|
1
|
Murata S, Iwahashi H, Mera Y, Shitahodo T, Inoue S, Kawamura K, Kadono A, Murai K, Hayashi T, Kitano Y, Yamada H. Efficacy and safety of multidrug cocktail injections in postoperative pain management for lumbar microendoscopic decompression surgery: a prospective randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:301-307. [PMID: 39369370 DOI: 10.1007/s00586-024-08512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/19/2024] [Accepted: 09/29/2024] [Indexed: 10/07/2024]
Abstract
PURPOSE This study aimed to evaluate the analgesic effects and safety of multidrug cocktail injections for postoperative pain management in patients undergoing lumbar microendoscopic decompression surgery. METHODS A prospective randomized controlled trial was conducted with 70 patients who underwent lumbar microendoscopic decompression surgery between December 2023 and May 2024. Patients were randomly assigned to receive either a multidrug cocktail injection (cocktail group, n = 35) or no cocktail injection (non-cocktail group, n = 35). Primary outcomes included scores of the numerical rating scale (NRS) for pain from postoperative days 1 to 7 and the number of analgesics used within the first 3 postoperative days. Secondary outcomes included sex, age, body mass index, preoperative diagnosis, surgical levels, duration of surgery, blood loss, C-reactive protein (CRP) levels on postoperative day 1, and drain output. RESULTS The cocktail group experienced significantly lower pain levels from postoperative days 1 to 7 (p < 0.05) and used fewer analgesics within the first 3 days (p = 0.01) compared with the non-cocktail group. Additionally, the cocktail group had significantly lower CRP levels (p < 0.001) and a shorter hospital stay (p = 0.01). No significant differences were observed in the duration of surgery, blood loss, or drain output between the groups. CONCLUSION Multidrug cocktail injections are effective and safe for postoperative pain management in lumbar microendoscopic decompression surgery, significantly reducing pain, analgesic use, CRP levels, and hospital stay. These findings suggest that incorporating multidrug cocktail injections into postoperative care protocols can enhance patient recovery and outcomes.
Collapse
Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan.
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Yoshimasa Mera
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Toshiya Shitahodo
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Shingo Inoue
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Kota Kawamura
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Aozora Kadono
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Kusushi Murai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Taiki Hayashi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yoji Kitano
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu City, Wakayama, 647-0072, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| |
Collapse
|
|
2
|
Peterson G, Nilsing Strid E, Jönsson M, Hävermark J, Peolsson A. Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial. J Rehabil Med 2024; 56:jrm34785. [PMID: 39072427 PMCID: PMC11301840 DOI: 10.2340/jrm.v56.34785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion. DESIGN Randomized controlled trial. PATIENTS A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups. METHODS Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups. RESULTS There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance. CONCLUSION Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.
Collapse
Affiliation(s)
- Gunnel Peterson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden.
| | - Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Margaretha Jönsson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Jesper Hävermark
- Centre for Clinical Research, Development and Education, County Council Uppsala, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden; Occupational and Environmental Medicine Centre and Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
|
3
|
Smith A, Andruski B, Deng G, Burnham R. Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of longer term 6- and 12- month outcomes. INTERVENTIONAL PAIN MEDICINE 2023; 2:100237. [PMID: 39239611 PMCID: PMC11373009 DOI: 10.1016/j.inpm.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/11/2023] [Accepted: 02/11/2023] [Indexed: 09/07/2024]
Abstract
Objective To explore the 6- and 12-month effectiveness of a single autologous injection of platelet-rich plasma (PRP) in cervical facet joints of people with chronic WAD and facet-mediated pain. Design A prospective case series of people with chronic whiplash-associated disorders and cervical facet joint mediated pain in a community setting. Interventions We investigated 44 consecutive people who underwent cervical facet joint PRP ( ± adjunct physiotherapy) between 2019 and 2021, selected for PRP based on 80% relief following single diagnostic medial branch blocks or 50% relief and a significant improvement in performing a previously limited activity of daily living. Measures Measures of pain (numerical pain rating scale - NPRS) and disability (Neck Disability Index - NDI) were collected prior to and 3-, 6- and 12- months following cervical facet joint PRP in an electronic registry database. Success was defined as those exceeding the minimal clinically important difference (MCID) for pain (>15%) and disability (>10%). We also calculated the proportion of people with greater than 50% relief of pain. People not reached for follow-up were considered failures for worst-case analysis. Results Forty-four people (82% female, mean age = 45.2 (range: 25-71) years) underwent cervical facet joint PRP. Nine people received repeat PRP interventions. Thirty-five people provided 12-month data. There was a significant improvement in pain and disability following PRP (and possibly adjunct physiotherapy) received during this time period. At 12-months, 53% of people exceeded MCID for pain, reporting a mean improvement of 66% (95%CI: 55-77%) on the NPRS. For NDI scores, 69% of people exceeded MCID, reporting a mean improvement of 48% (95%CI: 38-58%). Thirty-seven percent of people reported greater than 50% relief of pain 12-months post-cervical facet joint PRP. Conclusion In people with chronic WAD and facet-mediated pain, our long-term data suggests that PRP (and possibly adjunct physiotherapy) is effective. A controlled study is warranted to evaluate the efficacy of PRP.
Collapse
Affiliation(s)
- Ashley Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive, Calgary, Alberta, T2N 1N4, Canada
- VivoCura Health, #100, 325 Manning Rd NE, Calgary, Alberta, T2E 2P5, Canada
| | - Ben Andruski
- VivoCura Health, #100, 325 Manning Rd NE, Calgary, Alberta, T2E 2P5, Canada
| | - George Deng
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive, Calgary, Alberta, T2N 1N4, Canada
- VivoCura Health, #100, 325 Manning Rd NE, Calgary, Alberta, T2E 2P5, Canada
| | - Robert Burnham
- VivoCura Health, #100, 325 Manning Rd NE, Calgary, Alberta, T2E 2P5, Canada
- Central Alberta Pain and Rehabilitation Institute, #1,6220 AB-2A, Lacombe, Alberta, T4L 2G5, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| |
Collapse
|
|
4
|
Park D, Kwak SG, Chang MC. Five to ten-year prognosis of whiplash injury-related chronic neck pain: A brief report. J Back Musculoskelet Rehabil 2023; 36:271-275. [PMID: 35754262 DOI: 10.3233/bmr-220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Whiplash injury-related neck pain frequently hinders daily life activities, resulting in poor quality of life. Recovery time is prolonged in many patients. Long-term outcomes of refractory whiplash injury-related neck pain remain poorly understood. OBJECTIVE This study aimed to evaluate the long-term prognosis of chronic whiplash injury-related neck pain. METHODS We evaluated the prognosis of 38 patients with whiplash injury-induced neck pain via phone interviews. We investigated the data on current presence and degree of neck pain, current pain medication, physical modality or injection procedures, and difficulty performing daily life activities or occupational duties. RESULTS At least 5 years after the whiplash injury, 34 patients (89.5%) experienced whiplash injury-related neck pain. The average numeric rating scale (NRS) score on the initial visit to our spine center was 5.3 ± 1.7 and that at the follow-up interview was 4.3 ± 2.6. Twenty-six (68.4%) patients had pain scores ⩾ 3 on the NRS. Additionally, 26 (68.4%) patients were receiving at least one of the following pain-management treatments: oral pain medications, physical modality, and injection procedures. Twenty-eight (73.7%) patients encountered difficulty performing daily life activities and occupational duties. CONCLUSIONS The long-term prognosis of patients with whiplash injury-related neck pain was found to be poor.
