Unfortunately, the 5th author name was incorrectly published in the original paper. The complete correct name is given below.

BACKGROUND CONTEXT: Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma. PURPOSE: Our objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Forty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited. OUTCOME MEASURES: Self-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale. METHODS: The participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2- C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months. RESULTS: No systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%-78%) and for the group with high neck tilt, 8% (95% CI: 3%-25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%-72%) and for those with high TIA 14% (95% CI 4%-26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias. CONCLUSIONS: This study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries. (c) 2020 Elsevier Inc. All rights reserved.

Unfortunately, the 5th author name was incorrectly published in the original paper. The complete correct name is given below.

Unfortunately, the 5th author name was incorrectly published in the original paper. The complete correct name is given below.

BACKGROUND CONTEXT: Pre-existing radiological degenerative changes have not previously been considered a risk factor for nonrecovery from neck pain due to motor vehicle accidents (MVA). Results from previous studies are however often based on assessment of plain radiography or MRI and little consideration has been given to facet joints. Furthermore, previous studies have often lacked a validated scoring system for degenerative changes. PURPOSE: To investigate the association between cervical degeneration on computed tomography (CT) and nonrecovery after whiplash trauma. STUDY DESIGN: Longitudinal cohort study. PATIENT SAMPLE: One hundred twenty-one patients attending the Emergency Department because of neck pain after MVA, 2015-2017, with a valid CT-scan of the cervical spine and completion of follow up after 6 months. OUTCOME MEASURES: The primary outcome measure was self-perceived nonrecovery (yes/no) after 6 months. A secondary outcome measure was self-reported pain level (Numeric Rating Scale). METHODS: Baseline data regarding demographics and health factors were gathered through a web-based questionnaire. Degeneration of facet joints and intervertebral discs was assessed on CT-scans according to a validated scoring system. Binary logistic regression was used to study the association between cervical degeneration and nonrecovery. RESULTS: Moderate facet joint degeneration was associated with nonrecovery. In the group with moderate degree of facet joint degeneration, 69.6% reported nonrecovery compared with 23.6% among patients without any signs of degeneration (adjusted odds ratio 6.7 [95% confidence interval: 1.9-24.3]). There was no association between disc degeneration and nonrecovery. Combined facet joint degeneration and disc degeneration were associated with nonrecovery (adjusted odds ratio 6.2 [2.0-19.0]). CONCLUSIONS: These results suggest that cervical degeneration, especially facet joint degeneration, is a risk factor for nonrecovery after whiplash trauma. We hypothesize that whiplash trauma can be a trigger for painful manifestation of previously asymptomatic facet joint degeneration. (C) 2019 Elsevier Inc. All rights reserved.

Background: Low back pain (LBP) with or without lumbar disc herniation (LDH) is one of the most commonly found symptoms worldwide. The etiology is often unclear, but a low-grade infection caused by the anaerobic skin bacterium Cutibacterium acnes (formerly Propionibacterium acnes), sometimes found on culture during LDH surgery, has been suggested as a cause. Given worldwide concern over multidrug resistant bacteria, further investigation is highly warranted. Our study aimed to compare findings regarding bacterial presence in painful lumbar degenerative disc disease (DDD) in adults having LDH with findings in young patients with scoliosis, but without DDD or relevant lumbar pain. Methods: Between 2015 and 2017, 40 adults with LDH (median age 43, IQR 33-49) and 20 patients with scoliosis (median age 17, IQR 15-20) underwent surgery at seven Swedish hospitals. Samples were collected and cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single nucleotide polymorphism (SNP) analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. Preoperative MRI findings were assessed for inflammatory Modic changes. Findings: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group; in the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, while the corresponding figure in the scoliosis group was 14/20 (70%). There was no association between bacterial findings and Modic changes. Interpretations: The results suggest that finding bacteria like C. acnes in discs and vertebrae during surgery is likely due to contamination. Antibiotic use to treat LBP/LDH without signs of clinical discitis/spondylitis should be seriously questioned. Funding Statement: The study was funded by FORSS, a Swedish regional research foundation Declaration of Interests: The authors state: " no conflicts of interest to declare."Ethics Approval Statement: The study was approved by the ethical committee in Linköping (EPN, Ref. no. 2015/152-31). All patients gave their written informed consent.

