Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis

Abstract

Background There is uncertainty regarding the clinical significance of findings on MRI in patients with whiplash associated disorder (WAD) or nonspecific neck pain (NSNP). Purpose To compare the presence of cervical spine MRI findings in people with WAD or NSNP with pain‐free controls. Study Type Systematic review and meta‐analysis. Population Adults with WAD (n = 994), NSNP (n = 715), or pain‐free controls (n = 2323). Field Strength 0.5T, 1.5T, and 3.0T. Assessment Medline, EMBASE, CINAHL, Web of Science, SCOPUS, and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies for inclusion and extracted data. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Overall quality of the evidence from meta‐analysis was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Statistical Tests Meta‐analysis was performed using a random‐effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data. Results In total, 31 studies were included (eight comparing acute WAD to controls, 14 comparing chronic WAD to controls, 12 comparing chronic NSNP to controls) comprising 4032 participants. Rectus capitis posterior major cross‐sectional area was smaller in people with chronic NSNP than controls (two studies: SMD –1.18 [95% confidence interval [CI] –1.65, –0.71]). The remaining meta‐analysis comparisons showed no group differences in MRI findings. The quality of evidence was mostly low due to small sample sizes and high heterogeneity. Data Conclusion Given the typically low‐quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared with pain‐free controls. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018.

Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash?

“…Furthermore, for any of the candidate lesions, no structural cause of whiplash and its associated disorders (WAD) following a MVC has been consistently found with routine imaging applications, supporting the acknowledged position that the clinical course is driven by complex interactions of biological, psychological, and social factors [8]. The preponderance of such evidence appears to be driving a shift in clinical behaviours in which potential structural pathology is not adequately investigated [9,10].…”

Fluoroscopic Findings of Extra-Cervical Facet Joint Flow and Its Incidence on Cervical Facet Joint Arthrograms

“…CFJ pain is defined as pain originating from the CFJ. Because the clinical symptoms [11] and imaging findings [18] of CFJ syndrome are vague and unreliable, it is clinically diagnosed by excluding other causes of cervical pain, similar to low back pain [19]. CFJ injections with hypertonic saline can reproduce similar pain in patients with neck pain and headache [20].…”

Small fibre pathology in chronic whiplash‐associated disorder: A cross‐sectional study

“…Chronic WAD is thought to represent a complex interplay of musculoskeletal, psychosocial and neurological factors (Banic et al, 2004; Bogduk, 2011; Kamper et al., 2012; Sterling, 2010; Sterling, Jull, Vicenzino, & Kenardy, 2003). While it is plausible that some form of tissue lesion may occur in the initial injury (Uhrenholt, Grunnet‐Nilsson, & Hartvigsen, 2002), routine clinical imaging or electrodiagnostic testing typically does not identify a pathology that explains patients’ symptoms (Curatolo et al, 2011; Farrell, Smith, Hancock, Webb, & Sterling, 2019). Nevertheless, sensory impairments such as elevated thermal detection thresholds (Chien, Eliav, & Sterling, 2008b, 2009, 2010; Chien & Sterling, 2010; Raak & Wallin, 2006) and widespread hyperalgesia (Chien, Eliav, & Sterling, 2008b, 2009; Schneider et al, 2010) have been reported in patients with chronic WAD (van Oosterwijck, Nijs, Meeus, & Paul, 2013).…”