The behavioural response to whiplash injury

Abstract

Thirty-five patients were managed operatively after failure of an anterior cervical discectomy and arthrodesis. Failure was classified as the absence of fusion without deformity but with neck pain or radiculopathy, or both; the absence of fusion after anterior or posterior dislodgment of the graft; or kyphosis due to collapse of the graft or to an unrecognized posterior soft-tissue injury. Twenty-three patients had failure of the arthrodesis without deformity (with neck pain only, neck and arm pain, radiculopathy, or myelopathy). Four patients had dislodgment of the graft; in two of them the graft migrated anteriorly after a multilevel Robinson arthrodesis, and in two it migrated posteriorly after a Cloward arthrodesis. Eight patients had a failure because of a kyphotic deformity. Five of them had had a Cloward arthrodesis; one, a discectomy; and two, a Robinson arthrodesis. Six had received allograft bone. Operative treatment of the pseudarthrosis consisted of repeat resection of the disc space in the area of the failed arthrodesis followed by repeat anterior Robinson arthrodesis with decompression of the nerve root if the patient had radiculopathy. It consisted of anterior corpectomy or vertebral-body resection and strut-grafting with reduction of the deformity if the patient had migration of the graft and kyphosis. The reoperations were performed four months to fourteen years (average, thirty-two months) after the initial operation. The duration of follow-up after the second operation averaged forty-four months (range, twenty-four to 216 months). The result was excellent for twenty-nine patients, good for one, fair for four, and poor for one. We concluded that, in patients who have persistent symptoms after an anterior cervical arthrodesis, an excellent result can be achieved with repeat anterior decompression and autogenous bone-grafting.

The effect of pre-injury physical fitness on the initial severity and recovery from whiplash injury, at six-month follow-up

“…Four previous whiplash studies have used methods similar enough for some comparison to be made. 32,33,36,37 Gargan et al 36 found a recovery rate of 29% at three months (15 of 52), and Radanov et al 37 found a recovery rate of 56% (66 of 117) at three months and 69% (81 of 117) at six months. Overall, the findings of the current study fall within the range of these two previous studies, however it should be noted that the measurement methods were different in these two studies and recovery was used as the outcome rather than functional recovery.…”

Incidence and Outcome of Whiplash Injury After Multiple Trauma

“…63 It is now also speculated that some individuals are less able to cope with musculoskeletal disorders and, thus, may be slower in recovery from whiplash injury. 16 Identifying the etiology of whiplash injury has been proven difficult, however, in our study, we aimed to investigate the cause of whiplash injury in the study group by objectively scoring the severity of the injuries sustained, using AIS and ISS. AIS is grading the severity of individual injury in 6 defined anatomic regions: 1, minor injury; and 6, unsurvivable injury.…”

Frequency, Timing, and Course of Depressive Symptomatology After Whiplash

“…However, there is conflicting evidence about how soon or how frequently symptoms of depression occur after whiplash, and whether such symptoms resolve over time or increase in those whose pain persists. For example, Mayou et al 7 found that approximately 40% of patients had depressive symptomatology within 3 months of whiplash injury, whereas Gargan et al 8 reported no early elevations in psychological distress but increasing distress among whiplash patients failing to recover by 3 months. Wenzel et al 9 reported more depressive symptoms in those whose whiplash had occurred more than 2 years previously, but not in the more recently injured; and Richter et al 10 found that those with more severe or longer duration of pain had greater depressive symptomatology at 6 months.…”