Comparative Roentgen Findings in Symptomatic and Asymptomatic Backs

NOT LONG AGO a large industrial company (1) decided to survey a group of men who had been in its employ for ten years or more, who denied having discomfort in the back either on or off the job, and who had not asked for treatment for back disability at any time during their employment. Chosen for this survey were 200 men in the outside equipment and construction forces, including some drivers and supplymen, who had worked in these forces exclusively for not less than ten years. The average age of the group was forty years, and the average length of service was eighteen years. Anteroposterior and lateral films of the entire lumbar spine and a spot film of the fifth lumbar vertebral area were made. All abnormalities were reported in the following classifications: congenital, traumatic, degenerative, inflammatory, arthritic, neoplastic, and structural For purposes of comparison, 200 consecutive patients referred for myelography were studied. The average age was thirtyeight years. All of these patients had low back and/or leg pain. Of this last group of 200 patients, 68 were operated on for herniated nucleus pulposus (2). All of the findings are noted in Table 1. Congenital lesions of the back (spondylolisthesis, etc.) were found to have essentially the same incidence in symptomatic and asymptomatic patients, and old traumatic lesions of the spine were also evenly distributed. Of the degenerative changes, narrowed disks with spurs showed a much higher incidence in patients having symptoms; there was no significant difference in the incidence of other degenerative lesions. Arthritis occurred in a definitely greater percentage of patients with symptoms than of those without. Malignant neoplasms are, naturally, a cause of back pain, but benign tumors are often discovered incidentally. Structural changes were found in equal number in the two groups. No cases of inflammatory disease or infection were found. Many authors are in agreement that congenital abnormalities are a significant cause of low back pain (3-7). Dively and Oglevie (8) make the statement: "It is our feeling that back examinations should not be used simply as a means of evaluating the prospective employee. The adolescent should have a careful back examination, including x-rays, to determine any serious congenital architectural defects of the spine. If such defects are found, the individual can be advised to study a profession or trade in order that he rnay depend upon his brains and not his back for his livelihood." In their series of 6,523 pre-employment x-ray studies of the back the incidence of congenital anomalies was 41 per cent. Bohart (9) and Splithoff (10) in studies similar to ours obtained comparable results. Bohart states that developmental anomalies did not prove a source of symptoms in a large series of men who were subjected frequently to severe trauma.