Radiofrequency Versus Cervical Fusion for Chronic Whiplash

NCT07535515 | Completed

• 1 other identifier: CEIm PI 28-2026
• Study Type: observational
• Target: 170
• Locations: 1 country
• Sites: 1

Brief Summary

Chronic neck pain after whiplash injury is a common and disabling condition that can significantly affect quality of life, daily activities, and psychological well-being. In some patients, pain persists for months or years despite conservative treatments, leading to consideration of more invasive therapeutic options. Two commonly used treatments in selected patients are cervical zygapophyseal (facet) joint radiofrequency and anterior cervical discectomy and fusion (ACDF), but their comparative long-term outcomes in routine clinical practice are not well defined. This study aims to compare the clinical, functional, and psychological outcomes of patients with chronic post-traumatic cervical whiplash who were treated either with cervical medial branch radiofrequency or with anterior cervical discectomy and fusion. The study uses a retrospective observational design based on the review of medical records from a tertiary hospital over a 20-year period. Adult patients diagnosed with chronic post-traumatic whiplash and treated between 2005 and 2025 are included. All treatments were performed as part of usual clinical care and were not assigned for research purposes. Data collected include patient characteristics, injury mechanism, type of treatment received, pain intensity, functional disability, psychological symptoms, need for repeat procedures or additional surgery, and clinical follow-up information. The primary objective is to compare pain relief between the two treatment groups. Secondary objectives include comparison of functional recovery, duration of treatment benefit, recurrence of pain, psychological symptoms, need for further interventions, and return to daily activities or work. By analyzing long-term real-world data, this study seeks to improve understanding of the relative effectiveness of cervical radiofrequency and surgical fusion for chronic whiplash pain, helping clinicians and patients make more informed treatment decisions. No new interventions are performed as part of this study, and all data are analyzed anonymously.

Conditions

Whiplash Injury; Whiplash Injury of Cervical Spine; Chronic Neck Pain; Post-Traumatic Neck Pain

Keywords

Whiplash; Cervical Facet Joint Pain; Cervical Radiofrequency; Anterior Cervical Discectomy and Fusion; Chronic Neck Pain; Post-Traumatic Neck Pain; Radiofrequency Neurotomy; Comparative Effectiveness; Retrospective Cohort

Outcome Measures

Primary Outcomes (1)

• Pain Relief After Treatment

  Change in neck pain intensity following treatment measured using the Visual Analogue Scale for pain (VAS; 0-10 scale, where 0 indicates no pain and 10 indicates worst imaginable pain). Pain relief will be evaluated as absolute change from baseline and as the proportion of patients achieving a clinically meaningful reduction of at least 50% from baseline.

  From baseline (pre-treatment) to last documented clinical follow-up, assessed up to 12 months after treatment.

Secondary Outcomes (5)

• Functional Disability of the Neck

  From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.

• Duration of Pain Relief

  From date of index treatment to documented recurrence of pain or last clinical follow-up, assessed up to 24 months after treatment.

• Need for Additional Interventions

  From treatment to additional intervention or last documented follow-up, assessed up to 24 months.

• Psychological Symptoms Related to Chronic Pain

  From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.

• Return to Daily Activities or Work

  From treatment to documented return to work or resumption of usual daily activities, assessed up to 12 months after treatment.

Study Arms (2)

Cervical Medial Branch Radiofrequency

Patients with chronic post-traumatic cervical whiplash who were treated with cervical zygapophyseal (facet) joint medial branch radiofrequency as part of routine clinical care.

Anterior Cervical Discectomy and Fusion (ACDF)

Patients with chronic post-traumatic cervical whiplash who were treated with anterior cervical discectomy and fusion as part of routine clinical care.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients with chronic post-traumatic cervical whiplash who were treated at a tertiary care hospital between 2005 and 2025. Eligible patients are those aged 18 years or older who developed persistent neck pain following a traumatic acceleration-deceleration injury and whose symptoms persisted for at least three months. All patients received either cervical medial branch radiofrequency or anterior cervical discectomy and fusion as part of routine clinical care, based on standard clinical indications. The population includes both male and female patients and represents a real-world cohort managed in specialized clinical practice. Only patients with sufficient clinical documentation and available follow-up data to assess pain, functional outcomes, and treatment durability are included.

You may qualify if:

• Adults aged 18 years or older at the time of treatment.
• Clinical diagnosis of chronic post-traumatic cervical whiplash, with symptoms persisting for at least 3 months following the traumatic event.
• Cervical pain attributed to a traumatic acceleration-deceleration mechanism (whiplash injury).
• Treatment with either:
• cervical medial branch radiofrequency, or
• anterior cervical discectomy and fusion performed as part of routine clinical care.

