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

James M Elliott; Mark J Hancock; Rebecca J Crawford; Andrew C Smith; David M Walton

doi:10.1016/j.spinee.2017.06.015

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

Spine J. 2018 Aug;18(8):1489-1497. doi: 10.1016/j.spinee.2017.06.015. Epub 2017 Jul 31.

Authors

James M Elliott¹, Mark J Hancock², Rebecca J Crawford³, Andrew C Smith⁴, David M Walton⁵

Affiliations

¹ Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1100, Chicago, IL, USA; School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland. Electronic address: j-elliott@northwestern.edu.
² Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia.
³ Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
⁴ Regis University School of Physical Therapy, 3333 Regis Boulevard, Denver, CO 80221, USA.
⁵ School of Physical Therapy, Western University, Room 1588, London, Ontario N6G 1H1, Canada.

Abstract

Background context: Radiological 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 are 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. Although 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.

Purpose: This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging 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/setting: A non-systematic review of the literature is carried out.

Methods: A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided.

Results: An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain.

Conclusions: Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.

Keywords: Biopsychosocial; Imaging; Low back pain; MRI; Neck pain; Whiplash.

Publication types

Review

MeSH terms

Back Pain / diagnostic imaging*
Back Pain / pathology
Humans
Image Processing, Computer-Assisted / methods
Magnetic Resonance Imaging / methods*
Whiplash Injuries / diagnostic imaging*
Whiplash Injuries / pathology

Grants and funding

R01 HD079076/HD/NICHD NIH HHS/United States