Farrell S1,2, Smith A3, Hancock M4, Webb A5, Sterling M1,2
1The University of Queensland, RECOVER Injury Research Centre, Brisbane, Australia, 2Griffith University, Menzies Health Institute Queensland, Gold Coast, Australia, 3Griffith University, School of Allied Health Sciences, Gold Coast, Australia, 4Macquarie University, Discipline of Physiotherapy, Sydney, Australia, 5Australian National University, Medical School, College of Health and Medicine, Canberra, Australia
Background: Uncertainty exists regarding the clinical significance of findings on cervical spine magnetic resonance imaging (MRI) in people with whiplash associated disorder (WAD) or non-specific neck pain (NSNP).
Purpose: To compare the presence of cervical spine MRI findings in individuals with WAD or NSNP with pain-free controls.
Methods: A systematic review with meta-analysis was undertaken, comparing cervical spine MRI findings in people with WAD or NSNP, with pain-free controls. Medline, EMBASE, CINAHL, Web of Science, SCOPUS and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies that reported cervical spine MRI findings in adults with WAD and pain-free controls, or with NSNP and pain-free controls. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted, and meta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data, respectively. Overall quality of the evidence from meta-analyses was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach.
Results: In total, 31 studies were included (eight comparing individuals with acute WAD to controls, 14 comparing individuals with chronic WAD to controls, 12 comparing individuals with chronic NSNP to controls) comprising 3,995 participants. Rectus capitis posterior major cross-sectional area was smaller in people with chronic NSNP than controls (two studies: SMD -1.18 [95% CI -1.65, -0.71]). The remaining meta-analysis comparisons showed no significant between group differences in MRI findings (i.e. multifidus cross sectional area, multifidus muscle fat infiltration and alar ligament signal intensity in people with chronic WAD; multifidus, sternocleidomastoid, semispinalis capitis, longus capitis, rectus capitis posterior minor, splenius capitis cross sectional area, disc degeneration and Modic changes in people with chronic NSNP). The quality of evidence of these meta-analyses were mostly low or very low, due to small sample sizes and high heterogeneity.
Conclusion(s): Due to the typically low-quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared to pain-free controls.
Implications: These data indicate that the current evidence regarding the presence - and conversely, absence - of differences in cervical spine MRI findings between people with neck pain and pain-free controls is typically weak. As such, the clinical significance of cervical spine MRI findings in WAD and NSNP remains unclear. Physical therapists should continue to embrace existing guidelines on imaging in WAD and NSNP, and interpret MRI as part of the wider clinical scenario in patients with these neck pain conditions.
Keywords: Neck pain, whiplash injuries, magnetic resonance imaging
Funding acknowledgements: No specific funding was received for this study
Purpose: To compare the presence of cervical spine MRI findings in individuals with WAD or NSNP with pain-free controls.
Methods: A systematic review with meta-analysis was undertaken, comparing cervical spine MRI findings in people with WAD or NSNP, with pain-free controls. Medline, EMBASE, CINAHL, Web of Science, SCOPUS and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies that reported cervical spine MRI findings in adults with WAD and pain-free controls, or with NSNP and pain-free controls. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted, and meta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data, respectively. Overall quality of the evidence from meta-analyses was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach.
Results: In total, 31 studies were included (eight comparing individuals with acute WAD to controls, 14 comparing individuals with chronic WAD to controls, 12 comparing individuals with chronic NSNP to controls) comprising 3,995 participants. Rectus capitis posterior major cross-sectional area was smaller in people with chronic NSNP than controls (two studies: SMD -1.18 [95% CI -1.65, -0.71]). The remaining meta-analysis comparisons showed no significant between group differences in MRI findings (i.e. multifidus cross sectional area, multifidus muscle fat infiltration and alar ligament signal intensity in people with chronic WAD; multifidus, sternocleidomastoid, semispinalis capitis, longus capitis, rectus capitis posterior minor, splenius capitis cross sectional area, disc degeneration and Modic changes in people with chronic NSNP). The quality of evidence of these meta-analyses were mostly low or very low, due to small sample sizes and high heterogeneity.
Conclusion(s): Due to the typically low-quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared to pain-free controls.
Implications: These data indicate that the current evidence regarding the presence - and conversely, absence - of differences in cervical spine MRI findings between people with neck pain and pain-free controls is typically weak. As such, the clinical significance of cervical spine MRI findings in WAD and NSNP remains unclear. Physical therapists should continue to embrace existing guidelines on imaging in WAD and NSNP, and interpret MRI as part of the wider clinical scenario in patients with these neck pain conditions.
Keywords: Neck pain, whiplash injuries, magnetic resonance imaging
Funding acknowledgements: No specific funding was received for this study
Topic: Musculoskeletal: spine
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Systematic review research - ethics approval not applicable
All authors, affiliations and abstracts have been published as submitted.
