Degenerative Disc Disease: The Myth of Work-Related “Cumulative Trauma”
Christopher R. Brigham
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James B. Talmage
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Charles Brooks
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Gunnar Andersson
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Craig Uejo
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Abstract

The primary cause of degenerative disc disease (DDD) is nonoccupational factors such as genetics and aging, and attributing DDD to “cumulative trauma” at work is a myth that is not supported by current scientific evidence. Some authors have suggested that DDD is a misnomer because the condition is not a disease but rather an inevitable component of the aging process that occurs at variable rates in different persons. Causation analysis requires a link between a cause and an effect, and reference to “cumulative trauma” without identification of a specific accident is incomplete. Physicians appear sometimes to opine “to a reasonable degree of medical certainty” that certain work events caused or aggravated a condition solely on the basis of a temporal relationship. Further, DDD usually is not the cause of neck or back pain but rather is an incidental finding on x-rays or advanced imaging studies. A dominant view of disc degeneration has been that disc structures are damaged by occasional excessive forces and the cumulative effects of repeated loading—but modern science contradicts this view. The authors examine current publications regarding DDD (including four full abstracts from recent articles) and conclude that current scientific evidence does not support the premise that “cumulative trauma” results in or aggravates degenerative disc disease. “Repetitive strain injury” of the spine is a mythical medicolegal concept, not a clinical or pathologic reality.

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  • Battie, MC, Videman T, Levälahti E, Gill K, Kaprio J. Heritability of low back pain and the role of disc degeneration. Pain. 2007 Oct;131(3):272-80. Epub 2007 Mar 1 (PMID: 17335977)

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  • Videman T, Levälahti E, Battié MC. The Effects of Anthropometrics, Lifting Strength, and Physical Activities in Disc Degeneration. Spine 2007; 32 (13): 1406-1413 (PMID: 17545908)

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