The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia; Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
Am J Emerg Med. 2020 May;38(5):869-873. doi: 10.1016/j.ajem.2019.06.052. Epub 2019 Jul 1.
There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery.
This is a secondary analysis from a database of 97 acutely injured participants enrolled in a prospective inception cohort study. Thirty-eight participants underwent standard of care cervical spine CT in the emergency medicine department. All 38 participants were assessed at <1-week, 2-weeks, and 3-months post-injury and classified using percentage scores on the Neck Disability Index (recovered/mild (NDI of 0-28%) or moderate/severe (NDI ≥ 30%)). Between-group comparison of categorical variables (gender (male/female), presence of at least one CT finding (yes/no), and presence of ≥3 pathologies on CT (yes/no)) was conducted using 2-tailed Fisher's exact test.
Participants from both groups demonstrated at least one observable pathology. The group with persistent moderate/severe symptoms presented with significantly more pathology at baseline than those who later reported recovery or milder symptoms at 3-months post injury (p = 0.02).
This preliminary study, which needs replication in a larger cohort, provides foundation that the number of degenerative pathologies seen on initial post MVC CT may be associated with the subsequent clinical course of whiplash.
在挥鞭样损伤中，大多数影像学表现的临床重要性仍然有限。然而，CT 上发现的病变类型和数量可能有助于预后恢复模型。本研究的目的是根据影响恢复的已知因素来解释颈椎病变。
这是一项从前瞻性队列研究的数据库中进行的二次分析，该数据库纳入了 97 名急性损伤参与者。38 名参与者在急诊医学科进行了标准的颈椎 CT 检查。所有 38 名参与者在受伤后<1 周、2 周和 3 个月进行评估，并使用 Neck Disability Index（恢复/轻度（NDI 为 0-28%）或中度/重度（NDI≥30%）的百分比评分进行分类）。使用双侧 Fisher 精确检验比较分类变量（性别（男性/女性）、至少存在 1 项 CT 发现（是/否）和 CT 上至少存在 3 种病变（是/否））的组间差异。
两组参与者均表现出至少一种可观察到的病变。持续存在中度/重度症状的组在基线时的病变明显多于那些在受伤后 3 个月报告恢复或轻度症状的组（p=0.02）。
这项初步研究需要在更大的队列中进行复制，为初始 MVC CT 后看到的退行性病变数量可能与挥鞭样损伤的后续临床过程相关提供了基础。
