Occupational influences on Spondylolysis and Spondylolisthesis in a cohort of 18-year-old male military conscripts
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RESEARCH ARTICLE
Open Access
Occupational influences on Spondylolysis and Spondylolisthesis in a cohort of 18-year-old male military conscripts Oren Zack1,2†, Yair Barak1†, Aharon S. Finestone3, Ayala Krakov2,4, Dani Slodownik2,5, Deborah Alperovitch-Najenson2,6 and Shlomo Moshe2,4*
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. Keywords: Spondylolysis, Spondylolisthesis, Occupational, Low Back pain, Army recruits, Risk factor, Athlete, Adolescents
* Correspondence: [email protected]; [email protected] † Oren Zack and Yair Barak contributed equally to this work. 2 Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel 4 Department of Occupational Medicine, Hashfela and Jerusalem district, Maccabi Healthcare Services, 15 Rothschild St., Rishon Letzion, Israel Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source,
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