J Korean Neurosurg Soc.  2020 Sep;63(5):623-630. 10.3340/jkns.2020.0096.

Is the Agricultural Work a Risk Factor for Koreans Elderly Spinal Sagittal Imbalance?

• Hong JH
• Han MS
• Lee SK
• Lee JK
• Moon BJ

• KMID: 2506026
• DOI: http://doi.org/10.3340/jkns.2020.0096

Abstract

Objective
: A primary degenerative sagittal imbalance has been considered because of unique lifestyles such as the prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Previous papers have reported that sagittal imbalance disease is often seen distinctly in the farming districts of “oriental” countries such as Korea and Japan. However, this finding was only evaluated with the use of X-ray, and other factors such as magnetic resonance imaging (MRI), muscle volume, compression fracture, and laboratory results were not considered. Thus, using these, we evaluate the agricultural work-associated factors for Korean elderly spinal sagittal imbalance.
Methods
: We recruited 103 Korean participants who had a sagittal vertical axis (SVA) of >5 cm in this Korean Elderly Sagittal Imbalance Cohort Study. The following were evaluated : radiological parameters, MRI, compression fracture, vitamin D, parathyroid hormone, C-telopeptide, osteocalcin, bone mineral density and muscle fatty change, muscle volume, and health-related quality of life from patients’ survey. Moreover, in this survey, the farmers’ annual working hours were investigated. Subsequently, we analyzed the associated factors for spinal sagittal imbalance depending on occupation.
Results
: A total of 46 participants were farmers, and the others were housewives, sellers, and office workers. The farmer group had more SVA (141 vs. 99 mm, p=0.001) and pelvic tilt (31° vs. 24°, p=0.004) and lesser lumbar lordosis (20° vs. 30°, p=0.009) and thoracic kyphosis (24° vs. 33°, p=0.03) than non-farmer group. A significantly positive correlation was noted between the working hour and SVA in the farmer group (p=0.014). The visual analogue scale score for back pain (8.26 vs. 6.96, p=0.008) and Oswestry Disability Index (23.5 vs. 19.1, p=0.003) in the farmer group were higher than that in the non-farmer group, but the Short Form-36 score was not significantly different between the two groups. The Mini-Mental State Exam score was significantly lower in the farmer group than in the non-farmer group (24.85 vs. 26.98, p=0.002).
Conclusion
: The farmer group had more sagittal imbalance and back pain in proportion to the working hours even though the muscle and bone factors and general laboratory condition were not significantly different between the two groups. These results supported that the long hours spent in the crouched posture while performing agricultural work were a risk factor for severe sagittal imbalance.

Keyword

Sagittal; Imbalance; Kyphosis; Quality of life; Agriculture

Figure

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  Fig. 1. Definitions of each radiologic parameter. The angle between the lines from the centroid of T1 to the femoral head axis and from the femoral axis to the middle of the S1 endplate. T1PA : T1 pelvic angle.

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  Fig. 2. Occupation of participants. There were 46 farmers and 50 non-farmers. Non-agricultural occupations consisted of 24 housewives, 11 self-employed, 8 office workers, and 7 others.

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  Fig. 3. A photograph showing female farmers working in a crouched posture on the ground in a farm in Korea. This photograph is courtesy of Korea Agency of Education, Promotion and Information Service in Food, Agriculture, Forestry and Fisheries.

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  Fig. 4. The whole-body X-rays of two participants with different working hours and degrees of sagittal imbalance. A : Working hour, 450 hour-years; SVA, 18.7 cm. B : Working hour, 250 hour-years; SVA, 5.2 cm. SVA : sagittal vertical axis.

Reference

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