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[Injuries of the cervical spine in Switzerland]
Abstract:
The post traumatic evaluation of patients after soft tissue injuries of cervical spine is not clear. As objective criteria of the injury are often absent, the judgement in the medical expertise is difficult. 1100 medical records as a representative sample of 11,000 patients with cervical spine injury recorded at the Swiss National Insurance Company during the years 1978-81 were analysed. 320 records were evaluated in detail. Those injured received a questionnaire about their present psychosocial situation, complaints, necessity of treatment and financial compensation. 207 or 65% returned the filled out questionnaire. X-rays verified that 12.6% of all injured had fractures or luxation of the cervical spine, 4.2% of all patients showed fracture combined with spinal cord lesion. In 87.4% only soft tissue injury was described. About the half of the accidents were road accidents, the other half occurred during sport, work etc. 30% of the patients with fracture are receiving financial compensation as a result of working disability, 70% of them are still, i.e. 4-7 years after injury, under medical care. Only 1% of the injured patients without fracture are receiving a financial compensation, while 25% of them do need treatment for their symptoms caused by the accident. The therapeutical procedures range from application of Myotonolytics, pain killers, Infiltrations to Physiotherapy and Manipulation. Almost all of those 25% injured are not in agreement with the decision of the insurance company based upon the medical expertise. 12% of all injured developed, after the accident, psychological symptoms, such as decreased concentration, vitality or productivity, melancholy etc. The discrepancy between the judgement of the insurance company based upon the medical records and the patients complaints also 4-7 years after injury as well as the diversification of therapeutical procedures used in the long term patients career are indicating a necessity of prospective study on cervical spine injury.