Association between cervical degeneration and self-perceived non-recovery after whiplash injury

Abstract Background Context Pre-existing radiological degenerative changes have not previously been considered a risk factor for non-recovery from neck pain due to motor vehicle accidents (MVA). Results from previous studies are however often based on assessment of plain radiography or MRI and little consideration has been given to facet joints. Furthermore, previous studies have often lacked a validated scoring system for degenerative changes. Purpose To investigate the association between cervical degeneration on computed tomography (CT) and non-recovery after whiplash trauma. Study Design Longitudinal cohort study. Patient Sample One hundred twenty-one patients attending the Emergency Department because of neck pain after MVA, 2015-2017, with a valid CT-scan of the cervical spine and completion of follow up after 6 months. Outcome measures The primary outcome measure was self-perceived non-recovery (yes/no) after 6 months. A secondary outcome measure was self-reported pain level (Numeric Rating Scale). Methods Baseline data regarding demographics and health factors were gathered through a web-based questionnaire. Degeneration of facet joints and intervertebral discs was assessed on CT-scans according to a validated scoring system. Binary logistic regression was used to study the association between cervical degeneration and non-recovery. Results Moderate facet joint degeneration was associated with non-recovery. In the group with moderate degree of facet joint degeneration, 69.6% reported non-recovery compared with 23.6% among patients without any signs of degeneration (adjusted OR 6.7 (95 % C.I: 1.9-24.3)). There was no association between disc degeneration and non-recovery. Combined facet joint degeneration and disc degeneration were associated with non-recovery (aOR 6.2 (2.0-19.0)). Conclusions These results suggest that cervical degeneration, especially facet joint degeneration, is a risk factor for non-recovery after whiplash trauma. We hypothesize that whiplash trauma can be a trigger for painful manifestation of previously asymptomatic facet joint degeneration.