[Street traffic accident--whiplash injury of the cervical spine from the viewpoint of insurance medicine]

Abstract

The Swiss Accident Insurance Institute (SUVA), as the largest mandatory insurer against accidents in Switzerland, handles approximately 3000 cases of injury to the cervical spine every year, half of which are the result of traffic accidents. A considerable proportion of these involve whiplash injuries to the cervical spine. Epidemiological and statistical results according to this medical definition and based on material collected over a period of several years are presented. The assessment of these cases from the medical insurance point of view is discussed. Mild whiplash injuries are very common and as a rule they heal without sequelae. Severe whiplash injuries with massive soft-tissue damage and fractures are rare and present few problems for the causality assessment. Problemtical, on the other hand, are the not infrequent cases of whiplash injuries which initially seem to be ordinary sprains but which subsequently develop into lasting clinical syndromes that are very difficult to objectify. Further, the assessment and care of these problem cases in particular are discussed from the medical insurance point of view. In these patients, who suffer severe pain and discomfort, it is in most cases not possible to obtain any objective findings with the classical diagnostic measures of radiology, orthopaedics and neurology. They can very soon be suspected of malingering, exaggeration or pension neurosis. Only with the very sophisticated, modern diagnostic methods of neuropsychology, chiropraxis and functional computed tomography is it sometimes possible to objectify these syndromes in a reproducible manner and possibly to establish a post-traumatic instability as the cause. This then again opens up promising possibilities for the treatment of these patients. The SUVA supports research aimed at developing and testing such promising new methods of examination. However, it at the same time warns against the uncritical use of these expensive methods of examination, the informative value and the scientific validity of which are in some respects still not sufficiently well established.