Occupational influences on Spondylolysis and Spondylolisthesis in a cohort of 18-year-old male military conscripts

Abstract

Background The reported prevalence of spondylolysis (SL) in the adult population is 6–7%. Data concerning adolescent-onset spondylolisthesis (SLS) and the impact of certain activities on it is scarce. We examined the risk of clinical progression of SL and SLS as a function of primary severity and occupational strain among military recruits. Methods Based on the Israel defense Force (IDF) central human resources database, we identified 1521 18-year-old males inducted to the IDF with SL/SLS between the late nineteen nineties and early two-thousands. We followed changes in the SL/SLS status during the 3 years of obligatory military service. Disease severity was classified as Cat2: radiological findings of SL without clinical findings; Cat3: painful SL or asymptomatic grade 1 SLS; Cat4: grade 1 SLS with pain; Cat5: Grade 2 SLS. The soldiers were subdivided into the following occupational categories: administrative, combat, maintenance, and driving. The purpose was to compare the progression rates in different medical categories and job assignments. Results There were 162 recruits in Cat2, 961 in Cat3, and 398 recruits in Cat4. The overall progression rate to Cat5 (grade 2 SLS) was 1.02%. Significant progression rates were seen amongst administrative soldiers with a relatively higher risk of progression from Cat4 (painful-grade-1 SLS: 2.2%) vs. Cat3 (asymptomatic SLS: 0.5%, relative risk = 4.7, p < 0.02). Other occupational categories did not exhibit significant progression rates. Conclusion Progression of SL/SLS was highest in Cat4, i.e. for recruits already diagnosed with painful SLS (i.e. with a more severe baseline disorder). Progression did not correlate with military occupation. We recommend further follow-up studies that include, aside from progression rates, incidence rates of newly diagnosed grade 2 SL during military service.

Diagnostic Performance of the Darth Vader Sign for the Diagnosis of Lumbar Spondylolysis in Routinely Acquired Abdominal CT

“…In addition to the studies of McAfee [25] and others [14], the continuously increasing availability of high-resolution cross-sectional imaging resulted in a presumably increasing prevalence of spondylolysis in the general population and in patients suffering from lowerback pain [26][27][28]. Thus, a series of investigations focused on the correlation between spondylolysis vs. spondylolisthesis and clinical symptoms [29][30][31]. Exemplarily, the relation with repetitive force due to occupation, e.g., in infantry soldiers with high axial load, is being discussed controversially [30,31].…”

“…Thus, a series of investigations focused on the correlation between spondylolysis vs. spondylolisthesis and clinical symptoms [29][30][31]. Exemplarily, the relation with repetitive force due to occupation, e.g., in infantry soldiers with high axial load, is being discussed controversially [30,31]. To date, a causal relationship between lower-back or radicular pain and spondylolysis/spondylolisthesis is a matter of continuous debate [22].…”