Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy.
BACKGROUND
Although in clinical use, there is only 1 published case report on the efficacy of intraarticular regeneration injection therapy (RIT) (a.k.a. prolotheraphy). This report supports a rationale for future clinical trials of this technique.


OBJECTIVE
To assess the efficacy of intraarticular zygapophysial joint RIT in patients with chronic whiplash related neck pain that failed other conservative and interventional procedures. Patients were treated with intraarticular RIT and reassessed over 1 year.


METHODS
Retrospective case review of prospective data.


METHODS
Eighteen consecutive patients were treated with intraarticular prolotherapy by placing 0.5 - 1mL of 20% dextrose solution into each zygapophysial joint, after confirmation of intraarticular location with radiographic contrast, using 25-gauge spinal needles and fluoroscopic guidance. Solution was prepared by diluting D50W with 1% lidocaine.


RESULTS
Fifteen patients completed treatment. Three patients had bilateral treatment, leaving 18 sides for analysis. Mean Neck Disability Index (NDI) pre-treatment was 24.71 and decreased post-treatment to 14.21 (2 months), 13.45 (6 months), 10.94 (12 months). Average change NDI=13.77 (p<0.0001) baseline versus 12 months. Symptoms for 14 patients were from motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2) p=0.0003.


CONCLUSIONS
Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy. Concurrent physiotherapy helped reduce post-procedure neck stiffness. Future trials should consider gender when deciding how many treatments to administer. Litigation was not a barrier to recovery.
Hooper
R Allen
RA
Advanced Spinal Care Centre, Calgary, Alberta, Canada. ahooper@ucalgary.ca
Frizzell
J Bevan
JB
Faris
Peter
P
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002574:Cervical Vertebrae; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007593:Joint Instability / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008012:Lidocaine / Q000008:administration & dosage*; D008023:Ligaments, Articular / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000503:physiopathology; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D026741:Physical Therapy Modalities; D012038:Regeneration / Q000187:drug effects; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D021801:Zygapophyseal Joint / Q000187:drug effects / Q000502:physiology* / Q000503:physiopathology
D000779:Anesthetics, Local; D008012:Lidocaine; D005947:Glucose