What can you tell me about a procedure called neurotomy for chronic neck pain from a whiplash injury? Does it really work? How long does the pain relief last? I've heard it works for some people but not for others.
Successful treatment for chronic neck pain associated with a history of whiplash has eluded physicians and patients for a long time. Part of the difficulty is the fact that the actual source of chronic neck pain after whiplash injuries has been a mystery.
It has been difficult to sort out because there are so many possibilities within the neck structures (hemorrhage, fracture, contusion, tears). But over the last 10 years studies have started to consistently point to one area: the cervical zygapophysial joints.
A more common term for these joints is facet joints. Between each pair of vertebrae are two facet joints. These joints connect the vertebrae together in a chain but slide against one another to allow the neck to move in many directions. Except for the very top and bottom of the spinal column, each vertebra has two facet joints on each side. The ones on top connect to the vertebra above; the ones below join with the vertebra below.
Studies of humans after death called postmortem studies have really helped identify the problem areas. Animal studies and biomechanics studies have also added similar information about the possible lesions of whiplash. The agreement among all these studies called convergence has increased the validity of what were previously just theories about the physical causes of neck pain after whiplash.
Experimental treatment blocking the nerves to the facet joints has also added confirmation that the source of chronic post-whiplash neck pain is coming from those particular joints. Nerve blocks have become both a diagnostic test and a treatment. In other words, if the nerve block eliminates the pain, the problem is coming from the facet joint.
Radiofrequency neurotomy is another treatment that has developed out of the knowledge that blocking nerve signals to the joint can eliminate the pain. This is a neurosurgical procedure. Radiofrequency waves directed at the tiny nerve branches to the joints create enough heat to destroy the nerve endings.
The pain relief is long-lasting and works better than any other surgical or conservative approach for 70 per cent of the patients studied. And if the pain comes back, the neurotomy procedure can be repeated successfully. Ongoing relief with return to work and daily activities is reported for 60 per cent of patients who have a repeat radiofrequency neurotomy.
Diagnostic nerve blocks help identify patients who might benefit from neurotomy before actually doing the procedure. This may be a good first step for you. But keep in mind that zygapophysial (facet) joint pain is not the only cause of chronic whiplash pain. But it does account for up to half of all chronic neck pain sufferers. A 70 per cent success rate for that many patients is considered a major breakthrough in this area.
Nikolai Bogduk, MD, PhD. On Cervical Zygapophysial Joint Pain After Whiplash. In Spine. December 1, 2011. Vol. 36. No. 25S. Pp. S194-199.
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