Johansson Mats Peter, Baann Liane Martin Skogheim, Bendix Tom, Kasch Helge, Kongsted Alice
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Man Ther. 2011 Aug;16(4):378-83. doi: 10.1016/j.math.2011.01.004. Epub 2011 Feb 3.
The mechanisms for developing long-lasting neck pain after whiplash injuries are still largely unrevealed. In the present study it was investigated whether a kyphotic deformity of the cervical spine, as opposed to a straight or a lordotic spine, was associated with the symptoms at baseline, and with the prognosis one year following a whiplash injury. MRI was performed in 171 subjects about 10 d after the accident, and 104 participated in the pain recording at 1-year follow-up. It was demonstrated that postures as seen on MRI can be reliably categorized and that a straight spine is the most frequent appearance of the cervical spine in supine MRI. In relation to symptoms it was seen that a kyphotic deformity was associated with reporting the highest intensities of headache at baseline, but not with an increased risk of long-lasting neck pain or headache. In conclusion, a kyphotic deformity is not significantly associated with chronic whiplash associated pain. Moreover, it is a clear clinical implication that pain should not be ascribed to a straight spine on MRI. We suggest that future trials on cervical posture focus upon the presence of kyphotic deformity rather than just on the absence of lordosis.
挥鞭样损伤后出现长期颈部疼痛的机制在很大程度上仍未明了。在本研究中，调查了与直形或前凸脊柱相反的颈椎后凸畸形是否与基线时的症状以及挥鞭样损伤后一年的预后相关。事故发生约10天后，对171名受试者进行了MRI检查，104名受试者参与了1年随访时的疼痛记录。结果表明，MRI上所见的姿势可以可靠地分类，并且直形脊柱是仰卧位MRI中颈椎最常见的表现。关于症状，发现后凸畸形与基线时报告的最高强度头痛相关，但与长期颈部疼痛或头痛风险增加无关。总之，后凸畸形与慢性挥鞭样损伤相关疼痛无显著关联。此外，一个明确的临床意义是，不应将疼痛归因于MRI上的直形脊柱。我们建议，未来关于颈椎姿势的试验应关注后凸畸形的存在，而不仅仅是前凸的缺失。
