@article{ref1,
title="The long-term impact of whiplash injuries on patient symptoms and the associated degenerative changes detected using MRI a prospective 20-year follow-up study  comparing patients with whiplash-associated disorders with asymptomatic subjects",
journal="Spine",
year="2020",
author="Tsuji, Takashi and Ichihara, Daisuke and Nishiwaki, Yuji and Katoh, Hiroyuki and Watanabe, Masahiko and Nojiri, Kenya and Okada, Eijiro and Matsumoto, Morio and Nakamura, Masaya and Fujiwara, Hirokazu and Daimon, Kenshi and Watanabe, Kota and Fujita, Nobuyuki and Ishihama, Hiroko and Shimizu, Kentaro",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="STUDY DESIGN: A longitudinal, 20-year comparative study of patients with whiplash-associated disorders (WAD). <br><br>OBJECTIVE: To clarify the long-term impact of  WAD on patient symptoms and on magnetic resonance imaging (MRI) findings of the  cervical spine, in comparison with asymptomatic volunteers. SUMMARY OF BACKGROUND  DATA: The long-term impact of WAD has not been fully elucidated. <br><br>METHODS: Between  1993 and 1996, we conducted a cross-sectional comparative study of 508 acute WAD  patients and 497 asymptomatic volunteers, all of whom underwent MRI on cervical  spine and physical examinations. For this 20-year follow-up comparative study, 75  WAD patients and 181 control subjects aged <60 years were recruited from the  original cohort. The MRI findings, including discs' signal intensities, posterior  disc protrusions, anterior dural compressions, spinal cord disc space narrowing, and  foraminal stenoses, were evaluated using 2 to 4 numerical grades. The results of the  WAD patients and control subjects were compared. <br><br>RESULTS: In this follow-up, the  prevalence of shoulder stiffness (72.0% vs. 45.9%), headache (24.0% vs. 12.2%), and  arm pain (13.3% vs. 3.9%) were significantly greater in WAD patients than in control  subjects. The multi-regression analysis revealed that a history of WAD was  associated with shoulder stiffness (odds ratio [OR]: 3.36), headache (OR: 2.39), and  arm pain (OR: 3.82). Although MRI findings in WAD patients were more degenerated  than in control subjects in the initial study, all MRI findings were similar at the  20-year follow-up. There were no significant correlations between clinical cervical  symptoms and progression in each MR finding in either group. <br><br>CONCLUSION: After  20 years, whiplash injuries significantly impacted the residual symptoms of shoulder  stiffness, headache, and arm pain when compared with initially asymptomatic  volunteers. The progression of degenerative changes in the cervical intervertebral  discs after 20 years revealed no association with existing whiplash injuries,  neither did the residual cervical-related symptoms.Level of Evidence: 3.<p /> <p>Language: en</p>",
language="en",
issn="0362-2436",
doi="10.1097/BRS.0000000000003901",
url="http://dx.doi.org/10.1097/BRS.0000000000003901"
}