Nikolai Bogduk1. 1. Department of Clinical Research, Newcastle Bone and Joint Institute, University of Newcastle, Royal Newcastle Centre, Newcastle, Australia. vicki.caesar@hnehealth.nsw.gov.au
Abstract
STUDY DESIGN: Narrative review. OBJECTIVE: To summarize the evidence that implicates the cervical zygapophysial joints as the leading source of chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA: Reputedly a patho-anatomic basis for neck pain after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case. METHODS: Data were retrieved from studies that addressed the postmortem features and biomechanics of injury to the cervical zygapophysial joints, and from clinical studies of the diagnosis and treatment of zygapophysial joint pain, to illustrate convergent validity. RESULTS: Postmortem studies show that a spectrum of injuries can befall the zygapophysial joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries.Clinical studies have shown that zygapophysial joint pain is very common among patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy. CONCLUSION: The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical zygapophysial joints as a site of injury and source of pain, strongly implicates injury to these joints as a common basis for chronic neck pain after whiplash.
STUDY DESIGN: Narrative review. OBJECTIVE: To summarize the evidence that implicates the cervical zygapophysial joints as the leading source of chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA: Reputedly a patho-anatomic basis for neck pain after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case. METHODS: Data were retrieved from studies that addressed the postmortem features and biomechanics of injury to the cervical zygapophysial joints, and from clinical studies of the diagnosis and treatment of zygapophysial joint pain, to illustrate convergent validity. RESULTS: Postmortem studies show that a spectrum of injuries can befall the zygapophysial joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries.Clinical studies have shown that zygapophysial joint pain is very common among patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy. CONCLUSION: The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical zygapophysial joints as a site of injury and source of pain, strongly implicates injury to these joints as a common basis for chronic neck pain after whiplash.
Authors: Robert W Hurley; Meredith C B Adams; Meredith Barad; Arun Bhaskar; Anuj Bhatia; Andrea Chadwick; Timothy R Deer; Jennifer Hah; W Michael Hooten; Narayan R Kissoon; David Wonhee Lee; Zachary Mccormick; Jee Youn Moon; Samer Narouze; David A Provenzano; Byron J Schneider; Maarten van Eerd; Jan Van Zundert; Mark S Wallace; Sara M Wilson; Zirong Zhao; Steven P Cohen Journal: Pain Med Date: 2021-11-26 Impact factor: 3.750