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Objectives of the Preplacement X-Ray Investigation of the Low-Back Area

1954; Radiological Society of North America; Volume: 63; Issue: 5 Linguagem: Inglês

10.1148/63.5.664

1527-1315

John R. Winston, Robert D. Moreton,

Spine and Intervertebral Disc Pathology

The essentially rural economy that prevailed in the early history of our nation was no less in need of man power than is our industrial economy of today. Our predecessors met the problem in a way that was perhaps more philosophical than scientific. Communities were small. Through personal acquaintance the special aptitudes and weaknesses of the individual were known to the group. Perhaps it is trite to say that survival of the community, as well as the individual, depended upon proper use of this information. Thus, information gained with much effort by the employer today was at that time common knowledge. In recent years the medical literature has given considerable space to various examination programs for workers in industry. Our military experience in this generation has amplified the use of the scientific approach to proper placement and maintenance of personnel in positions where they will be most productive. And now at least one governmental agency has been using a measuring stick of this type to determine which of its employees shall be retained in service incident to curtailment of its program. These efforts represent our scientific attack upon the problem of more satisfactory placement and maintenance of our industrial population. Pre-employment physical examinations had their inception some forty years ago, and have now become well standardized. X-ray investigation of the low back area as part of the pre-employment examination has been used only sporadically in the past, and then only by a few industries. At the present time this practice is becoming more widespread but it is by no means a generally accepted or stabilized procedure. Because the greatest number of man-hours lost from work on account of back complaints occurs in a relatively small segment of our employees (Atchison, Topeka & Santa Fe Railway System), a program of x-ray investigation of prospective employees in these jobs was undertaken. Many plans, ranging from a single anteroposterior view of the lumbar area to roentgen investigation of the entire spine, are being used in other surveys of this type. Since most back complaints are confined to the low back area and most lesions demonstrated by x-ray investigation are at the fourth and fifth lumbar and first sacral segments, it was concluded that these areas would hold the center of our attention, although the adjacent areas were also to be observed. To accomplish this in a survey type of investigation, it was concluded that four views would suffice, namely, anteroposterior, lateral, and right and left 45-degree obliques. It was decided to grade the various abnormalities into four groups. Thus all prospective employees examined under this program would fall into one of the following classifications: Class I: No abnormalities. Class II: Abnormalities not associated with clinical back complaints. Class III: Abnormalities rarely associated with clinical back complaints.