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Vertebral slippage causes taxi drivers’ back pain

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A cross sectional study linking acquired lumbar spondylolisthesis with taxi drivers may ultimately lead to preventive measures against this important cause of disabling back pain. It is the first analytical study to show a link with this occupation.

ASL in a male taxi driver: lateral view of grade 1 spondylolisthesis of L4 on L5.

Not only was taxi driving significantly associated with acquired spondylolisthesis (ASL), those who had worked as taxi drivers longest had the highest risk. Drivers with 15 years’ service or more had over three times the risk than drivers with up to 5 years’ service, and drivers with 6–15 years’ service had almost twice the risk, after adjustment for confounding factors. Age, overweight or obesity, and frequent strenuous exercise were also associated with the condition.

Baseline data from the taxi drivers health study, part of a Taipei city government backed programme to monitor taxi drivers’ health, were used for the regression analyses. The data covered a sample cohort of 1242 registered taxi drivers in the city who had been operating for at least one year during the first five months of 2000. ASL was diagnosed as non-lytic spondylolisthesis above L5 from lumbosacral x ray films; demographic data and data about the job and health behaviours were taken from standard self administered questionnaires.

Our knowledge about ASL comes mostly from descriptive work, but identifying the environmental and work factors on which to base preventive measures needs more population based studies. The next step will be to test these results in prospective studies and then to pinpoint work exposures carrying a risk for the condition.