The impact of cervical spine radiographs in the diagnosis and management of patients that presented with neck pain to the Chiropractic Day Clinic at the Durban University of Technology

Abstract

Background Literature has shown that clinical and radiological diagnoses do not always correlate in patients with neck pain (Ferrari and Russel, 2003; Peterson and Hsu, 2004). It is not known if this applies to the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) and if the radiological diagnosis leads to a change in the patient’s initial management plan. The impact of cervical spine plain film radiographs will therefore be investigated in the diagnosis and management of patients that presented with neck pain to the CDC at the DUT. It is also not known whether the reason for referral for cervical spine plain film radiographs is always indicated as per the indications in the clinic handbook and radiological referral guidelines. Objectives Objectives were: (1) To determine the suspected pre-radiographic clinical diagnosis and management of the selected clinical records prior to referral for cervical spine plain film radiography; (2) To record the reasoning to send for cervical spine plain film radiographic imaging and to establish whether these are in line with proposed guidelines for referral as found in the literature; (3) To determine the relationship between the suspected pre-radiographic clinical and the radiological diagnoses of patients with neck pain; (4) To determine the number of incidental findings in the selected patients’ plain film radiographs; (5) To determine any change in the pre-radiographic clinical diagnoses and management following radiological reporting of the selected patient’s plain film radiographs. Method This was a quantitative, retrospective, clinical study. The archives at the CDC at the DUT were searched for cervical spine plain film radiographs between 1 January 1997 to 31 December 2013 and these were matched with the corresponding clinical records. After applying the inclusion and exclusion criteria, 73 records were included in the study. The patient’s personal information was coded to ensure confidentiality (Appendix A) and specific clinical and radiological information was recorded (Appendix B). Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Results A total of 73 clinical files and corresponding plain film radiographs were assessed. The mean age of the patients was 44 years. The gender distribution was 64.4% (n=47) females and 35.6% (n=26) males. The most frequent primary radiological diagnosis was loss of lordosis at 41.1% (n=30) followed by cervical spondylosis at 35.6% (n=26) and old cervical spinal trauma at 12.3% (n=9). Sixty four percent (n=47) of patients in this study were sent for cervical spine plain film radiographs after their initial clinical consultation. Reasons that are not considered relevant indications for plain film radiographic referral were present in 46.2% (n=34) of cases; these described non-specific mechanical disorders. The most common reason for plain film radiographic referral was due to positive orthopaedic tests 57.5% (n=42). A total of 27.4% (n=20) of clinical files reviewed had a change in their initial clinical diagnosis and 72.6% (n=53) of these patients had no change in diagnosis. All of the post-radiographic clinical diagnoses were non-specific mechanical conditions. Numerous treatment modalities were utilized by the students with the most common pre-radiographic treatment being soft tissue therapy at 63.0% (n=46). A total of 75% (n=55) of patients had a change of treatment after plain film radiographs were performed and spinal manipulative therapy (SMT) was the main treatment added in 41% of cases. Conclusion Cervical spine plain film radiographs have little impact on the diagnosis of patients with non-specific mechanical neck pain without red flags. It was however found that plain film radiographs had an impact on the management in the majority of cases, especially with an increase in SMT use after plain film radiographs.