Cervical Sprain / Strain

 

A cervical strain/strain is the result of a forceful flexion and extension injury typically from a motor vehicle accident, but other causes such as falls or certain sports can also contribute to this pain.  This is also frequently called a "whiplash".  A whiplash injury can cause a sprain injury of the ligaments and strain injury of the muscles around the neck.  

 

The force required to injury the ligaments and muscles will also often injury the small cervical facet joints in the back of the neck at one or several levels.  The facet joint pain may or may not be apparent initially after the injury; it is possible to be delayed months or years.  It is important to have a thorough physical exam by a Spine specialists who is trained in these disorders to identify which cervical facet joints are the source of the pain.

 

What gets injured during a whiplash accident?

Cervical facet joint pain is very common, and is the single most common cause for chronic neck pain after whiplash. The muscles and ligaments/tendons are forcibly torn to some degree with whiplash injuries.  These soft tissues are what cause the immediate pain soon after the accident.  Strong steroid or non-steroid anti-inflammatories are initial treatment of choice.  Icing the area and possibly gentle stretching via physical therapy is often needed.  If the pain persists, it may be that the cervical facet joints are too inflammed, and at this point, interventional pain injections are needed.

 

What are the options for treatment?

There are many excellent treatment options that can achieve long-term relief. Conservative treatments include steroid and non-steroid anti-inflammatory medications as needed, postural correction by stretching the shortened muscles and strengthening the opposing supportive muscles can be helpful. In recent studies, yoga has also been found to be beneficial.  Other options if medically appropriate include manipulation by a Doctor Osteopathic Medicine or Chiropractor, while others find benefit from acupuncture.

 

If conservative options no longer provide adequate relief, there are minimally invasive procedures that can help you achieve long term relief.  In a double-blind, placebo-controlled study, it was established that 70% of patients who obtained relief from medial branch blocks could obtain complete relief of pain if treated with radiofrequency ablation (RFA).  This study also showed unequivocally the results of cervical medial branch radiofrequency ablation were not a placebo.

 

Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the nerve (medial branch nerve) that provides the painful sensation from the facet joints to the brain is interrupted.  Radiofrequency can offer more long term relief of the cervical or lumbar region, and even other peripheral nerves.

 

What is Radiofrequency Ablation? 

Radiofrequency neurotomy is a safe, minimally-invasive procedure using a specialized machine and insulated needles with a probe to deliver high-frequency, low voltage radio waves that convert to heat that interrupts and eliminates the sensation of the pain from the target nerves.  Thermal radiofrequency interrupts the painful stimuli.

 

How is Radiofrequency Ablation Performed? 

The procedure is performed in a special fluoroscopy room utilized only for xray-guided injections.  The needle is positioned using bony landmarks seen on the x-ray that identify the nerve location. The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore, pinpoint accuracy is important in achieving the best results. Depending on the area treated, the procedure may take 30-45 minutes.

 

Is Radiofrequency Neurotomy Painful? 

Patients typically tolerate the procedure very well. Occasionally, if very nervous, we'll provide the patients with oral xanax to relax them during the procedure.  I utilize lots of numbing medicine in order to minimize any pain from the needle movement (much like a dentist does).  

 

How Long Does The Relief Last from Radiofrequency Ablation? 

The results with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between treatments, and lifestyle choices.  Results are also dependent on an accurate diagnosis made with nerve blocks that would indicate concordant pain relief.  Typically, we expect an average of 12 months of pain relief, however we've seen as short as 6-9 months or as long as 18+ months.

 

Is Radiofrequency Ablation Safe? 

Radiofrequency ablation is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies that claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer-reviewed scientific studies.