You may not qualify if:

• Cervical pain primarily attributable to non-traumatic conditions, including degenerative cervical disease, inflammatory disorders, neoplastic disease, infection, radiculopathy, or cervical myelopathy.
• History of previous cervical spine surgery before the index treatment, which could interfere with the assessment of treatment outcomes.
• Patients who received both cervical radiofrequency and anterior cervical discectomy and fusion for the same clinical episode of whiplash-related pain.
• Cervical procedures performed outside the Hospital General Universitario de Valencia or without verifiable technical documentation in the medical record.
• Insufficient clinical documentation to confirm the diagnosis of post-traumatic whiplash or to evaluate pain, functional, or psychological outcomes after treatment.
• Absence of clinical follow-up data after the index treatment.
• Age under 18 years at the time of treatment. Availability of clinical follow-up data after treatment that allows assessment of pain and/or functional outcomes.
• Treatment performed at the Hospital General Universitario de Valencia between 2005 and 2025.

Sponsors & Collaborators

• University of Valencia: lead

Study Sites (1)

Consorcio Hospital General Universitario de Valencia

Valencia, Valencia, 46015, Spain

Location

Related Publications (16)

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• Manchikanti L, Knezevic NN, Knezevic E, Abdi S, Sanapati MR, Soin A, Wargo BW, Navani A, Atluri S, Gharibo CG, Simopoulos TT, Kosanovic R, Abd-Elsayed A, Kaye AD, Hirsch JA. A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain. Pain Ther. 2023 Feb;12(1):19-66. doi: 10.1007/s40122-022-00455-0. Epub 2022 Nov 24.

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• Yen CY, Lin SM, Chen HY, Wang SW, Tsai YD, Chye CL, Chen TY, Wang HK, Wang KW. Sagittal alignment to predict efficiency in pulsed radiofrequency for cervical facet joint pain. Sci Rep. 2024 Nov 19;14(1):28563. doi: 10.1038/s41598-024-79181-w.

  PMID: 39557962 BACKGROUND

• Burnham R, Trow R, Trow J, Smith A, Burnham T. Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study. Pain Med. 2024 Nov 1;25(11):671-674. doi: 10.1093/pm/pnae054.

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• Sherwood D, Berlin E, Epps A, Gardner J, Schneider BJ. Cervical medial branch block progression to radiofrequency neurotomy: A retrospective clinical audit. N Am Spine Soc J. 2021 Nov 3;8:100091. doi: 10.1016/j.xnsj.2021.100091. eCollection 2021 Dec.

  PMID: 35141655 BACKGROUND

• Shin WR, Kim HI, Shin DG, Shin DA. Radiofrequency neurotomy of cervical medial branches for chronic cervicobrachialgia. J Korean Med Sci. 2006 Feb;21(1):119-25. doi: 10.3346/jkms.2006.21.1.119.

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• MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012 May;13(5):647-54. doi: 10.1111/j.1526-4637.2012.01351.x. Epub 2012 Mar 28.

  PMID: 22458772 BACKGROUND

• Sapir DA, Gorup JM. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study. Spine (Phila Pa 1976). 2001 Jun 15;26(12):E268-73. doi: 10.1097/00007632-200106150-00016.

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• Prushansky T, Pevzner E, Gordon C, Dvir Z. Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures. J Neurosurg Spine. 2006 May;4(5):365-73. doi: 10.3171/spi.2006.4.5.365.

  PMID: 16703903 BACKGROUND

• Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Dunne-Proctor R, Sterling M. Cervical radiofrequency neurotomy reduces psychological features in individuals with chronic whiplash symptoms. Pain Physician. 2014 May-Jun;17(3):265-74.

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  PMID: 9414052 BACKGROUND

• Smith AD, Jull G, Schneider GM, Frizzell B, Hooper RA, Sterling M. Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash: A Prospective Study. PM R. 2015 Sep;7(9):913-921. doi: 10.1016/j.pmrj.2015.03.014. Epub 2015 Mar 21.

  PMID: 25805617 BACKGROUND

• McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery. 1999 Jul;45(1):61-7; discussion 67-8. doi: 10.1097/00006123-199907000-00015.

  PMID: 10414567 BACKGROUND

• Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996 Dec 5;335(23):1721-6. doi: 10.1056/NEJM199612053352302.

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• Barnsley L. Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients. Pain Med. 2005 Jul-Aug;6(4):282-6. doi: 10.1111/j.1526-4637.2005.00047.x.

  PMID: 16083457 BACKGROUND

MeSH Terms

Conditions

Whiplash Injuries

Condition Hierarchy (Ancestors)

Neck Injuries; Wounds and Injuries

Study Officials

• Vicente Vanaclocha Vanaclocha, MD PhD

  University of Valencia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Full Professor

Study Record Dates

• First Submitted: April 7, 2026
• First Posted: April 17, 2026
• Study Start: January 1, 2005
• Primary Completion: December 1, 2025
• Study Completion: December 1, 2025
• Last Updated: April 17, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

ES (1)