Cho Dosang
Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2022 Mar;65(2):173-179. doi: 10.3340/jkns.2021.0171. Epub 2021 Dec 10.
Disabilities can emerge due to traumatic spinal fractures. In terms of sacrococcygeal spine, because of its unique anatomic structure with minimal movement, the possibility for it to have a disability is relatively low. In Korea, unlike most disability criteria, private insurance companies acknowledge angular deformities caused by vertebral fractures as disabilities according to their degree, so there were several cases where patients required compensation, arguing angular deformity caused by sacrococcygeal fracture, which in some cases led to legal conflicts. Except the Act Welfare of Persons with Disabilities which recognizes only severe angular deformity affecting internal organs as disability and the industrial accident disability evaluation which does not recognize coccygeal fracture as disability but rarely recognizes sacral vertebra deformity equivalent to compressive deformation, there is little or no case where angular deformity is recognized as disability. Given the impairment evaluation standards in social insurance, McBride system, American Medical Association (AMA) guides, and newly proposed standards by the Korean Academy of Medical Sciences (KAMS), the most contentious point in the general terms and conditions of private insurance is spinal deformity. To overcome controversy over disability evaluation, the private insurance sector is now applying criteria for axial skeleton to sacrococcygeal vertebrae through revision of standards. Under these circumstances, it is fair to recognize sacrococcygeal fracture as impairment in terms of the pelvis only when the fracture leaves serious deformity and neurological symptoms with clear relevancy. Though it may not be easy to develop accurate disability evaluation standards, improvement is necessary to remove any irrationalities and make the standards as objective as possible.
创伤性脊柱骨折可能导致残疾。就骶尾椎而言，由于其独特的解剖结构且活动极少，发生残疾的可能性相对较低。在韩国，与大多数残疾标准不同的是，私人保险公司根据椎体骨折导致的角状畸形程度认定其为残疾，因此出现了几起患者要求赔偿的案例，他们声称骶尾椎骨折导致了角状畸形，在某些情况下引发了法律冲突。除了《残疾人福利法》仅将影响内部器官的严重角状畸形认定为残疾，以及工伤残疾评估不将尾骨骨折认定为残疾但很少认可相当于压缩性变形的骶椎畸形外，几乎没有角状畸形被认定为残疾的情况。鉴于社会保险、麦克布莱德系统、美国医学协会（AMA）指南以及韩国医学科学院（KAMS）新提出的标准中的损伤评估标准，私人保险一般条款和条件中最具争议的点是脊柱畸形。为了克服残疾评估方面的争议，私人保险部门目前正在通过修订标准，将轴向骨骼标准应用于骶尾椎。在这种情况下，只有当骶尾椎骨折留下严重畸形和明显相关的神经症状时，才公平地将其认定为仅涉及骨盆的损伤。尽管制定准确的残疾评估标准可能不容易，但有必要进行改进，以消除任何不合理之处并使标准尽可能客观。
