An observational study in Whiplash Injury, Whiplash Injury of Cervical Spine and Chronic Neck Pain, sponsored by University of Valencia. Completed at 1 site in Spain. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-04-17.
Sponsored by University of Valencia · Observational
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.
Chronic post-traumatic cervical whiplash is a frequent cause of persistent neck pain, functional disability, and psychological distress following acceleration-deceleration injuries. Although many patients recover with conservative management, a substantial proportion develop chronic symptoms lasting months or years. In these cases, identifying the predominant pain generator is essential for guiding treatment.
Previous studies have shown that the cervical zygapophyseal (facet) joints are a common source of chronic pain after whiplash injury, leading to the development of targeted interventional strategies. Cervical medial branch radiofrequency is a minimally invasive technique designed to interrupt nociceptive input from the facet joints and has been associated with meaningful pain relief and functional improvement in appropriately selected patients. In parallel, anterior cervical discectomy and fusion (ACDF) has been used in selected patients with persistent post-traumatic neck pain, particularly when structural abnormalities are identified. However, ACDF is a more invasive intervention, associated with greater treatment burden and potential long-term consequences, and its role in isolated chronic whiplash without radiculopathy or myelopathy remains debated.
Despite the widespread clinical use of both approaches, there is limited evidence directly comparing their real-world effectiveness in patients with chronic post-traumatic whiplash. The present study addresses this gap by examining long-term outcomes in a large, single-center cohort treated as part of routine clinical practice over a 20-year period.
This study is designed as a retrospective observational cohort analysis conducted at a tertiary care hospital. Patients are categorized according to the definitive treatment they received as part of standard clinical care: cervical medial branch radiofrequency or anterior cervical discectomy and fusion. Treatment decisions were based on clinical judgment and available diagnostic information and were not determined by any research protocol.
Clinical data are obtained through review of electronic medical records and procedural documentation. The analysis focuses on comparative evaluation of outcomes between treatment groups, with attention to differences in patient characteristics and clinical context. Multivariable statistical methods, and where appropriate propensity-based adjustment, are used to account for potential confounding factors inherent to observational comparative research.
Because this is a retrospective observational study based on routine clinical care, all analyses are exploratory and hypothesis-generating in nature. By leveraging long-term real-world clinical data, this study seeks to improve understanding of the relative benefits and limitations of minimally invasive versus surgical treatment strategies for chronic post-traumatic whiplash, supporting more informed and evidence-based clinical decision-making.
68 studies on the registry are indexed under Whiplash Injuries; 8 are open to participants now.
This study's enrollment of 170 is above the median of 98 across 16 observational studies indexed under Whiplash Injuries.
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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.
Exclusion Criteria
Insufficient clinical documentation to confirm the diagnosis of post-traumatic whiplash or to evaluate pain, functional, or psychological outcomes after treatment.
Treatment performed at the Hospital General Universitario de Valencia between 2005 and 2025.
Patients with chronic post-traumatic cervical whiplash who were treated with cervical zygapophyseal (facet) joint medial branch radiofrequency as part of routine clinical care.
Patients with chronic post-traumatic cervical whiplash who were treated with anterior cervical discectomy and fusion as part of routine clinical care.
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.
Time frame: From baseline (pre-treatment) to last documented clinical follow-up, assessed up to 12 months after treatment.
Functional Disability of the Neck
Functional disability assessed using the Neck Disability Index (NDI; 0-50 points, where higher scores indicate greater disability), when available in the medical record. Outcomes will be analyzed as change from baseline and overall functional improvement after treatment.
Time frame: From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
Duration of Pain Relief
Time from index treatment to recurrence of neck pain defined as a return to at least 50% of baseline pain intensity, based on clinical records.
Time frame: 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
Proportion of patients requiring repeat cervical radiofrequency procedures, revision surgery, or additional cervical interventions due to recurrence or persistence of symptoms.
Time frame: From treatment to additional intervention or last documented follow-up, assessed up to 24 months.
Psychological Symptoms Related to Chronic Pain
Presence and evolution of psychological symptoms assessed using standardized instruments such as the Hospital Anxiety and Depression Scale (HADS; 0-21 per subscale, where higher scores indicate worse symptoms) or the Symptom Checklist-90-Revised (SCL-90-R; higher scores indicate greater psychological distress), when available, or through structured clinical documentation.
Time frame: From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
Return to Daily Activities or Work
Functional recovery assessed through clinical documentation of return to work or resumption of usual daily activities after treatment.
Time frame: From treatment to documented return to work or resumption of usual daily activities, assessed up to 12 months after treatment.
Plan to share: No
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University of Valencia