26235456.

9. Korea Occupational Safety and Health Agency. Questionnaire for musculoskeletal symptoms. Guideline for evaluation of risk factors for musculoskeletal disorders. Ulsan: Korea Occupational Safety & Health Agency;2003.

10. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976). 1994; 19:1371–1380. PMID: 8066518.

11. Osborne A, Blake C, McNamara J, Meredith D, Phelan J, Cunningham C. Musculoskeletal disorders among Irish farmers. Occup Med (Lond). 2010; 60:598–603. PMID: 20844056.

12. Punnett L, Pruss-Utun A, Nelson DI, Fingerhut MA, Leigh J, Tak S, et al. Estimating the global burden of low back pain attributable to combined occupational exposures. Am J Ind Med. 2005; 48:459–469. PMID: 16299708.

13. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81:646–656. PMID: 14710506.

14. Torgerson WR, Dotter WE. Comparative roentgenographic study of the asymptomatic and symptomatic lumbar spine. J Bone Joint Surg Am. 1976; 58:850–853. PMID: 134040.

15. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009; 34:199–205. PMID: 19139672.

16. Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine (Phila Pa 1976). 2000; 25:487–492. PMID: 10707396.

17. Berlemann U, Gries NC, Moore RJ. The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs. Eur Spine J. 1998; 7:212–217. PMID: 9684954.

18. Shao Z, Rompe G, Schiltenwolf M. Radiographic changes in the lumbar intervertebral discs and lumbar vertebrae with age. Spine (Phila Pa 1976). 2002; 27:263–268. PMID: 11805689.

19. Ozguler A, Leclerc A, Landre MF, Pietri-Taleb F, Niedhammer I. Individual and occupational determinants of low back pain according to various definitions of low back pain. J Epidemiol Community Health. 2000; 54:215–220. PMID: 10746116.

20. Holmberg SA, Thelin AG. Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population. BMC Musculoskelet Disord. 2006; 7:66. PMID: 16907991.

21. Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly: a systematic review of the literature. Spine (Phila Pa 1976). 1999; 24:1813–1819. PMID: 10488512.

22. Biering-Sorensen F. A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology. Scand J Rehabil Med. 1983; 15:71–79. PMID: 6223365.

23. Igbinedion BO, Akhigbe A. Correlations of radiographic findings in patients with low back pain. Niger Med J. 2011; 52:28–34. PMID: 21969104.

24. Rubinstein SM, van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008; 22:471–482. PMID: 18519100.