Chronic incapacitating neck and radiating arm pain and
other associated symptoms are common sequelae of auto accident-related neck injuries. The
majority of the patients eventually recover with the passage of time and non-operative
treatment. Ten to 15% of these patients go on to develop chronic incapacitating symptoms,
which often go undiagnosed because of the lack of specificity and sensitivity of routine
diagnostic studies. These patients become an enormous financial burden to society,
accounting for approximately 40% of all costs, most of which are related to reimbursement
for lost income. The patient often becomes frustrated, depressed, alienated and labeled as
fraudulent or a malingerer.By utilizing diagnostic blocks and
discography, pain generators have been more clearly identified in the cervical spine,
which allows for more effective treatment protocols and options for the patients. Although
some investigators feel that the cervical facet joint is the main source of whiplash
symptoms, the cervical disc has also been identified as a significant source of pain and
as amenable to anterior cervical discectomy and fusion.
It needs to be appreciated that this is a very complex condition that requires a
multidisciplinary team including psychologists, therapists, and pain management
specialists. We feel it is important to clearly identify the pain generators with
discography and, if necessary, with facet blocks before making a surgical decision.
Cervical injuries related to motor vehicle accidents may be associated with
cervical disc injuries. Approximately 90% of the chronic whiplash patients in our practice
have symptomatic provocative discography. Anterior cervical discectomy and fusion at the
symptomatic levels reliably relieved the majority of the symptoms in over 90% of our
patients. There is a high patient satisfaction rate and results are reproducible.
