Cervical Radiofrequency Neurotomy Reduces Central Hyperexcitability and Improves Neck Movement in Individuals with Chronic Whiplash

Authors

  • Ashley Dean Smith PT,

    Corresponding author
    1. Division of Physiotherapy, NHMRC Centre of Clinical Excellence Spinal Pain, Injury and Health, University of Queensland, Brisbane, Queensland, Australia
    2. Advanced Spinal Care Centre, Calgary, Alberta
    • Reprint requests to: Ashley Dean Smith, PT, Evidence Sport & Spinal Therapy, 201, 2000 Veteran's Place NW, Calgary, AB, Canada T3B 4N2. Tel: 403-210-9969; Fax: 403-210-9084; E-mail: ashley.smith2@uqconnect.edu.au

    Search for more papers by this author
  • Gwendolen Jull PhD,

    1. Division of Physiotherapy, NHMRC Centre of Clinical Excellence Spinal Pain, Injury and Health, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Geoff Schneider PhD,

    1. Advanced Spinal Care Centre, Calgary, Alberta
    2. Faculty of Medicine, University of Calgary, Calgary, Alberta
    3. LifeMark Health, Calgary, Alberta
    Search for more papers by this author
  • Bevan Frizzell MD,

    1. Faculty of Medicine, University of Calgary, Calgary, Alberta
    2. Advanced Spinal Care Centre (EFW Radiology), Calgary, Alberta, Canada
    Search for more papers by this author
  • Robert Allen Hooper MD,

    1. Advanced Spinal Care Centre, Calgary, Alberta
    2. Faculty of Medicine, University of Calgary, Calgary, Alberta
    Search for more papers by this author
  • Michele Sterling PhD

    1. Centre of National Research on Disability and Rehabilitation Medicine, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author

  • Funding: MS receives a fellowship from the National Health and Medical Research Council of Australia. No funding sources were utilized for this study.
  • Conflict of Interest: The authors do not have any conflicts of interest to disclose.

Abstract

Objective

This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms.

Design

Prospective observational study of consecutive patients with healthy control comparison.

Setting

Tertiary spinal intervention centre in Calgary, Alberta, Canada.

Subjects

Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls.

Methods

Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann–Whitney tests.

Results

Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P < 0.0001). A nonsignificant trend for reduced muscle activity with the craniocervical flexion test (P > 0.13) was measured.

Conclusions

Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input.

Ancillary