Collapse
Affiliation(s)
- Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| |
Collapse
|
|
5
|
Manchikanti L, Knezevic NN, Knezevic E, Abdi S, Sanapati MR, Soin A, Wargo BW, Navani A, Atluri S, Gharibo CG, Simopoulos TT, Kosanovic R, Abd-Elsayed A, Kaye AD, Hirsch JA. A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain. Pain Ther 2022; 12:1-48. [PMID: 36465720 PMCID: PMC9686245 DOI: 10.1007/s40122-022-00455-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks. Study Design Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis. Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain. Methods Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined. Results Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is level II in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was level III to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions. Limitations There was a paucity of literature and heterogeneity among the available studies. Conclusion This systematic review and meta-analysis shows level II evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with level III to IV evidence in managing cervicogenic headaches. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00455-0.
Collapse
Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Centers of America, 67 Lakeview Drive, Paducah, KY 42001 USA
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY USA
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL USA
- College of Medicine, University of Illinois, Chicago, IL USA
| | - Emilija Knezevic
- College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Salahadin Abdi
- Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | | | - Amol Soin
- Ohio Pain Clinic and Wright State University, Dayton, OH USA
| | - Bradley W. Wargo
- Interventional Pain Management, Mays & Schnapp Neurospine & Pain, Memphis, TN USA
| | - Annu Navani
- Comprehensive Spine & Sports Center and Le Reve Regenerative Wellness, Campbell, CA USA
| | | | | | - Thomas T. Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Arnold Warfield Pain Management Center, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA USA
| | | | - Alaa Abd-Elsayed
- UW Health Pain Services and UW Pain Clinic, Chronic Pain Medicine, Department of Anesthesiology, and University of Wisconsin School of Medicine and Public Health,, Madison, WI USA
| | - Alan D. Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSUHSC, Shreveport, LA USA
| | - Joshua A. Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| |
Collapse
|
|
6
|
Chang MC, Yang S. Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain. World J Clin Cases 2022; 10:7720-7727. [PMID: 36158472 PMCID: PMC9372847 DOI: 10.12998/wjcc.v10.i22.7720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/26/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical facet joint pain (CFP) is one of the most common causes of neck pain and headache. Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work. AIM To investigate the effectiveness of pulsed radiofrequency (PRF) stimulation of cervical medial branches in patients with chronic CFP. METHODS We retrospectively included 21 consecutive patients (age = 50.9 ± 15.3 years, range 26-79 years; male: female = 8:13; pain duration = 7.7 ± 5.0 mo) with chronic CFP, defined as ≥ 4 on the numeric rating scale (NRS). We performed PRF stimulation on the cervical medial branches. The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment. Successful pain relief was defined as a ≥ 50% reduction in the NRS score at 3 mo when compared with the pretreatment NRS score. RESULTS No patient had immediate or late adverse effects following PRF. The average NRS score for CFP decreased from 5.3 ± 1.1 at pre-treatment to 2.4 ± 0.6 at the 1 mo follow-up, and 3.1 ± 1.1 at the 3 mo follow-up. Compared to the NRS scores before PRF stimulation, those at 1 and 3 mo after PRF stimulation had significantly decreased. Eleven of the 21 patients (52.4%) reported successful pain relief 3 mo after the PRF procedure. PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP. CONCLUSION PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP. PRF can effectively alleviate CFP, and is safe to perform.
Collapse
Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu 42415, South Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, School of Medicine, Ewha Woman's University Seoul Hospital, Seoul 07804, South Korea
| |
Collapse
|
|
7
|
Aarnio M, Fredrikson M, Lampa E, Sörensen J, Gordh T, Linnman C. Whiplash injuries associated with experienced pain and disability can be visualized with [11C]-D-deprenyl positron emission tomography and computed tomography. Pain 2022; 163:489-495. [PMID: 34232928 PMCID: PMC8832543 DOI: 10.1097/j.pain.0000000000002381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Knowledge of etiological mechanisms underlying whiplash-associated disorders is incomplete. Localisation and quantification of peripheral musculoskeletal injury and inflammation in whiplash-associated disorders would facilitate diagnosis, strengthen patients' subjective pain reports, and aid clinical decisions, all of which could lead to improved treatment. In this longitudinal observational study, we evaluated combined [11C]-D-deprenyl positron emission tomography and computed tomography after acute whiplash injury and at 6-month follow-up. Sixteen adult patients (mean age 33 years) with whiplash injury grade II were recruited at the emergency department. [11C]-D-deprenyl positron emission tomography and computed tomography, subjective pain levels, self-rated neck disability, and active cervical range of motion were recorded within 7 days after injury and again at 6-month follow-up. Imaging results showed possible tissue injuries after acute whiplash with an altered [11C]-D-deprenyl uptake in the cervical bone structures and facet joints, associated with subjective pain locale and levels, as well as self-rated disability. At follow-up, some patients had recovered and some showed persistent symptoms and reductions in [11C]-D-deprenyl uptake correlated to reductions in pain levels. These findings help identify affected peripheral structures in whiplash injury and strengthen the idea that positron emission tomography and computed tomography detectable organic lesions in peripheral tissue are relevant for the development of persistent pain and disability in whiplash injury.
