Radiofrequency Versus Cervical Fusion for Chronic Whiplash (WHIPLASH-RFvsA)

April 14, 2026 updated by: Vicente Vanaclocha, University of Valencia

Comparative Effectiveness of Cervical Zygapophyseal Joint Radiofrequency Versus Anterior Cervical Discectomy and Fusion in Chronic Post-Traumatic Whiplash: A Retrospective Cohort Study

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.

Study Overview

Status

Completed

Conditions

Detailed Description

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.

Study Type

Observational

Enrollment (Actual)

170

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
    • Valencia
      • Valencia, Valencia, Spain, 46015
        • Consorcio Hospital General Universitario de Valencia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

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.

Description

Inclusion Criteria

  • Adults aged 18 years or older at the time of treatment.
  • Clinical diagnosis of chronic post-traumatic cervical whiplash, with symptoms persisting for at least 3 months following the traumatic event.
  • Cervical pain attributed to a traumatic acceleration-deceleration mechanism (whiplash injury).
  • Treatment with either:
  • cervical medial branch radiofrequency, or
  • anterior cervical discectomy and fusion performed as part of routine clinical care.

Exclusion Criteria

  • Cervical pain primarily attributable to non-traumatic conditions, including degenerative cervical disease, inflammatory disorders, neoplastic disease, infection, radiculopathy, or cervical myelopathy.
  • History of previous cervical spine surgery before the index treatment, which could interfere with the assessment of treatment outcomes.
  • Patients who received both cervical radiofrequency and anterior cervical discectomy and fusion for the same clinical episode of whiplash-related pain.
  • Cervical procedures performed outside the Hospital General Universitario de Valencia or without verifiable technical documentation in the medical record.

Insufficient clinical documentation to confirm the diagnosis of post-traumatic whiplash or to evaluate pain, functional, or psychological outcomes after treatment.

  • Absence of clinical follow-up data after the index treatment.
  • Age under 18 years at the time of treatment. Availability of clinical follow-up data after treatment that allows assessment of pain and/or functional outcomes.

Treatment performed at the Hospital General Universitario de Valencia between 2005 and 2025.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Cervical Medial Branch Radiofrequency
Patients with chronic post-traumatic cervical whiplash who were treated with cervical zygapophyseal (facet) joint medial branch radiofrequency as part of routine clinical care.
Anterior Cervical Discectomy and Fusion (ACDF)
Patients with chronic post-traumatic cervical whiplash who were treated with anterior cervical discectomy and fusion as part of routine clinical care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain Relief After Treatment
Time Frame: From baseline (pre-treatment) to last documented clinical follow-up, assessed up to 12 months 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.
From baseline (pre-treatment) to last documented clinical follow-up, assessed up to 12 months after treatment.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Functional Disability of the Neck
Time Frame: From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
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.
From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
Duration of Pain Relief
Time Frame: From date of index treatment to documented recurrence of pain or last clinical follow-up, assessed up to 24 months after treatment.
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.
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
Time Frame: From treatment to additional intervention or last documented follow-up, assessed up to 24 months.
Proportion of patients requiring repeat cervical radiofrequency procedures, revision surgery, or additional cervical interventions due to recurrence or persistence of symptoms.
From treatment to additional intervention or last documented follow-up, assessed up to 24 months.
Psychological Symptoms Related to Chronic Pain
Time Frame: From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
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.
From baseline to last documented clinical follow-up, assessed up to 12 months after treatment.
Return to Daily Activities or Work
Time Frame: From treatment to documented return to work or resumption of usual daily activities, assessed up to 12 months after treatment.
Functional recovery assessed through clinical documentation of return to work or resumption of usual daily activities after treatment.
From treatment to documented return to work or resumption of usual daily activities, assessed up to 12 months after treatment.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Valencia

Investigators

  • Principal Investigator: Vicente Vanaclocha Vanaclocha, MD PhD, University of Valencia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2005

Primary Completion (Actual)

December 1, 2025

Study Completion (Actual)

December 1, 2025

Study Registration Dates

First Submitted

April 7, 2026

First Submitted That Met QC Criteria

April 14, 2026

First Posted (Actual)

April 17, 2026

Study Record Updates

Last Update Posted (Actual)

April 17, 2026

Last Update Submitted That Met QC Criteria

April 14, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CEIm PI 28-2026

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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