05/08/2023
WHIPLASH: CERVICAL FACET ARTHRITIS AND CHRONIC PAIN
It is a demonstrated fact that not all who suffer a whiplash type injury fully recover. Various research indicates that 40%-50% of those injured do not fully recover. (1-3). The most recent study, published June 2022, indicated that 89.5% still experience injury related neck pain 5 years after the collision. (4)
One of the x-ray findings that has been associated with chronic pain after a whiplash injury is cervical facet joint degeneration.
One study of 121 with neck pain post MVC underwent a 6-month follow-up which included a CT scan of the discs and facet joints. They demonstrated that 69% of those with facet degeneration reported nonrecovery vs 23.6% without degeneration. Their conclusion was “Moderate facet joint degeneration was associated with nonrecovery.”(5)
Another study demonstrated a significant association between moderate facet joint degeneration and nonrecovery. Their conclusion: “We present moderate evidence to suggest that preexisting facet joint degeneration is a negative prognostic indicator for long-lasting symptoms in WAD. Conversely, preexisting disc degeneration is not associated with chronicity of WAD symptoms.”(6)
Additionally, both these studies could not demonstrate a significant correlation with disc degeneration alone and nonrecovery. The second study did note that total cervical degeneration (facet joint + disc degeneration) was shown to correlate with nonrecovery.
The takeaway: if cervical facet degeneration is present, it is one prognostic factor that the patient may develop chronic pain.
(1) Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003 Jan;35(1):36-43. doi: 10.1080/16501970306109. PMID: 12610847.
(2) Walton DM, Elliott JM. An Integrated Model of Chronic Whiplash-Associated Disorder. J Orthop Sports Phys Ther. 2017 Jul;47(7):462-471. doi: 10.2519/jospt.2017.7455. Epub 2017 Jun 16. PMID: 28622487; PMCID: PMC7351370.
(3) Carroll, L.J., Holm, L.W., Hogg-Johnson, S. et al. Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD). Eur Spine J 17 (Suppl 1), 83–92 (2008). https://doi.org/10.1007/s00586-008-0628-7
(4) Park, Donghwi, Kwak, Sang Gyu, and Chang, Min Cheol. ‘Five to Ten-year Prognosis of Whiplash Injury-related Chronic Neck Pain: A Brief Report’. 1 Jan. 2022 : 1 – 5.
Study Design Best evidence synthesis. Objective To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD). Summary of Background Data Knowledge of the course of recovery of WAD guides exp...
