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European Spine Journal

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01-08-2014 | Original Article

Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?

Authors: Rasmus Hertzum-Larsen, Henrik Petersen, Helge Kasch, Tom Bendix

Published in: European Spine Journal | Issue 8/2014

Abstract

Purpose

Whiplash trauma in motor vehicle accidents (MVA) may involve various painful soft tissue damages, but weeks/months later a minority of victims still suffers from various long-lasting and disabling symptoms, whiplash-associated disorders (WAD). The etiology is currently unknown, but X-ray-occult fractures may be one cause in some cases. The purpose of this prospective study was to examine the association between occult fractures, as seen on bone single photon emission computed tomography (SPECT), with neck-, head- and arm pain.

Methods

An inception cohort of 107 patients presenting with acute whiplash symptoms following an MVA was invited to have a cervical SPECT shortly post injury and again 6 months later. Associations between occult fractures and pain levels at baseline, 6 and 12 months of follow-up were analyzed.

Results

Eighty-eight patients had baseline SPECT performed at median 15 days (range 3–28) post injury, but only 49 patients accepted to have the follow-up SPECT at 6 months. Abnormal SPECT, defined as minimum one area of focal uptake, was seen in 32 patients at baseline, reflecting an occult fracture. Occult fractures were not associated with pain levels, neither at baseline nor at follow-up.

Conclusion

Occult fractures do not seem to play a role for development of chronic pain after whiplash.

Grauer JN, Panjabi MM, Cholewicki J et al (1997) Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine 22:2489–2494PubMedCrossRef

Kasch H, Stengaard-Pedersen K, Arendt-Nielsen L, Staehelin Jensen T (2001) Headache, neck pain, and neck mobility after acute whiplash injury: a prospective study. Spine 26:1246–1251PubMedCrossRef

Spitzer WO, Skovron ML, Salmi LR et al (1995) Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 20:1S–73SPubMedCrossRef

Carroll LJ, Holm LW, Hogg-Johnson S et al (2009) Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 32:S97–S107. doi:10.1016/j.jmpt.2008.11.014 PubMedCrossRef

Kongsted A, Qerama E, Kasch H et al (2007) Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial. Spine 32:618–626. doi:10.1097/01.brs.0000257535.77691.bd PubMedCrossRef

Freeman MD, Sapir D, Boutselis A, et al (2001) Whiplash injury and occult vertebral fracture: a case series of bone SPECT imaging of patients with persisting spine pain following a motor vehicle crash. Proceedings of the Cervical Spine Research Society

Rodriquez AA, Barr KP, Burns SP (2004) Whiplash: pathophysiology, diagnosis, treatment, and prognosis. Muscle Nerve 29:768–781. doi:10.1002/mus.20060 PubMedCrossRef

Statistics Denmark (2002) Statistisk Årbog 2002 (statistical yearbook 2002). Aarhuus Stiftsbogtrykkerie, Århus

Hurst SA (2014) Declaration of Helsinki and protection for vulnerable research participants. JAMA 311:1252. doi:10.1001/jama.2014.1272 PubMedCrossRef

10.

Jensen MP, Karoly P, O’Riordan EF et al (1989) The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain 5:153–159PubMedCrossRef

11.

Kongsted A, Qerama E, Kasch H et al (2008) Education of patients after whiplash injury: is oral advice any better than a pamphlet? Spine 33:E843–E848. doi:10.1097/BRS.0b013e318182bee2 PubMedCrossRef

12.

Kasch H, Bach FW, Jensen TS (2001) Handicap after acute whiplash injury: a 1-year prospective study of risk factors. Neurology 56:1637–1643PubMedCrossRef

13.

Kongsted A, Sorensen JS, Andersen H et al (2008) Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. Eur Spine J 17:996–1005. doi:10.1007/s00586-008-0687-9 PubMedCentralPubMedCrossRef

14.

Bolton JE, Wilkinson RC (1998) Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipulative Physiol Ther 21:1–7PubMed

15.

Fejer R, Jordan A, Hartvigsen J (2005) Categorising the severity of neck pain: establishment of cut-points for use in clinical and epidemiological research. Pain 119:176–182. doi:10.1016/j.pain.2005.09.033 PubMedCrossRef

16.

Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley-Interscience Publication

17.

Core Team R (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

18.

Sarikaya I, Sarikaya A, Holder LE (2001) The role of single photon emission computed tomography in bone imaging. Semin Nucl Med 31:3–16PubMedCrossRef

19.

Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299PubMedCrossRef

20.

Kasch H, Kongsted A, Qerama E et al (2013) A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study. BMJ Open. doi:10.1136/bmjopen-2012-002050 PubMedCentralPubMed

21.

Jennum P, Kjellberg J, Ibsen R, Bendix T (2013) Health, social and economic consequences of neck injuries: a controlled national study evaluating societal effects on patients and their partners. Spine 38:449–457. doi:10.1097/BRS.0b013e3182819203 PubMedCrossRef

22.

Smith GD, Lawlor DA, Harbord R et al (2007) Clustered environments and randomized genes: a fundamental distinction between conventional and genetic epidemiology. PLoS Med 4:e352. doi:10.1371/journal.pmed.0040352 PubMedCentralPubMedCrossRef

23.

Côté P, Hogg-Johnson S, Cassidy JD et al (2001) The association between neck pain intensity, physical functioning, depressive symptomatology and time-to-claim-closure after whiplash. J Clin Epidemiol 54:275–286PubMedCrossRef

24.

Obelieniene D, Schrader H, Bovim G et al (1999) Pain after whiplash: a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatr 66:279–283PubMedCentralPubMedCrossRef

25.

Wenzel HG, Vasseljen O, Mykletun A, Nilsen TIL (2012) Pre-injury health-related factors in relation to self-reported whiplash: longitudinal data from the HUNT study, Norway. Eur Spine J 21:1528–1535. doi:10.1007/s00586-012-2186-2 PubMedCentralPubMedCrossRef

Title: Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?
Authors: Rasmus Hertzum-Larsen
Henrik Petersen
Helge Kasch
Tom Bendix
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3362-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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