BACKGROUND CONTEXT

Degenerative changes due to cervical spondylosis (CS) can detrimentally affect work ability and quality of life yet understanding of how physical exposure affects disease progression is limited.

PURPOSE

To assess the associations between occupational physical exposures and occurrence of surgically treated cervical spondylosis (ST-CS) and early exit from the labor market via disability pension.

STUDY DESIGN/SETTING

Prospective register study with 20 years follow-up period.

PATIENT SAMPLE

Swedish construction workers participating in a national health surveillance project conducted between 1971 and 1993.

OUTCOME MEASURES

Surgically treated cervical spondylosis (ST-CS) and early labor market exit at a minimum rate of 25% time on disability pension.

METHODS

Associations between occupational physical exposures (job exposure matrix) and subsequent ST-CS (National Hospital in-patient register) and early labor market exit via disability pension (Swedish Social Insurance Agency register) were assessed in a cohort of male construction workers (n=237,699).

RESULTS

A total of 1381 ST-CS cases were present and a 20 years incidence rate of 35.1 cases per 100,000 person years (95% confidence interval (CI) 33.2–36.9). Increased relative risk (RR) for ST-CS was found for workers exposed to non-neutral (RR 1.40, 95% CI 1.15–1.69), and awkward neck postures (1.52, 1.19–1.95), working with the hands above shoulder height (1.30, 1.06–1.60), and high upper extremity loading (1.35, 1.15–1.59). Increased risk was also present for workers who reported frequent neck (3.06, 2.18–4.30) and upper back (3.84, 2.57–5.73) pain in the 12 months prior to survey. Among workers with elevated arm exposure, higher risk was seen in those who also had more frequent neck pain. ST-CS cases took early retirement more often (41.3%) and at a younger age (53 years) than the total study cohort (14.8% and 56 years of age, respectively).

CONCLUSIONS

Occupational exposure to non-neutral neck postures, work with hands above shoulders and high loads born through the upper extremities increased the risk for ST-CS and early retirement due to disability. Decreasing postural and load exposure is salient for primary, secondary, and tertiary prevention of CS. Neck pain was shown to be a prognostic factor for ST-CS, which stresses the importance of acting early and taking preventative action to reduce workplace exposure, and the need for systematic medical check-ups within primary or occupational care to mitigate disease progression and early labour market exit due to disability.

中文翻译：

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男性建筑工人颈椎病手术治疗的危险因素：一项为期 20 年的前瞻性研究

背景语境

颈椎病 (CS) 引起的退行性变化会对工作能力和生活质量产生不利影响，但对身体暴露如何影响疾病进展的了解有限。

目的

评估职业性身体暴露与手术治疗的颈椎病 (ST-CS) 的发生以及通过残疾养老金提前退出劳动力市场之间的关联。

研究设计/设置

具有 20 年随访期的前瞻性注册研究。

患者样本

参加 1971 年至 1993 年间开展的国家健康监测项目的瑞典建筑工人。

结果测量

接受手术治疗的颈椎病 (ST-CS) 和早期劳动力市场退出率至少为 25% 的伤残抚恤金时间。

方法

在一组男性建筑工人 (n= 237,699）。

结果

共有 1381 例 ST-CS 病例，20 年发病率为每 100,000 人年 35.1 例（95% 置信区间 (CI) 33.2–36.9）。暴露于非中性环境（RR 1.40，95% CI 1.15-1.69）和尴尬的颈部姿势（1.52，1.19-1.95）、双手高于肩高的工人发现 ST-CS 的相对风险 (RR) 增加(1.30, 1.06–1.60)，以及高上肢负荷 (1.35, 1.15–1.59)。在调查前 12 个月内报告经常出现颈部 (3.06, 2.18–4.30) 和上背部 (3.84, 2.57–5.73) 疼痛的工人的风险也有所增加。在手臂接触较多的工人中，那些颈部疼痛也更频繁的人风险更高。与整个研究队列（分别为 14.8% 和 56 岁）相比，ST-CS 病例提前退休的频率更高 (41.3%) 且年龄更小（53 岁）。

结论

职业暴露于非中立的颈部姿势、双手高于肩膀的工作以及通过上肢承受的高负荷增加了 ST-CS 和因残疾而提前退休的风险。减少姿势和负荷暴露对于 CS 的一级、二级和三级预防非常重要。颈部疼痛被证明是 ST-CS 的预后因素，这强调了及早采取预防措施以减少工作场所暴露的重要性，以及需要在初级或职业护理中进行系统的体检以减轻疾病进展和早期因残疾退出劳动力市场。