Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically Guided Cervical Prolotherapy for with Blinded Pre and Post Radiographic Reading Pain Physician. 2005;8:67-72.
Centeno et al 2005. Reduction in laxity demonstrated by radiographic imaging.
DR. REEVES’ NOTES:
This is a very small but intriguing case series looking at flexion and extension views of accepting patients with confirmed cervical instability and accepting patientsonly with 50% pain reduction with rigid immobilization. Three injection sessions were given into all areas with demonstrated translation (laxity). Pain improvements and laxity reductions were demonstrated.
An abstract is available below.
Several authors have postulated that cervical instability is a major cause of traumatic spinal pain.
The purpose of this prospective case series study (n = 6) was to determine if proliferant injections have an effect cervical translation as measured by a blinded reader.
This study was a prospective case series. Study participants were selected from patients seen for the primary complaint of Motor Vehicle Collision related neck pain in a private sub-specialty pain clinic.
Flexion and extension views were obtained by standard radiographs taken with a C-Arm fl uoroscope under Valium sedation. Patients with more than 2.7 mm absolute cervical translation and at least 50% reduction of cervical and referred pain with a two day rigid cervical immobilization test were admitted into the study. Participants underwent 3 prolotherapy injections at all sites that demonstrated translation. The difference in means between pre-test and post-test measurements (fl exion translation, extension translation, and pain VAS scores) were assessed by a Wilcoxon signed ranks test (alpha = 0.05).
The mean post-test VAS score (M= 3.83, SD=2.3, t=2.889) was significantly less (p=0.04) than the mean pre-test VAS score (M=5.75, SD=1.94). The correlation between difference in mean extension at C2-3 and C5-6 and difference in mean extension was signifi cant (rho=0.89, p=0.02 and rho=0.85, p=0.03 respectively). Difference in mean fl exion at C3-4 and C4-5 was significantly correlated with difference in mean flexion (rho=0.88, p=0.02 and rho=0.941, p<0.01 respectively).
The results of this study demonstrate statistically signifi cant correlations between proliferant injections, a reduction of both cervical flexion and extension translation, as well as a reduction in pain VAS score. Since patients with traumatic cervical instability have few viable treatment options other than surgical fusion, cervical proliferant injections under C-Arm fluoroscope may be a viable treatment option.