A Design for Assessment of Sequelae and Disability in Patients with Spinal Injuries

Lee, Kyeong Seok; Doh, Jae Won; Bae, Hack Gun; Yun, Il Gyu

Abstract

It is never easy to assess the rate of disability from spinal injuries objectively. One reason is that the pain is an unmeasurable subjective symptom, and the other is that the disability is usually not confirmed by or correlated with radiological or laboratory examinations. The disability is an essentially subjective inconvenience or limitation, which is hard to measure objectively. However, compensation or reparation requires a scale to measure this unmeasurable disability, even with a universal validity and equity. There are several guidelines or criteria for a quantitative assessment of the disability. They differ from each other and have their own advantages and disadvantages. This difference may cause confusion or inequity. To improve the validity and equity, we propose a new design for the disability evaluation in patients with spinal injuries. We reviewed the Korean law for compensation in industrial accidents, McBride's disability table, the guideline proposed by American Medical Association, and a impairment rating table. Disabilities resulting from spinal injuries were classified into three types, i.e., morphologic sequelae(deformity), functional sequelae(dysfunction), and others. Only objective findings were considered as criteria for rating the disability. Disability resulting from deformity were rated from 0 to 20% by the degree of compression. Dysfunction can be rated by the number of lost motion segment from 10 to 60%. Disability from other compensable spinal pain were rated by objective physical findings or neurologic deficit from 0 to 25%. By eliminating the subjective or intentional complaints, this design can be a useful method minimizing the differences from the multiple examiners.