title: Simulation in spinal diseases.
abstract: Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumathologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability Based on the clinical-Forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistences, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, adapting them to a uniform terminology with clear meaning of signs and symptoms.
authors.affiliation: Servicio de Neurocirugía, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España; Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, España. Electronic address: jaso@maz.es.
authors.forename: José
authors.initials: J
authors.lastname: Aso Escario
authors.affiliation: Servicio de Neurocirugía, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Martínez Quiñones
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aso Vizán
authors.affiliation: Servicio de Neurocirugía, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Arregui Calvo
authors.affiliation: Servicio de Valoración, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Bernal Lafuente
authors.affiliation: Servicio de Valoración, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España.
authors.forename: Andrés
authors.initials: A
authors.lastname: Alcázar Crevillén
mesh_terms: D003937:Diagnosis, Differential; D005162:Factitious Disorders / Q000175:diagnosis*; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D011581:Psychological Tests; D013122:Spinal Diseases / Q000175:diagnosis* / Q000523:psychology*; D009626:Terminology as Topic
keywords: Back pain; Compensación; Compensation; Exageración; Exaggeration; Legal; Lumbalgia; Médico-legal; Raquis; Simulación; Simulation; Spine