Background and aims Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) ( p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified.

Purpose To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes ( Propionibacterium acnes ) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence. Methods Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes. Results No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes , was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated. Conclusions Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

BACKGROUND:Grading of degeneration of the cervical spine is of great clinical value, considering the vast amount of radiological investigations that are being done with this query. Despite the fact that Computed Tomography (CT) is frequently used in clinical practice there is today no user-friendly and reliable scoring system for assessment of cervical spondylosis on CT-scans available. The aim of this study was to establish a scoring system for cervical spondylosis based on CT-scans and to test it for reliability.METHODS:Twenty adult patients undergoing CT of the cervical spine due to neck pain following a motor vehicle accident were included in the study. Three independent raters, i.e. one orthopedic surgeon and two radiologists, assessed their CT-scans. Two of the raters repeated the assessments after three months. A radiographic-based scoring system for cervical disc degeneration, addressing disc height, osteophytes and endplate sclerosis, was applied on CT and tested for reliability. A pre-existing, reliable CT-based scoring system for facet joint degeneration, considering joint space narrowing, osteophytes and irregularity of the articular surface was modified and reevaluated. This in order to develop a coherent CT-based total degeneration score for cervical spondylosis.RESULTS:The scoring systems for cervical disc degeneration and facet joint degeneration both exhibited an acceptable or better level of strength of agreement regarding intra- and interrater agreement. The total disc degeneration score showed a moderate level of inter-rater reliability with a kappa-value of 0.47 and a good intra-rater agreement with intra-class correlation coefficients (ICC) of 0.67 and 0.60 for the two raters performing the assessments. The total facet joint degeneration score showed a moderate level of inter-rater reliability (kappa 0.54) and an excellent intra-rater agreement with ICC 0.75 for one of the raters and fair for the other rater (ICC 0.54). When the total disc and facet joint degeneration score were classified into a three-point total degeneration score the inter-rater agreement was 0.695 and the ICC 0.82 and 0.73 respectively.CONCLUSIONS:This coherent scoring system assessing both disc degeneration and facet joint degeneration on CT-scans of the cervical spine was shown to meet the standards of reliability.

The long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the "compensation hypothesis" suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2-4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation. 144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2-4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation. The overall non-recovery rate after 2-4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37-13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7-446.0)]. However, no association was found between pain level at baseline and financial compensation. The non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis.

Background The COMT (Catechol-O-Methyl Transferase) gene may influence a person’s vulnerability to develop long-term pain and some COMT single nucleotide polymorphisms (SNPs) may associate with patterns of acute or chronic pain. Many patients with whiplash-associated disorders (WADs) suffer from long-term pain and other related symptoms, but it is less known if genetic factors play a role in the recovery process. The primary aim of this study was to evaluate whether self-reported non-recovery, including pain, was related to COMT genotype in patients with WAD. The secondary aim was to investigate whether or not background factors, including mental health, were related to genotype and non-recovery. Methods A total of 133 patients with neck pain after a whiplash trauma were included. Background factors were collected and blood samples were taken during the acute phase after the accident. DNA was isolated from blood and used to genotype the SNPs rs6269, rs4633, rs4818 and rs4680 in the COMT gene; additionally haplotypes were estimated and haplogenotypes inferred. The patients were followed up after 12 months and asked to rate their recovery including pain, mental health and quality of life. Results The overall reported non-recovery rate at 12 months was 44% with no significant differences in distribution of the COMT haplotypes. High levels of self-reported pain (OR 7.2) and anxiety (OR 4.4) after the accident were associated with non-recovery, but not related to the haplotypes. None of the other background factors were related to the haplotypes or non-recovery. Conclusion No association between self-reported non-recovery or pain levels and COMT haplotypes in patients with acute whiplash injuries could be detected. Independent replications are necessary to discard the hypothesis that COMT haplotypes do not influence non-recovery or pain levels in patients with acute whiplash injuries. High levels of initial pain and anxiety were associated with non-recovery, thereby confirming previously published reports.

To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting.