Document Detail


Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study.
MedLine Citation:
PMID:  11426167     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: The efficacy of radiofrequency medial branch neurotomy to treat cervical zygapophysial joint pain from whiplash was compared prospectively in litigants and nonlitigants. OBJECTIVES: 1) To assess the effect of monetary gain on treatment of zygapophysial joint pain in cervical whiplash. 2) To determine whether radiofrequency medial branch neurotomy is effective treatment for whiplash. SUMMARY OF BACKGROUND DATA: The influence of litigation on treatment outcome is a subject of controversy in both the medical and legal professions. This is the first study to examine this issue in a prospective manner using a previously proven diagnostic and therapeutic method. METHODS: Sixty patients with cervical whiplash who remained symptomatic after 20 weeks of conservative management were referred for radiofrequency cervical medial neurotomy. The patients were classified as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed. Each group underwent identical evaluation and treatment. Patients were observed for 1 year. Visual analogue scores and self-reported improvement were obtained before, immediately after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS: Forty-six patients completed the study. The overall reduction in cervical whiplash symptoms and visual analogue pain scores were significant immediately after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1 year (nonlitigants vs. litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up scores were higher than immediate post-treatment scores (nonlitigants vs. litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in the degree of symptomatology or response to treatment did not reach significance. CONCLUSIONS: These results demonstrate that the potential for secondary gain in patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment. These data contradict the common notion that litigation promotes malingering. This study also confirms the efficacy of radiofrequency medial branch neurotomy in the treatment of traumatic cervical facet arthropathy.
Authors:
D A Sapir; J M Gorup
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Spine     Volume:  26     ISSN:  0362-2436     ISO Abbreviation:  Spine     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-26     Completed Date:  2001-08-23     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E268-73     Citation Subset:  IM    
Affiliation:
Indiana Pain Institute, Lafayette, Indiana 47905, USA. sapirmd@aol.com
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic / legislation & jurisprudence*
Adult
Cervical Vertebrae / innervation,  surgery*
Electrosurgery*
Female
Humans
Insurance, Accident / economics
Male
Neck Pain / economics,  etiology,  physiopathology,  surgery*
Pain Measurement
Single-Blind Method
Treatment Outcome
Whiplash Injuries / complications,  economics,  surgery*
Zygapophyseal Joint / injuries,  physiopathology,  surgery*
Comments/Corrections
Comment In:
Spine (Phila Pa 1976). 2002 Feb 1;27(3):327-8   [PMID:  11805701 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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