Collapse
Affiliation(s)
- Mikko Aarnio
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lampa
- UCR, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- PET Centre, Department of Medical Imaging, Uppsala University Hospital, Sweden
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Clas Linnman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, United States
| |
Collapse
|
|
8
|
Usmani H, Hussain A, Huda M, Dureja G, Bibra D. Comparison of cervical medial branch nerve block versus trigger point injection in patients with chronic neck pain. INDIAN JOURNAL OF PAIN 2020. [DOI: 10.4103/ijpn.ijpn_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
9
|
Rydman E, Bankler S, Ponzer S, Järnbert-Pettersson H. Quantifying cervical spondylosis: reliability testing of a coherent CT-based scoring system. BMC Med Imaging 2019; 19:45. [PMID: 31146696 PMCID: PMC6543559 DOI: 10.1186/s12880-019-0342-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
Background Grading of degeneration of the cervical spine is of great clinical value, considering the vast amount of radiological investigations that are being done with this query. Despite the fact that Computed Tomography (CT) is frequently used in clinical practice there is today no user-friendly and reliable scoring system for assessment of cervical spondylosis on CT-scans available. The aim of this study was to establish a scoring system for cervical spondylosis based on CT-scans and to test it for reliability. Methods Twenty adult patients undergoing CT of the cervical spine due to neck pain following a motor vehicle accident were included in the study. Three independent raters, i.e. one orthopedic surgeon and two radiologists, assessed their CT-scans. Two of the raters repeated the assessments after three months. A radiographic-based scoring system for cervical disc degeneration, addressing disc height, osteophytes and endplate sclerosis, was applied on CT and tested for reliability. A pre-existing, reliable CT-based scoring system for facet joint degeneration, considering joint space narrowing, osteophytes and irregularity of the articular surface was modified and reevaluated. This in order to develop a coherent CT-based total degeneration score for cervical spondylosis. Results The scoring systems for cervical disc degeneration and facet joint degeneration both exhibited an acceptable or better level of strength of agreement regarding intra- and interrater agreement. The total disc degeneration score showed a moderate level of inter-rater reliability with a kappa-value of 0.47 and a good intra-rater agreement with intra-class correlation coefficients (ICC) of 0.67 and 0.60 for the two raters performing the assessments. The total facet joint degeneration score showed a moderate level of inter-rater reliability (kappa 0.54) and an excellent intra-rater agreement with ICC 0.75 for one of the raters and fair for the other rater (ICC 0.54). When the total disc and facet joint degeneration score were classified into a three-point total degeneration score the inter-rater agreement was 0.695 and the ICC 0.82 and 0.73 respectively. Conclusions This coherent scoring system assessing both disc degeneration and facet joint degeneration on CT-scans of the cervical spine was shown to meet the standards of reliability.
Collapse
Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Orthopedics, Södersjukhuset, SE-118 83, Stockholm, Sweden.
| | - Sara Bankler
- Department of Radiology, Södersjukhuset, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
|
10
|
The Impact of Psychosocial and Contextual Factors on Individuals Who Sustain Whiplash-Associated Disorders in Motor Vehicle Collisions. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9317-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|