Crippling upper back pain after whiplash and other motor vehicle collisions caused by thoracic disc herniations: report of 10 cases.
METHODS
Retrospective analysis of a prospectively collected database of thoracoscopic microdiscectomies performed at the Maastricht University Medical Center.


OBJECTIVE
Many victims of a motor vehicle collision (MVC) report crippling upper back pain resistant to conservative treatment. Although this pain is often regarded as nonspecific or related to a whiplash type of cervical spine injury, this study demonstrates it may be caused by a thoracic disc herniation.


BACKGROUND
Recent literature on bodily pain after whiplash and other MVCs has shown that most patients rather than pain confined to the posterior neck area (0.4%) report pain in multiple body areas, the most frequently affected region being the posterior trunk region, including the posterior neck, posterior shoulder, upper back, lumbar, and buttock areas. Although several patterns determining most variance in pain localization in these patients have been identified, different pathoanatomical and pathophysiological substrates underlying these patterns have not been identified. However, a high incidence of posterior shoulder pain (75%) and upper back pain (66%) is striking.


METHODS
In a series of 326 thoracoscopic microdiscectomies for one or more symptomatic TDHs, we identified 10 patients whose symptoms had started after an MVC. We analyzed their clinical and radiological presentation, intraoperative findings, and postoperative outcome.


RESULTS
All patients (7 females, 3 males; age, 26-58 yr, including 4 with typical whiplash complaints) had reported substantial improvement of their complaints except for their upper back pain. Most hernias were small or medium sized (n = 8), at the apex of the kyphotic curvature (n = 6), and to some extent calcified (n = 7). One year postoperatively, results were excellent in 7, good in 2, and poor in 1.


CONCLUSIONS
Crippling upper back pain after MVCs may be caused by a (previously asymptomatic) thoracic disc herniation. Although the exact pathophysiological mechanism has not been elucidated, results after thoracoscopic microdiscectomy are quite encouraging.
From the Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Erwin M J
EM
Cornips
D000063:Accidents, Traffic; D000328:Adult; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology*; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted; D013904:Thoracic Vertebrae / Q000601:surgery*; D014911:Whiplash Injuries / Q000150:complications* / Q000453:epidemiology