Citation

Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein B. Spine 2011; 36(25 Suppl): S309-15.

Affiliation

University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, 3010 Bern, Switzerland **University of Newcastle, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, New South Wales, Australia ***Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar St., P.O. Box 208071, New Haven CT 06520-8071, USA +Departments of Anesthesiology and Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599-7010 ++MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC, Canada V7A 4S5 +++School of Human Kinetics, University of British Columbia, 210-6081 University Blvd, Vancouver, BC, Canada V6T 1Z1 ++++Departments of Bioengineering & Neurosurgery, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St. Philadelphia, PA 19104-6392.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e318238842a

PMID

22020601

PMCID

PMC3248632

Abstract

Study Design. Non-systematic review of cervical spine lesions in whiplash-associated disorders (WAD).Objective. To describe whiplash injury models in terms of basic and clinical science, to summarize what can and cannot be explained by injury models, and to highlight future research areas to better understand the role of tissue damage in WAD.Summary of Background Data. The frequent lack of detectable tissue damage has raised questions about whether tissue damage is necessary for WAD and what role it plays in the clinical context of WAD.Methods. Non-systematic review.Results. Lesions of various tissues have been documented by numerous investigations conducted in animals, cadavers, healthy volunteers and patients. Most lesions are undetected by imaging techniques. For zygapophysial (facet) joints, lesions have been predicted by bioengineering studies and validated through animal studies; for zygapophysial joint pain, a valid diagnostic test and a proven treatment are available. Lesions of dorsal root ganglia, discs, ligaments, muscles and vertebral artery have been documented in biomechanical and autopsy studies, but no valid diagnostic test is available to assess their clinical relevance. The proportion of WAD patients in whom a persistent lesion is the major determinant of ongoing symptoms is unknown. Psychosocial factors, stress reactions and generalized hyperalgesia have also been shown to predict WAD outcomes.Conclusion. There is evidence supporting a lesion-based model in WAD. Lack of macroscopically identifiable tissue damage does not rule out the presence of painful lesions. The best available evidence concerns zygapophysial joint pain. The clinical relevance of other lesions needs to be addressed by future research.

Language: en