Head Position and Impact Direction in Whiplash Injuries: Associations with MRI-Verified Lesions of Ligaments and Membranes in the Upper Cervical Spine

Abstract

In the present study, we compared magnetic resonance imaging (MRI) findings of soft tissue structures in the upper cervical spine between whiplash-associated disorder (WAD) patients and population-based control persons, and examined whether MRI-verified abnormalities in WAD patients were related to accident-related factors hypothesized to be of importance for severity of injury. A total of 92 whiplash patients and 30 control persons, randomly drawn, were included. Information on the accident-related factors (i.e., head position and impact direction) was obtained by a questionnaire that was answered within 1 week after the accident. The MRI examination was performed 2-9 (mean 6) years after the accident. Focus was on MRI abnormalities of the alar and the transverse ligaments, and the tectorial and posterior atlanto-occipital membranes, graded 0-3. For all neck structures, the whiplash patients had more high-grade lesions (grade 2 or 3) than the control persons (Chi-square test, p < 0.055). An abnormal alar ligament was most common (66.3% graded 2 or 3). Whiplash patients who had been sitting with their head/neck turned to one side at the moment of collision more often had high-grade lesions of the alar and transverse ligaments (p < 0.001, p = 0.040, respectively). Severe injuries to the transverse ligament and the posterior atlanto-occipital membrane were more common in front than in rear end collisions (p < 0.001, p = 0.001, respectively). In conclusion, the difference in MRI-verified lesions between WAD patients and control persons, and in particular the association with head position and impact direction at time of accident, indicate that these lesions are caused by the whiplash trauma.

An Integrated Model of Chronic Whiplash-Associated Disorder

“…Other tissues targeted in the empirical search for a peripheral lesion (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) included the upper cervical ligaments, 50,55,56 the trigeminal nucleus, 99 and tears in the dura mater around the cord. 45 While the published literature includes evidence in support of such lesions, several have been subsequently refuted, 74,75 and none have achieved the mantle of "silver bullet lesion."…”

Occult Hypermobility of the Craniocervical Junction: A Case Report and Review

“…42,60 One hypothesis is that the alar ligaments are more likely to be sprained during auto accidents in which the head is rotated to one side during impact. 9,28,34 It has been noted that the alar ligaments could be irreversibly stretched after trauma, as they consist chiefly of inelastic collagen fibers potentially leading to chronic occult hypermobility of the CCJ region. …”

“…Kaale et al 28 performed MRI scans on 92 patients with whiplash-associated disorders resulting from accidents that occurred 2 to 9 years prior to examination and found increased signal intensity on MRI, suggestive of chronic lesions of the alar ligaments, in 66% of these patients. Vetti et al 59 performed cervical MRI of 1266 individuals with neck trauma.…”

The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation

“…The situation would be assisted if there were quantitative radiological markers of the disorder but markers of salient structural lesions in WAD remain inconclusive [26,38,42,43,47]. MRI markers of fatty infiltration have been reported in the cervical extensor musculature in females with chronic WAD [14].…”