Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Spine J. 2020 Aug;20(8):1229-1238. doi: 10.1016/j.spinee.2020.02.005. Epub 2020 Feb 10.
Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma.
Our objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury.
Prospective cohort study.
Forty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited.
Self-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale.
The participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2-C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months.
No systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%-78%) and for the group with high neck tilt, 8% (95% CI: 3%-25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%-72%) and for those with high TIA 14% (95% CI 4%-26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias.
This study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.
挥鞭样损伤相关性疾病是慢性颈痛的常见病因。有几种颈椎角度的放射学变量被认为具有固有特征，即它们受体位影响极小。然而，这些变量与疼痛状况之间的关系仍知之甚少。据我们所知，以前没有研究调查固有角度变量与挥鞭伤后结果之间的关系。
我们的目的是（1）研究 2 名评估者之间矢状面影像学变量的组内一致性，以及（2）研究这些变量与挥鞭伤后自我感知的无恢复之间的任何关联。
前瞻性队列研究。
46 名年龄在 16 岁至 70 岁之间的患者，因颈部疼痛在机动车事故后到急诊就诊。
自我感知的无恢复（是/否）是主要结局指标。次要结局指标为数字评分量表上的疼痛程度。
参与者接受仰卧位计算机断层扫描。由 2 名独立评估者测量计算机断层扫描上的矢状面排列变量（T1 斜率、颈部倾斜、胸入口角[TIA]和 C2-C7 角）。使用配对样本 t 检验和每个变量的 Bland-Altman 图测试组内一致性。患者在 6 个月后进行随访。
在评估的变量方面，2 名评估者之间没有发现系统差异。总无恢复率为 28%。对于低颈部倾斜组，无恢复率为 50%（95%置信区间：36%-78%），高颈部倾斜组为 8%（95%置信区间：3%-25%）。低 TIA 组的无恢复率为 50%（95%置信区间：29%-72%），高 TIA 组为 14%（95%置信区间：4%-26%）。在调整了可能的混杂因素后，这些关联仍然显著。组内分析显示出令人满意的一致性，没有比例偏差。
本研究表明颈椎矢状位固有排列与挥鞭伤后结果之间存在关联。
