TABLE 12.

Summary of evidence for surgical and injection-based therapies for chronic whiplash-associated disorder (WAD)

Intervention	Conclusions
Sterile water injections	Although there is evidence that sterile water injections are more effective than saline injections, methodological concerns prohibit definitive support for sterile water injections as beneficial for reducing whiplash-related symptoms
Botulinum toxin injections	There is contradictory evidence regarding the effectiveness of botulinum toxin injections during the chronic stage of WAD
Corticosteroid injections	Corticosteroid intra-articular and selective nerve root block injections did not appear to be effective for relieving pain in patients with chronic WAD. Based on the results of a case series, subacromial space corticosteroid injections combined with physiotherapy may be effective for patients with late-onset shoulder pain; however, further research is needed
Tropisetron injections	Although one case series reported that tropisetron injections temporarily relieve whiplash-related pain, the evidence is not strong enough to demonstrate the effectiveness of this treatment
Intra-articular dextrose and lidocaine injections	Although the results of one small case series suggested that ‘joint regeneration’ (intra-articular dextrose and lidocaine) therapy may reduce whiplash-related pain and disability, the evidence is not strong enough to establish the effectiveness of this treatment
Epidural blood patch therapy	While the results of one case series suggested that epidural blood patch therapy may be an effective treatment for chronic WAD involving a suspected cerebrospinal fluid leak, the association of a cerebrospinal fluid leak with chronic WAD has never been established
Radiofrequency neurotomy	Although relief may not be permanent, there is strong evidence that radiofrequency neurotomy is effective in reducing pain in patients with chronic WAD. Moreover, it appears that the procedure can be repeated with a similar probability of success. Nevertheless, further research is needed to determine which patients are most likely to obtain significant relief from this highly invasive procedure
Occipital nerve decompression	On the basis of one case series, there was limited evidence that greater occipital nerve decompression may be effective in reducing whiplash-related headache, although further research using more rigorous methodology is needed before definitive conclusions can be drawn
Carpal tunnel decompression	Although there was limited evidence that carpal tunnel decompression may be effective in reducing whiplash-related pain, the evidence was insufficient to determine the effectiveness of this procedure
Cervical discectomy and fusion	Only two low-quality case series reported on cervical discectomy and fusion; however, it is not clear whether this procedure provides substantial relief for patients with chronic WAD