The medical assessments drawn up for Occupational Disease (BK) No. 2108 concerning the exposure and effects of manual lifting have been the subject of much discussion. Criticism has been expressed above all about the epidemiological methods, investigations of the dose-response relationship, the development of exposure procedures for quantifying and assessing the workload of the spine and practical systems of risk assessment, and early diagnosis by medical surveillance. Despite some improvements, numerous inconsistencies and uncertainties remain. From 1993 to 2001 only about 2.4 % of the compensation claims under BK 2108 were successful, while a causal relationship between occupational exposure and disease was accepted in about 24 % of other suspected occupational diseases. A team of industrial medical officers from five states of the Federal Republic of Germany therefore evaluated BK 2108 cases in order to reveal current misunderstandings and conflicts in the decisionmaking process. The aim was to improve the argumentation basis and the communication of medical criteria between those dealing with BK 2108. The analysis of a sample (n = 835) from five states of the Federal Republic of Germany (Bremen, Hamburg, Lower Saxony, North Rhine-Westphalia, Sachsen-Anhalt) in 2001 showed that in 22 % of the cases (n = 184) the workload as assessed by the Employers’ Liability Insurance Association (Berufsgenossenschaft) was sufficient to consider a causal relationship. In this group compensation was accepted in 25 cases by the medical expert engaged by the Berufsgenossenschaft and the industrial medical officer. In 26 additional cases only the industrial medical officer and one case only the medical expert engaged by the Berufsgenossenschaft accepted a causal relationship. In 152 of the 828 suspected cases, a causal relationship was rejected solely because of the medical results without any exposure assessment. The non-transparent pre-selection of medical files for assessment without adequate evaluation of the occupational risk needs to be closely examined and is unacceptable from the point of view of quality improvement. A trend towards more pronounced radiological findings in younger claimants with an adequate level of exposure could not be shown. In the group of occupationally exposed persons the two distal segments of the lumbar spine were the area most affected by degenerative conditions. The assessment was particularly difficult to draw up when competing causes (e.g. Scheuermann’s disease) had to be taken into account and in cases where load-adaptive damage patterns were considered to be missing. To conclude, despite ten years of experience with BK 2108, non-uniform judgements are still common and there is still a considerable need to define the medical criteria for or against recognition of the disease on a scientific basis.
