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J Am Acad Orthop Surg, Vol 15, No 10, October 2007, 596-606.
© 2007 the American Academy of Orthopaedic Surgeons
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Chronic Whiplash and Whiplash-Associated Disorders: An Evidence-Based Approach

Jerome Schofferman, MD, Nikolai Bogduk, MD and Paul Slosar, MD

Dr. Schofferman is Section Head, Pain Medicine, SpineCare Medical Group, and Director, Research and Education, San Francisco Spine Institute, Daly City, CA. Dr. Bogduk is Conjoint Professor of Pain Medicine, University of Newcastle, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, Australia. Dr. Slosar is President, SpineCare Medical Group, and Associate Director, San Francisco Spine Institute, Daly City.

Dr. Schofferman or a member of his immediate family has received research or institutional support from Medtronic Sofamor Danek. Neither Dr. Bogduk nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. Slosar or a member of his immediate family has received research or institutional support from Medtronic.

Reprint requests: Dr. Schofferman, SpineCare Medical Group, Suite 200, 1850 Sullivan Avenue, Daly City, CA 94015.

Whiplash is neck pain experienced as a result of a motor vehicle collision or similar trauma. Following a motor vehicle collision, 15% to 40% of patients with acute neck pain develop chronic neck pain. The cervical facet joint is the most common source of chronic neck pain after whiplash injury, followed by disk pain. Some patients experience pain from both structures. Initial management recommendations need not be directed toward an exact structural cause, but treatment includes advising the patient to remain active, prescribing medications when necessary, and providing advice regarding the generally favorable outcome. When neck pain persists, the physician should recommend medial branch blocks of the dorsal rami of the spinal nerves that supply the putative painful facet joint or joints; this is done to determine whether the facet joints are the cause of pain. When significant relief occurs on two occasions, radiofrequency neurotomy typically provides substantial relief for approximately 8 to 12 months and can be repeated indefinitely as needed. Occasionally, long-term treatment with medication may be indicated. Anterior cervical diskectomy and fusion is necessary on rare occasions.




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J. Am. Acad. Ortho. Surg., March 1, 2008; 16(3): 121 - 122.
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Copyright © 2007 by the American Academy of Orthopaedic Surgeons.