Grosser V, Seide K, Schilling R, Wolter D
Abteilung für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg.
Unfallchirurg. 1996 Jul;99(7):470-6.
In Germany, disc-related disease of the lumbar spine is eligible for workmen's compensation if caused by long-standing work requiring heavy lifting or carrying or extreme trunk-bending (BK 2108). The appraisal of causality is particularly difficult if conditions like isthmic spondylolisthesis preexist. 250 consecutive appraisals in nurses concerning the BK 2108 were analysed, 12 applicants (4.8%) had isthmic spondylolisthesis (4.6% of females and 5.9% of males). The literature about the natural history of isthmic spondylolisthesis is reviewed. A person who has isthmic spondylolisthesis is up to 25% more likely to have significant back trouble during his life than one who does not. Back pain in adults associated with spondylolisthesis is usually heralded by back pain in the late teens or early twenties. Progression of the slip is rarely seen after maturity. Due to the loss of protection by the posterior elements the disc is prone to premature degeneration which, however, does not become clinically apparent in most cases. Longstanding vocational heavy lifting or excessive stooping can negatively influence the natural history of isthmic spondylolisthesis. It can produce symptomatic disease in a person who would otherwise have remained asymptomatic, or it can cause a deterioration in those with preexisting symptoms. Criteria for the appraisal of causality are proposed. It is stressed that the course of the disease in relation to age and vocational strains has to be analysed in each individual case.
在德国，如果腰椎间盘相关疾病是由长期需要重物搬运或极端躯干弯曲的工作引起的（BK 2108），则符合工伤赔偿条件。如果峡部裂性脊椎滑脱等情况预先存在，因果关系的评估就特别困难。分析了250例护士关于BK 2108的连续评估，12名申请人（4.8%）患有峡部裂性脊椎滑脱（女性为4.6%，男性为5.9%）。对有关峡部裂性脊椎滑脱自然史的文献进行了综述。患有峡部裂性脊椎滑脱的人一生中出现严重背部问题的可能性比没有该病的人高出25%。与脊椎滑脱相关的成年人背痛通常在青少年晚期或二十出头时以背痛为先兆。成熟后很少见到滑脱进展。由于后部结构失去保护作用，椎间盘易于过早退变，然而在大多数情况下这在临床上并不明显。长期的职业性重物搬运或过度弯腰会对峡部裂性脊椎滑脱的自然史产生负面影响。它可使原本无症状的人出现症状性疾病，或使已有症状的人病情恶化。提出了因果关系评估标准。强调必须对每个病例分析疾病与年龄和职业劳损的关系。
