Diagnostic accuracy of videofluoroscopy for symptomatic cervical spine injury following whiplash trauma

Abstract BackgroundIntervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time there are no studies of the diagnostic accuracy of VF for discriminating between injured and uninjured populations.MethodsSymptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with VF facilities. Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. Ethical review and oversight was provided by the Spinal Injury Foundation, Broomfield, CO. Three statistical models were utilized to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of positive VF findings to correctly discriminate between injured and injured subjects. ResultsAll 3 models demonstrated high levels of sensitivity and specificity (i.e. ROC values of 0.71 to 0.95), however, the model with the greatest practical clinical utility was based on the number of abnormal VF findings. For 2+ abnormal VF findings the ROC was 0.88 (93% sensitivity, 79% specificity), and the PPV and NPV were both 88%. ConclusionsVideofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.