THE IMPORTANCE OF ISTHMIC SPONDYLOLISTHES IS IN APPRAISAL OF WORK-RELATED DISEASE OF THE LUMBAR SPINE

In Germany, disc-related disease of the lumbar spine is eligible for w orkmen'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 spon dylolisthesis preexist. 250 consecutive appraisals in nurses concernin g the BK 2108 were analysed. 12 applicants (4,8%) had isthmic spondylo listhesis (4,6% of females and 5,9% of males). The literature about th e natural history of isthmic spondylolisthesis is reviewed. A person w ho has isthmic spondylolisthesis is up to 25% more likely to have sign ificant back trouble during his life than one who does not. Back pain in adults associated with spondylolisthesis is usually heralded by bac k 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 post erior elements the disc is prone to premature degeneration which, howe ver, does not become clinically apparent in most cases. Longstanding v ocational heavy lifting or excessive stooping can negatively influence the natural history of isthmic spondylolisthesis. It can produce symp tomatic disease in a person who would otherwise have remained asyptoma tic, or it can cause a deterioration in those with preexisting symptom s. Criteria for the appraisal of causality are proposed. It is stresse d that the course of the disease in relation to age and vocational str ains has to be analysed in each individual case.