Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma

Abstract

Background: Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of VF for discriminating between injured and uninjured populations. Methods: Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with VF facilities. Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. An ethical review and oversight were provided by the Spinal Injury Foundation, Broomfield, CO. Three statistical models were utilized to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of positive VF findings to correctly discriminate between injured and uninjured subjects. Results: A total of 196 subjects (119 injured, 77 uninjured) were included in the study. All three statistical models demonstrated high levels of sensitivity and specificity (i.e., receiver operating characteristic (ROC) values of 0.71 to 0.95), however, the model with the greatest practical clinical utility was based on the number of abnormal VF findings. For 2+ abnormal VF findings, the ROC was 0.88 (93% sensitivity, 79% specificity) and the PPV and NPV were both 88%. The highest PPV (1.0) was observed with 4+ abnormal findings. Conclusions: Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.

Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

“…The etiology of chronic symptoms following whiplash injury is however more challenging although a prerequisite is an acute whiplash injury and continued symptomatology over a period of at least six months. Although different types of injuries in chronic whiplash patients have been identified and debated, including for example injuries to the cervical facet joints [ 5 – 8 ], ligamentous instability in the craniocervical region [ 9 – 11 ], cervical spine muscle fat infiltration [ 12 , 13 ] and tonsillar ectopia [ 14 ], there is currently no evidence to support an association between identifiable structural/somatic injuries and chronic symptoms following whiplash injury [ 15 ]. Similarly, pathophysiological findings have been observed, e.g.…”

Myofascial Treatment for Microcirculation in Patients with Postural Neck and Shoulder Pain

“…Several factors, such as muscles, ligaments, tendons, skin, fat (or adipose) tissue, and joint structure must be considered when assessing flexibility around a joint. In contrast to the measurement of the global neck ROM that does not reveal the precise motion or restriction of individual vertebral segments, some researchers have applied videofluoroscopy to evaluate different motion patterns or anatomic changes between normal and pathological spine [ 12 , 13 , 14 ].…”

Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine

“…Intervertebral instability secondary to intervertebral ligamentous injury is a relatively common finding among patients with whiplash trauma-related chronic neck pain [ 1 ]. The clinical presentation can be particularly complicated when the instability is in the upper cervical spine (i.e., between the occiput, atlas, and axis [C0-2]), as patients may suffer from nonspecific symptoms of headache, vertigo, and neck pain, the origin of which can be difficult to pinpoint [ 2 ].…”

“…The diagnosis of symptomatic spinal instability requires a combination of symptoms consistent with the condition, and radiographic evidence of extra-physiologic movement at the joint in the relevant plane and direction, which may or may not be accompanied by MRI evidence of ligamentous disruption. A diagnosis of anterior or posterior instability of the sub-axial spine (C2–C7) may be made via flexion and extension radiographs, or more involved evaluations of wider range of movements can be accomplished via fluoroscopic examination [ 1 ]. In contrast, the evaluation and diagnosis of instability in the upper cervical spine is made more difficult by the anatomical complexity and predominant type of movement of the joints, which is rotation about the vertical axis [ 3 ].…”