Some people suffering from chronic whiplash pain may get substantial relief with cervical fusion surgery, say Swedish researchers.

The controversial finding runs against the last 2 published reviews, which found no evidence of a benefit from surgery following whiplash injury.

But the researchers from Stockholm’s Karolinska Hospital say this may be because no randomised trials have been conducted until now.

Their study identified 49 whiplash patients suffering from long-term pain who had symptoms indicating a segmental problem (persistent central neck ache and movement-related stabbing pains), despite normal x-rays.

These patients were randomised to a comprehensive rehabilitation program or to fusion surgery, once the affected segment had been clinically identified.

Two years later, patients who had undergone surgery were doing significantly better.

Over 80% of surgery patients said they had no or significantly less neck pain than before the intervention, compared with 12% of those randomised to rehabilitation.

“The results support the supposition that among patients with central neck pain for long periods of time following a whiplash injury, there are some in whom neck pain emanates from a motion segment, probably the disc, a situation suitable for fusion surgery,” the researchers write.

They caution that most whiplash patients will recover within weeks or months, although some may continue to have pain for years, despite conservative treatment.

Trial participants had all suffered neck pain following a car accident, mostly rear-end collisions.

Those in the rehabilitation arm received therapy for 6 weeks from a physiotherapist, occupational therapist, psychologist, social-service worker, nurse and physician.

Last Reviewed: 12/04/2016



Scandinavian Journal of Pain 2016; online.