Asian Spine J Search


Asian Spine J > Volume 15(3); 2021 > Article
Rustagi and Badve: Letter to the Editor: The Effect of Head Loading on Cervical Spine in Manual Laborers
Dear Editor,
We read with great interest, article by Dave et al. [1] titled “The effect of head loading on cervical spine in manual laborers.”
The paper very appropriately highlights the implications of upper cervical accelerated degeneration following head loading activities. This also brings about an important consideration of having an upper limit of permissible weights that should be carried by manual laborers. The functional disability can be profound in relatively young populations who develop this in developing and underdeveloped countries [2]. Badve et al. [3] on a similar pattern performed a cross-sectional study on railway porters and reported a significant increase in the prevalence of OC1C2 osteoarthritis. While the research by Dave et al. [1] analyses the acute plain radiographic implications to head loading on the cervical spine, the article by Badve et al. [3] investigates a more delayed response based on cross-sectional imaging. Other authors have also reported similar findings [2,4-6].
It will be interesting for future studies to assess weight wise effect on cervical spine loading based on morphological parameters like gender, muscle morphology, and so forth. This may form the basis of a concrete guideline for the concerned authorities to make necessary laws. More importantly, it may be useful for educational purposes and promote the use of alternate methods of carrying weight like push carts [2,6]. Additionally, eventually, it may aid to develop ergonomic designs or techniques of carrying weights on the head to mitigate the ill effects of head loading like designs to allow weight sharing over shoulders.
We again congratulate the authors to bring forward an important study to highlight this aspect.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.


1. Dave BR, Krishnan A, Rai RR, Degulmadi D, Mayi S. The effect of head loading on cervical spine in manual laborers. Asian Spine J 2021 15:17–22.
crossref pmid
2. Schaeren S, Jeanneret B. Atlantoaxial osteoarthritis: case series and review of the literature. Eur Spine J 2005 14:501–6.
crossref pmid pmc
3. Badve SA, Bhojraj S, Nene A, Raut A, Ramakanthan R. Occipito-atlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population. Spine (Phila Pa 1976) 2010 35:434–8.
4. Mahbub MH, Laskar MS, Seikh FA, et al. Prevalence of cervical spondylosis and musculoskeletal symptoms among coolies in a city of Bangladesh. J Occup Health 2006 48:69–73.
crossref pmid
5. Joosab M, Torode M, Rao PV. Preliminary findings on the effect of load-carrying to the structural integrity of the cervical spine. Surg Radiol Anat 1994 16:393–8.
crossref pmid
6. Echarri JJ, Forriol F. Influence of the type of load on the cervical spine: a study on Congolese bearers. Spine J 2005 5:291–6.
crossref pmid


Browse all articles >

Editorial Office
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine
88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3530    Fax: +82-2-3010-8555    E-mail:                

Copyright © 2021 by Korean Society of Spine Surgery.

Developed in M2PI

Close layer
prev next