Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study.

Full Abstract

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.

Author information

Author/s: Sapir, D A (DA); Gorup, J M (JM);

Affiliation: Indiana Pain Institute, Lafayette, Indiana 47905, USA. sapirmd(-atsign-)aol.com

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Journal Article

Journal: Spine (Spine (Phila Pa 1976)), published in United States. (Language: eng)

Reference: 2001-Jun; vol 26 (issue 12) : pp E268-73

Dates: Created 2001/06/26; Completed 2001/08/23; Revised 2009/07/09;

PMID: 11426167, status: MEDLINE (last retrieval date: 7/24/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Spine (Phila Pa 1976). 2002 Feb 1;27(3):327-8. (PMID: 11805701)

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.