Narrative review.
To summarize the evidence that implicates the cervical zygapophysial joints as the leading source of chronic neck pain after whiplash.
Reputedly a patho-anatomic basis for neck pain ...after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case.
Data were retrieved from studies that addressed the postmortem features and biomechanics of injury to the cervical zygapophysial joints, and from clinical studies of the diagnosis and treatment of zygapophysial joint pain, to illustrate convergent validity.
Postmortem studies show that a spectrum of injuries can befall the zygapophysial joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries.Clinical studies have shown that zygapophysial joint pain is very common among patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy.
The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical zygapophysial joints as a site of injury and source of pain, strongly implicates injury to these joints as a common basis for chronic neck pain after whiplash.
Summary Cervicogenic headache is characterised by pain referred to the head from the cervical spine. Although the International Headache Society recognises this type of headache as a distinct ...disorder, some clinicians remain sceptical. Laboratory and clinical studies have shown that pain from upper cervical joints and muscles can be referred to the head. Clinical diagnostic criteria have not proved valid, but a cervical source of pain can be established by use of fluoroscopically guided, controlled, diagnostic nerve blocks. In this Review, we outline the basic science and clinical evidence for cervicogenic headache and indicate how opposing approaches to its definition and diagnosis affect the evidence for its clinical management. We provide recommendations that enable a pragmatic approach to the diagnosis and management of probable cervicogenic headache, as well as a rigorous approach to the diagnosis and management of definite cervical headache.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background and Objective In systematic reviews of the reliability of diagnostic tests, no quality assessment tool has been used consistently. The aim of this study was to develop a specific ...quality appraisal tool for studies of diagnostic reliability. Methods Key principles for the quality of studies of diagnostic reliability were identified with reference to epidemiologic principles, existing quality appraisal checklists, and the Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS) resources. Specific items that encompassed each of the principles were developed. Experts in diagnostic research provided feedback on the items that were to form the appraisal tool. This process was iterative and continued until consensus among experts was reached. Results The Quality Appraisal of Reliability Studies (QAREL) checklist includes 11 items that explore seven principles. Items cover the spectrum of subjects, spectrum of examiners, examiner blinding, order effects of examination, suitability of the time interval among repeated measurements, appropriate test application and interpretation, and appropriate statistical analysis. Conclusions QAREL has been developed as a specific quality appraisal tool for studies of diagnostic reliability. The reliability of this tool in different contexts needs to be evaluated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
5.
The neck and headaches Bogduk, Nikolai
Neurologic clinics,
05/2014, Volume:
32, Issue:
2
Journal Article
Peer reviewed
Cervicogenic headache is pain referred to the head from a source in the cervical spine or mediated by cervical nerves. Clinical features allow for no more than a diagnosis of probable cervicogenic ...headache. Definitive diagnosis requires evidence of a cervical source of pain. For most treatments, the evidence is limited or poor. Many patients with probable cervicogenic headache can be managed with exercise therapy, with or without manual therapy. Intractable cervicogenic headache can be investigated with controlled diagnostic blocks of the upper cervical joints and treated with thermal radiofrequency neurotomy. Other interventions are experimental or speculative.
ABSTRACT
Objective. To determine the prevalence of different causes of neck pain in a private practice clinic.
Design. A retrospective audit of records.
Setting. A private spine pain clinic in the ...state of Washington, USA.
Patients. All consecutive patients, seen between January 2003 and January 2005, in whom a diagnosis of neck pain was made.
Interventions. The records of all patients were examined to determine the prevalence of various diagnostic entities determined by history, examination, and invasive test such as controlled diagnostic blocks and provocation discography.
Outcome Measures. Using different denominators, the prevalence of various conditions was determined in all patients who presented with neck pain, in patients in whom investigations were undertaken, and in patients who completed investigations.
Results. A large proportion of patients (36%) did not pursue investigations, which diluted the crude prevalence of various conditions. A further 17% deferred completing investigations. Among the 46% of patients who completed investigations, the prevalence of zygapophysial joint pain was 55%, discogenic pain was 16%, and lateral atlanto‐axial joint pain was 9%. A diagnosis remained elusive in only 32% of those patients who completed investigations.
Conclusions. In a private practice setting, a patho‐anatomic diagnosis for chronic neck pain can be established in over 80% of patients, provided that appropriate investigations are undertaken. The prevalence of cervical zygapophysial joint pain encountered in the present study corroborates the prevalence rates established in academic studies. Cervical discogenic pain does not appear to be common among patients with chronic neck pain.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Neck pain should not, and must not, be confused with cervical radicular pain. Equating the two conditions, or confusing them, results in misdiagnosis, inappropriate investigations, and inappropriate ...treatment that is destined to fail. So critical is the difference that pedagogically it is unwise to include the two topics in the same book, let alone the same article. However, traditions and expectations are hard to break. In deference to habit, this article addresses both entities, but does so by underplaying cervical radicular pain so as to retain the emphasis on neck pain.
ABSTRACT
Background. Confusion persists concerning the nature and efficacy of procedures variously known as facet denervation, lumbar medial branch radiofrequency neurotomy, and radiofrequency ...neurotomy or denervation for the treatment of back pain. Systematic reviews have not recognized the importance of patient selection and correct surgical technique when appraising the literature. As a result, negative conclusions about procedures have been drawn because lack of efficacy of one procedure has been misattributed to other, cognate, but different procedures.
Objectives. To demonstrate how the rationale and efficacy of lumbar medial branch neurotomy depends critically on correct selection of patients and use of surgically correct technique.
Methods. A narrative review and description of the available evidence, drawn from the personal libraries of the authors and from the bibliographies of systematic reviews.
Results. Three studies, commonly accepted as evidence of lack of effectiveness, were not valid tests of lumbar medial branch neurotomy because of errors in selection of patients or errors in surgical technique, or both. Two descriptive studies and three controlled studies that used valid or acceptable techniques consistently showed that lumbar medial branch neurotomy had positive effects on pain and disability. All valid, randomized controlled trials showed medial branch neurotomy to be more effective than sham treatment.
Discussion. Negative results have been reported only in studies that selected inappropriate patients or used surgically inaccurate techniques. All valid studies showed positive outcomes that cannot be attributed to placebo. Inappropriate conclusions have been drawn by systematic reviews that misrepresent invalid studies as providing evidence against the efficacy of lumbar medial branch neurotomy.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical ...spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of cervical spine injury. It summarizes the cardinal anatomical features of the cervical spine that determine how the cervical vertebrae and their joints behave. The results are collated of multiple studies that have measured the range of motion of individual joints of the cervical spine. However, modern studies are highlighted that reveal that, even under normal conditions, range of motion is not consistent either in time or according to the direction of motion. As well, detailed studies are summarized that reveal the order of movement of individual vertebrae as the cervical spine flexes or extends. The review concludes with an account of the location of instantaneous centres of rotation and their biological basis.
Relevance
The facts and precepts covered in this review underlie many observations that are critical to comprehending how the cervical spine behaves under adverse conditions, and how it might be injured. Forthcoming reviews draw on this information to explain how injuries might occur in situations where hitherto it was believed that no injury was possible, or that no evidence of injury could be detected.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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