Disc herniation by lumbar spine occupational overstress - case study - Eugenia NAGHI 1,2 Agripina RASCU 1,2 Claudia HANDRA 1,2 Raluca MAROIU ² Irina FOCIUC ² ¹Chair of Occupational Medicine, UMF, Bucharest ²Occupational Medicine Clinical Department, Colentina Hospital, Bucharest

D.C. – male, 37 - no medical history - no medical history - foundryman - foundryman - occupational exposure - 17 years - occupational exposure - 17 years

Professional path 1989 at the moment Foundryman Ironfoundry

Operating process STEPS IN PRODUCTION PROCESS OF ALLOYS MAKING MOULD/CORE MAKING CASTING EJECTING SANDBLASTING POLISHING DELIVERY

Jobs in the operating process Jobs in the operating process Preparation of moulds and cores (sand, bindings) - manually filling of the frames with moulding compound - compound pressing by air hammer Alloy sand casting

Casting and filling frames with liquid metal

Filling a hand ladle with liquid metal from a tank

Noxious agents Noxious agents Effort Weight handling ( 500 kg/ shift ) Prolonged & repetitive faulty body posture standing position standing position bent over position bent over position rotating motions of upper-body rotating motions of upper-bodyVibrations affect the whole body affect hand and arm

Hazardous microclimate Noise Crystalline silica dust Respiratory irritants (foundry gases ) Noxious agents Noxious agents

Admission reasons : Admission reasons : - lumbosacral pain, radiating to the posterior side of the right leg - lumbosacral pain, radiating to the posterior side of the right leg - paravertebral muscle cramp - paravertebral muscle cramp - discomfort when leaning on heels - discomfort when leaning on heels - paresthesis in the right thumb - paresthesis in the right thumb

History of disease: History of disease: Earliest occurrence of described symptoms: - October October immediately after lifting and handling weights - immediately after lifting and handling weights in the workplace in the workplace ► General Practitioner no result THERAPY (NSAID / myorelaxant )

History of the condition: – Internal medicine Right lumbar sciatica L5 Right lumbar sciatica L5 Diminished symptoms during admission period !! Referral to Occupational Medicine Clinical Department – condition diagnosed as profession-related THERAPY: NSAID, painkillers, myorelaxants, anxiolytics

admission to Occupational Medicine Clinical Department, Colentina Hospital, Bucharest ► Clinical exam : ● pain on lumbar spine percussion ● pain on lumbar spine percussion ● paravertebral muscle cramp (> right) ● paravertebral muscle cramp (> right) ● limitation of the lumbar spine flexion ● limitation of the lumbar spine flexion movements movements ● Lassegue +45° ● Lassegue +45° ● discomfort when leaning on heels ● discomfort when leaning on heels

► Lumbar X radiography – posterior narrowing of the L4-L5 space ► Orthopedic examination lumbar disc hernia L4-L5 ? lumbar disc hernia L4-L5 ? ► Neurological examination Spine MRI Spine MRI

► Lumbar spine MRI – Lumbar disc herniation L4-L5 with right radicular compression; right foraminal stenosis

► Neurosurgical examination ■ LDH L4-L5 with motor deficiency of the digital extension muscles and sensitive deficiency ■ LDH L4-L5 with motor deficiency of the digital extension muscles and sensitive deficiency Surgical treatment

Diagnosis Lumbar disc hernia L4-L5 with right foraminal stenosis due to occupational overstressing of the lumbar spine

Recommendations Admission to neurosurgery surgical treatment of lumbar disc hernia Treatment of symptoms

Considerations Young patient Crippling disease surgical treatment Temporary work disability undetermined period of time

Considerations Avoid physical effort, weight lifting, prolongued faulty posture Professional conversion Dim functional prognosis