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Disc herniation by lumbar spine occupational overstress - case study -

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 ¹ Chair of Occupational Medicine, UMF<Carol Davila> , Bucharest

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Disc herniation by lumbar spine occupational overstress - case study -

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  1. Disc herniation by lumbar spine occupational overstress- case study - EugeniaNAGHI 1,2 Agripina RASCU 1,2 Claudia HANDRA 1,2 RalucaMAROIU² Irina FOCIUC ² ¹Chair of Occupational Medicine, UMF<Carol Davila>, Bucharest ²Occupational Medicine Clinical Department, Colentina Hospital, Bucharest

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

  3. Professional path • 1989 at the moment Foundryman Ironfoundry

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

  5. 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

  6. Casting and filling frames with liquid metal http://www.go.ise.ro

  7. Filling a hand ladle with liquid metal from a tank http://www.go.ise.ro

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

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

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

  11. History of disease: • Earliest occurrence of described symptoms: - October 2007 - immediately after lifting and handling weights in the workplace ► General Practitionerno result THERAPY (NSAID / myorelaxant )

  12. History of the condition: • 08.10 - 12.10.2007 – Internal medicine 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

  13. 23.10.2007- admission to Occupational Medicine Clinical Department, Colentina Hospital, Bucharest ► Clinical exam : ● pain on lumbar spine percussion ● paravertebral muscle cramp (> right) ● limitation of the lumbar spine flexion movements ● Lassegue +45° ● discomfort when leaning on heels

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

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

  16. ► Neurosurgical examination ■ LDHL4-L5 with motor deficiency of the digital extension muscles and sensitive deficiency Surgical treatment

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

  18. Recommendations • Admission to neurosurgerysurgical treatment of lumbar disc hernia • Treatment of symptoms

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

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

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