Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury

Publication date: Available online 31 July 2017
Source:The Spine Journal
Author(s): James M. Elliott, Mark J. Hancock, Rebecca J. Crawford, Andrew C. Smith, David M. Walton
Background ContextRadiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. While we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies, may in part be due to limitations in the approaches used in assessment and analysis of imaging findings.PurposeThe purpose of this clinical commentary is to 1) briefly detail available imaging guidelines, 2) detail research based evidence around the clinical use of findings from advanced, but available, imaging applications (e.g. fat/water MRI and magnetization transfer imaging), and 3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes.Study Design/SettingNon-systematic review of the literatureMethodsA narrative summary (including studies from the authors' own work in whiplash injuries), of the available literature is provided. Relevant disclosures: JE reports relevant activities outside the body of work as 35% investment/ownership in a medical consulting start-up, Pain ID, LLC and an NIH grant (2014-2019) R01 R01HD079076. DW reports relevant activities outside the body of work including speaking/teaching arrangements, Scientific Advisory Board duties, Grants (CIHR and Canadian Pain Society). MH, RC, and AS confirm no relevant disclosures.ResultsAn emerging body of evidence suggests that the combination of existing imaging sequences and/or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk-factors, may provide important diagnostic information towards the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain.ConclusionsAdvancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.



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