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Causation and decision making

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Veröffentlicht am

Presented by:
Dr Paul Licina - Spine Surgeon

Event:
Compensation and the Spine - 2016

Veröffentlicht in: Gesundheit & Medizin
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Causation and decision making

  1. 1. MASTERCLASS Compensation and the Spine Paul Licina
  2. 2. disc herniation discogenic pain spinal stenosis
  3. 3. WHAT CAUSES IT? WHO YOU ARE WHAT YOU DO WHAT HAPPENED
  4. 4. genetics weight fitness psychology age WHO YOU ARE WHAT CAUSES IT?
  5. 5. WHAT YOU DO occupation pastimes WHAT CAUSES IT? previous injuries smoking
  6. 6. WHAT HAPPENED injury repetitive load WHAT CAUSES IT?
  7. 7. WHO YOU ARE WHAT YOU DO WHAT HAPPENED WHAT CAUSES IT?
  8. 8. WHAT CAUSES IT? The once commonly held view that disc degeneration is primarily a result of aging and “wear and tear” from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences. Although environmental factors also play a role, it is not primarily through routine physical loading exposures (eg, heavy vs. light physical demands) as once suspected. Previously, heavy physical loading was the main suspected risk factor for disc degeneration. Recent research indicates that heredity has a dominant role in disc degeneration, explaining 74% of the variance in adult populations studied to date.
  9. 9. WHO YOU ARE WHAT YOU DO WHAT HAPPENED WHAT CAUSES IT?
  10. 10. HOW DO WE DECIDE IF IT IS WORK-RELATED?
  11. 11. mechanism of injury • was there a specific event? • was it an unusual event? • could that injury have caused damage? 1 2 3 4 5
  12. 12. 1 2 3 4 5 1 2 3 4 5 mechanism of injury relationship to onset of pain • how soon did the pain start? • how similar was the pain at the start to the pain now? • when was the link made?
  13. 13. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 mechanism of injury relationship to onset of pain preexisting problems • have there been similar problems? • how long ago? • how much degeneration is present?
  14. 14. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 mechanism of injury relationship to onset of pain preexisting problems current pathology • is there something objective wrong? • does it explain the pain? • is trauma a factor in that condition?
  15. 15. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 mechanism of injury relationship to onset of pain preexisting problems current pathology consistency of presentation • abnormal illness behaviour • pain behaviour • credibility
  16. 16. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 mechanism of injury relationship to onset of pain preexisting problems current pathology consistency of presentation TOTAL
  17. 17. HOW DO WE DECIDE WHETHER TO APPROVE SURGERY?
  18. 18. 1 2 3 4 5 condition being treated • is the surgery aimed at the acute injury or the preexisting condition? • is there a simpler procedure that just addresses the acute injury?
  19. 19. 1 2 3 4 5 1 2 3 4 5 condition being treated nonoperative treatment • is there an effective nonoperative treatment at this time? • has nonoperative treatment been completed properly?
  20. 20. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 condition being treated nonoperative treatment effectiveness of surgery • is surgery normally effective for this diagnosis? • in this circumstance is surgery likely to be more or less effective?
  21. 21. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 condition being treated nonoperative treatment effectiveness of surgery likelihood of return to work • is return to work usually feasible after this type of surgery? • in this circumstance is return to work more or less likely?
  22. 22. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 condition being treated nonoperative treatment effectiveness of surgery likelihood of return to work capability of surgeon • are their outcomes usually favourable? • is the request reasonable?
  23. 23. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 condition being treated nonoperative treatment effectiveness of surgery likelihood of return to work capability of surgeon TOTAL
  24. 24. mechanism of injury relationship to onset of pain preexisting problems current pathology consistency of presentation • abnormal illness behaviour • pain behaviour • credibility • is there something objective wrong? • does it explain the pain? • is trauma a factor in that condition? • have there been similar problems? • how long ago? • how much degeneration is present? • how soon did the pain start? • how similar was the pain at the start to the pain now? • when was the link made? • was there a specific event? • was it an unusual event? • could that injury have caused damage?
  25. 25. condition being treated nonoperative treatment effectiveness of surgery likelihood of return to work capability of surgeon • are their outcomes usually favourable? • is the request reasonable? • is return to work usually feasible after this type of surgery? • in this circumstance is return to work more or less likely? • is surgery normally effective for this diagnosis? • in this circumstance is surgery likely to be more or less effective? • is there an effective nonoperative treatment at this time? • has nonoperative treatment been completed properly? • is surgery aimed at the acute injury or the preexisting condition? • is there a simpler procedure that just addresses the acute injury?

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