Since the inclusion of disc-related diseases of the lumbar spine (LS) to the official list of occupational diseases, the question whether the specific radiological "damage pattern" allows conclusions concerning the - occupational or non-occupational - aetiology of the respective disease is discussed controversially. It is often suggested that only a "load-conform" damage pattern of the lumbar spine with a radiologically provable affection that is decreasing from the lower to the upper LS can be acknowledged as an occupational disease according to Occupational Disease (BK) No. 2108 BKV. This case control study is the first study to investigate the relation between a cumulative occupational stress and the occurrence of specific damage patterns of the LS using a population-related epidemiological approach. 229 male patients with disc-related diseases of the lumbar spine (symptomatic osteochondrosis or spondylosis whereby a number of n = 115 of these additionally suffered from disc prolapses) were compared to 197 male control persons (107 population controls, 90 controls with hospital-based urolithiasis treatments whereby osteochondrosis/spondylosis were radiographically excluded). To determine the cumulative load dose applied to the lumbar spine through the lifting or carrying of loads as well as through working in extremely bend-over positions, the Mainz-Dortmund Dose Model (MDD) without consideration of minimum exposure limits, on the one hand, and a simplified approach where the squares of the weights lifted or carried at work were multiplied by the corresponding duration, on the other hand, were used. As effect estimators for the relative disease risks odds ratios were calculated and adjusted with respect to age, region, nationality and other diseases with a potential affection of the lumbar spine. Occupational risks were separately calculated for mono-segmental (one disc damaged) and multi-segmental (more than one disc damaged) damage patterns as well as for "load-conform" and "not load-conform" damage patterns according to the above definition. The study reveals that mono- and multi-segmental damage patterns have similar relative disease risks. The study revealed that "load-conform" damage patterns show considerably higher disease risks than "non load-conform" patterns; however, in cases of high occupation-related loads there were also considerably increased relative risks of disease - even for "non load-conform" disk-related diseases of the lumbar spine. In summary, this study questions the widespread concept of "load conformity" of disc-related diseases of the lumbar spine as far as the decreasing degree of the damages to the lumbar spine in an upward direction is concerned. Even damage patterns that were so far often considered as "not load-conform" can be - based on this study - consequences of (high) occupational loads.