Thomann K-D, Grosser V, Rauschmann M
Institut für Versicherungsmedizin, Eschersheimer Landstr. 353, 60320, Frankfurt am Main, Deutschland.
Orthopade. 2010 Mar;39(3):312-28. doi: 10.1007/s00132-009-1548-x.
Appraisals and expert opinions of clearly identified injuries of the spine, ranging from fractures and dislocations to intervertebral disc ruptures and haemorrhage into soft tissue are generally unproblematic. The residual functional deficit is commensurate with the extent of damage. However, differences between the patient's symptoms and objective findings can be unrelated to the injury, and are often explained by the actual compensation process or other psychological/psychosocial factors. The current article discusses a basis for providing expert medical opinions, as well as a number of practical tips on the German medical insurance system. Particular attention is paid to expert opinions on causality. The article also includes information on the evaluation of structural injuries to the spine on the basis of assessment criteria that have proven to be reliable and authoritative in recent decades.
对于明确诊断的脊柱损伤,从骨折、脱位到椎间盘破裂以及软组织出血等情况的评估和专家意见通常没有问题。残余功能缺陷与损伤程度相称。然而,患者症状与客观检查结果之间的差异可能与损伤无关,且往往可由实际的赔偿过程或其他心理/社会心理因素来解释。本文讨论了提供专家医学意见的依据,以及关于德国医疗保险系统的一些实用提示。特别关注因果关系的专家意见。本文还包括基于近几十年来已被证明可靠且权威的评估标准对脊柱结构损伤进行评估的信息。