Whiplash Injury

Patient, Mr. Pranit, 19 yr old male, presents with chief complaints of 'pain in the neck' since 3 months.

The pain started with a car accident that occured 3 months back. Patient was fine for 3-4 days before the pain started on both sides of the neck (left sided more than right sided pain) and at the back of the neck.
Pain has been gradually increasing, with few bouts of remission. Patient still complains of severe pain.

The car accident occured at night time, while he was travelling in the car at a speed of 60 kph, when the car hit a stone lying on the road and deccelrated suddenly to come to a complete stop.

The patient suffered a hyperextension, or rather a whiplash injury. As he was buckled up only the neck underwent severe strain during the crash.

The patient does not complain of any weakness, tingling or numbness in the upper extremity.
There is no history of any loss of vision, giddiness, headache etc..

The patient has no past history of any injury, backache, neck pain.
Patient has chronic complains of sore throat, fever, cough, cold. This has been diagnosed by an ENT specialist as Chonic tonsillitis with adenoiditis with deviated nasal septum.
There is no relevant past surgical history.

As of now, the patient complains of sleepless nights due to severe pain.
His appetite is normal, and so are his bladder and bowel movements.


On examination, patient is well oriented, afebrile.

Positive findings:
- Restricted neck movements
- Patient has marfanoid features.

There is no e/o any neurological deficit on examination of the upper limb.

There is no abnormality in his RS, CVS, P/A.

Investigations:
- X-RAY
- CT cervical spine
- MRI cervical spine with thoracic spine screening.

Results:
X-RAY - NAD

CT - There is some evidence of atlanto-axial rotation.
        No other abnormality seen.

MRI - The cervical vertebrae and discs appear normal
         No obvious encroachment of the spinal canal or
         cord compression. There is no CVJ abnormality  
         Subtle subchondral marrow edema along the  
         superior end plate of D2 with localised edema
         in the soft tissue musculature of the lower neck
         posteriorly on the left side- possibly post-    
         traumatic.

Medication taken:
- T.Tizanidine (2)  1-0-2
- T.Carisoprodol 1-1-1
- T.Lorazepam 0-0-1

The patient has been advised strict bed rest for another 21 days.
There has been no improvement in the patients condition and the pain keeps getting worse.
Is there any alternative line of treatment/ physiotherapy which will help reduce the pain?

What is the role of surgery for this particular patient?