Chronic Neck Pain, Post-Traumatic Neck Pain, Whiplash Injury, Whiplash Injury of Cervical Spine
Conditions
Keywords
Whiplash, Cervical Facet Joint Pain, Cervical Radiofrequency, Anterior Cervical Discectomy and Fusion, Chronic Neck Pain, Post-Traumatic Neck Pain, Radiofrequency Neurotomy, Comparative Effectiveness, Retrospective Cohort
Brief summary
Chronic neck pain after whiplash injury is a common and disabling condition that can significantly affect quality of life, daily activities, and psychological well-being. In some patients, pain persists for months or years despite conservative treatments, leading to consideration of more invasive therapeutic options. Two commonly used treatments in selected patients are cervical zygapophyseal (facet) joint radiofrequency and anterior cervical discectomy and fusion (ACDF), but their comparative long-term outcomes in routine clinical practice are not well defined. This study aims to compare the clinical, functional, and psychological outcomes of patients with chronic post-traumatic cervical whiplash who were treated either with cervical medial branch radiofrequency or with anterior cervical discectomy and fusion. The study uses a retrospective observational design based on the review of medical records from a tertiary hospital over a 20-year period. Adult patients diagnosed with chronic post-traumatic whiplash and treated between 2005 and 2025 are included. All treatments were performed as part of usual clinical care and were not assigned for research purposes. Data collected include patient characteristics, injury mechanism, type of treatment received, pain intensity, functional disability, psychological symptoms, need for repeat procedures or additional surgery, and clinical follow-up information. The primary objective is to compare pain relief between the two treatment groups. Secondary objectives include comparison of functional recovery, duration of treatment benefit, recurrence of pain, psychological symptoms, need for further interventions, and return to daily activities or work. By analyzing long-term real-world data, this study seeks to improve understanding of the relative effectiveness of cervical radiofrequency and surgical fusion for chronic whiplash pain, helping clinicians and patients make more informed treatment decisions. No new interventions are performed as part of this study, and all data are analyzed anonymously.
Detailed description
Chronic post-traumatic cervical whiplash is a frequent cause of persistent neck pain, functional disability, and psychological distress following acceleration-deceleration injuries. Although many patients recover with conservative management, a substantial proportion develop chronic symptoms lasting months or years. In these cases, identifying the predominant pain generator is essential for guiding treatment. Previous studies have shown that the cervical zygapophyseal (facet) joints are a common source of chronic pain after whiplash injury, leading to the development of targeted interventional strategies. Cervical medial branch radiofrequency is a minimally invasive technique designed to interrupt nociceptive input from the facet joints and has been associated with meaningful pain relief and functional improvement in appropriately selected patients. In parallel, anterior cervical discectomy and fusion (ACDF) has been used in selected patients with persistent post-traumatic neck pain, particularly when structural abnormalities are identified. However, ACDF is a more invasive intervention, associated with greater treatment burden and potential long-term consequences, and its role in isolated chronic whiplash without radiculopathy or myelopathy remains debated. Despite the widespread clinical use of both approaches, there is limited evidence directly comparing their real-world effectiveness in patients with chronic post-traumatic whiplash. The present study addresses this gap by examining long-term outcomes in a large, single-center cohort treated as part of routine clinical practice over a 20-year period. This study is designed as a retrospective observational cohort analysis conducted at a tertiary care hospital. Patients are categorized according to the definitive treatment they received as part of standard clinical care: cervical medial branch radiofrequency or anterior cervical discectomy and fusion. Treatment decisions were based on clinical judgment and available diagnostic information and were not determined by any research protocol. Clinical data are obtained through review of electronic medical records and procedural documentation. The analysis focuses on comparative evaluation of outcomes between treatment groups, with attention to differences in patient characteristics and clinical context. Multivariable statistical methods, and where appropriate propensity-based adjustment, are used to account for potential confounding factors inherent to observational comparative research. Because this is a retrospective observational study based on routine clinical care, all analyses are exploratory and hypothesis-generating in nature. By leveraging long-term real-world clinical data, this study seeks to improve understanding of the relative benefits and limitations of minimally invasive versus surgical treatment strategies for chronic post-traumatic whiplash, supporting more informed and evidence-based clinical decision-making.
Interventions
None listed
Sponsors
University of Valencia
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older at the time of treatment. * Clinical diagnosis of chronic post-traumatic cervical whiplash, with symptoms persisting for at least 3 months following the traumatic event. * Cervical pain attributed to a traumatic acceleration-deceleration mechanism (whiplash injury). * Treatment with either: * cervical medial branch radiofrequency, or * anterior cervical discectomy and fusion performed as part of routine clinical care.
Exclusion criteria
* Cervical pain primarily attributable to non-traumatic conditions, including degenerative cervical disease, inflammatory disorders, neoplastic disease, infection, radiculopathy, or cervical myelopathy. * History of previous cervical spine surgery before the index treatment, which could interfere with the assessment of treatment outcomes. * Patients who received both cervical radiofrequency and anterior cervical discectomy and fusion for the same clinical episode of whiplash-related pain. * Cervical procedures performed outside the Hospital General Universitario de Valencia or without verifiable technical documentation in the medical record. Insufficient clinical documentation to confirm the diagnosis of post-traumatic whiplash or to evaluate pain, functional, or psychological outcomes after treatment. * Absence of clinical follow-up data after the index treatment. * Age under 18 years at the time of treatment. Availability of clinical follow-up data after treatment that allows assessment of pain and/or functional outcomes. Treatment performed at the Hospital General Universitario de Valencia between 2005 and 2025.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Relief After Treatment | From baseline (pre-treatment) to last documented clinical follow-up, assessed up to 12 months after treatment. | Change in neck pain intensity following treatment measured using the Visual Analogue Scale for pain (VAS; 0-10 scale, where 0 indicates no pain and 10 indicates worst imaginable pain). Pain relief will be evaluated as absolute change from baseline and as the proportion of patients achieving a clinically meaningful reduction of at least 50% from baseline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Functional Disability of the Neck | From baseline to last documented clinical follow-up, assessed up to 12 months after treatment. | Functional disability assessed using the Neck Disability Index (NDI; 0-50 points, where higher scores indicate greater disability), when available in the medical record. Outcomes will be analyzed as change from baseline and overall functional improvement after treatment. |
| Duration of Pain Relief | From date of index treatment to documented recurrence of pain or last clinical follow-up, assessed up to 24 months after treatment. | Time from index treatment to recurrence of neck pain defined as a return to at least 50% of baseline pain intensity, based on clinical records. |
| Need for Additional Interventions | From treatment to additional intervention or last documented follow-up, assessed up to 24 months. | Proportion of patients requiring repeat cervical radiofrequency procedures, revision surgery, or additional cervical interventions due to recurrence or persistence of symptoms. |
| Psychological Symptoms Related to Chronic Pain | From baseline to last documented clinical follow-up, assessed up to 12 months after treatment. | Presence and evolution of psychological symptoms assessed using standardized instruments such as the Hospital Anxiety and Depression Scale (HADS; 0-21 per subscale, where higher scores indicate worse symptoms) or the Symptom Checklist-90-Revised (SCL-90-R; higher scores indicate greater psychological distress), when available, or through structured clinical documentation. |
| Return to Daily Activities or Work | From treatment to documented return to work or resumption of usual daily activities, assessed up to 12 months after treatment. | Functional recovery assessed through clinical documentation of return to work or resumption of usual daily activities after treatment. |
Countries
Spain
Contacts
PRINCIPAL_INVESTIGATORVicente Vanaclocha Vanaclocha, MD PhD
University of Valencia
Outcome results
None listed