Objective Conflicting evidence exists to what extent manual material handling (MMH) causes lumbar disc disease, lack of evidence exist that this effect takes place especially at L5-S1 level, where the greatest moment occurs. The aim was to assess if lumbar vertebral body and disc changes are more common in people whose job involves significant MMH and, if so, to evaluate if lumbar vertebral body and disc changes are more prevalent in the lower part of the lumbar spine (L4-L5 and L5-S1). Design Observational, cross-sectional, with quasi-random recruitment. Setting Outpatient radiology units of three large hospitals in northern (Bologna and Brescia) and southern (Bari) Italy. Participants 183 consecutive adult subjects (89 males, 94 females) ...