MR analysis of the transverse ligament in the late stage of whiplash                injury

Kråkenes, Jostein; Kaale, Bertel Rune; Nordli, H.; Moen, Gunnar; Rørvik, Jarle; Ne, Gilhus

doi:10.1080/02841850312331287739

Cited by 46 publications

(41 citation statements)

References 23 publications

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“…In one cohort, a considerable part of patients with chronic WAD were observed to have lesions in the upper cervical ligaments as visualised on MRI of the craniovertebral junction [21][22][23]. This study indicated that the alar and transverse ligaments as well as tectorial and posterior atlanto-occipital membranes can be damaged by whiplash injuries.…”

mentioning

confidence: 77%

“…A fourth consideration is that having known more recent results demonstrating signs of injury to the upper cervical ligaments in chronic whiplash-associated disorders [15,[21][22][23] when planning this study, we would have focused more upon the upper cervical spine. The importance of upper ligament injuries should be evaluated in future prospective trials.…”

Section: Discussionmentioning

confidence: 99%

“…To explore the biological component of neck pain following whiplash injuries, studies of magnetic resonance imaging (MRI) have been performed in order to visualise potential damage to the cervical spine [3,4,8,17,[21][22][23]29]. Generally, very few identifications of traumatic lesions have been described in the acute phase after whiplash injuries and findings do not seem to be associated with the prognosis [4,17,29].…”

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confidence: 99%

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Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

et al. 2008

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Neck pain is the cardinal symptom following whiplash injuries. The trauma mechanism could theoretically lead to both soft tissue and bone injury that could be visualised by means of MRI. From previous quite small trials it seems that MRI does not demonstrate significant tissue damage. Large prospectively followed cohorts are needed to identify possible clinically relevant MRI findings. The objective of this trial was to evaluate (1) the predictive value of cervical MRI after whiplash injuries and (2) the value of repeating MRI examinations after 3 months including sequences with flexion and extension of the cervical spine. Participants were included after rearend or frontal car collisions. Patients with fractures or dislocations diagnosed by standard procedures at the emergency unit were not included. MRI scans of the cervical spine were performed at baseline and repeated after 3 months. Clinical follow-ups were performed after 3 and 12 months. Outcome parameters were neck pain, headache, neck disability and working ability. A total of 178 participants had a cervical MRI scan on average 13 days after the injury. Traumatic findings were observed in seven participants. Signs of disc degeneration were common and most frequent at the C5-6 and C6-7 levels. Findings were not associated with outcome after 3 or 12 months. The population had no considerable neck trouble prior to the whiplash injury and the non-traumatic findings represent findings to be expected in the background population. Trauma-related MRI findings are rare in a whiplash population screened for serious injuries in the emergency unit and not related to a specific symptomatology. Also, pre-existing degeneration is not associated with prognosis.

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confidence: 77%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

et al. 2008

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“…One study was further excluded after detailed screening of full text articles because the comparison was performed in quantitative date of signal alterations of the transverse ligament [32], not qualitative date in other studies. Another two papers by the same authors, evaluating alar and transverse ligaments, respectively, shared the same subjects, thus were combined and considered as one study [20,23]. Because MRI scan protocol and evaluation criteria for ligament changes used in the paper by Lindgren et al [24] (1.5 T dynamic kine MRI and two-point grading scale and movement) was completely different from other six papers (1.5 T fast spin-echo proton density-weighted sequences and four-point grading scale), this paper was excluded in order to minimize clinical bias.…”

Section: Resultsmentioning

confidence: 99%

“…These structures could be well visualized by magnetic resonance imaging (MRI) [17][18][19]. In recent years, with the development of more detailed MRI techniques morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed [18,[20][21][22][23][24][25][26][27]. However, most of these studies include relatively small samples of patients and thus their results were inconsistent and lacked statistical strength.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Shen

2012

Eur Spine J

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Purpose Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A metaanalysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs. Methods A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced. Results Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80-2.94). Heterogeneity was present (I 2 = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87-1.86, I 2 = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49-4.21). Heterogeneity was present (I 2 = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49-1.28, I 2 = 0 %). Conclusion MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

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Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis

Farrell

Smith

Hancock

et al. 2019

Magnetic Resonance Imaging

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Background There is uncertainty regarding the clinical significance of findings on MRI in patients with whiplash associated disorder (WAD) or nonspecific neck pain (NSNP). Purpose To compare the presence of cervical spine MRI findings in people with WAD or NSNP with pain‐free controls. Study Type Systematic review and meta‐analysis. Population Adults with WAD (n = 994), NSNP (n = 715), or pain‐free controls (n = 2323). Field Strength 0.5T, 1.5T, and 3.0T. Assessment Medline, EMBASE, CINAHL, Web of Science, SCOPUS, and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies for inclusion and extracted data. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Overall quality of the evidence from meta‐analysis was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Statistical Tests Meta‐analysis was performed using a random‐effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data. Results In total, 31 studies were included (eight comparing acute WAD to controls, 14 comparing chronic WAD to controls, 12 comparing chronic NSNP to controls) comprising 4032 participants. Rectus capitis posterior major cross‐sectional area was smaller in people with chronic NSNP than controls (two studies: SMD –1.18 [95% confidence interval [CI] –1.65, –0.71]). The remaining meta‐analysis comparisons showed no group differences in MRI findings. The quality of evidence was mostly low due to small sample sizes and high heterogeneity. Data Conclusion Given the typically low‐quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared with pain‐free controls. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018.

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MR analysis of the transverse ligament in the late stage of whiplash injury

Abstract: Whiplash trauma can damage the transverse ligament. By use of high-resolution proton-weighted MR images such lesions can be detected and classified. The reliability of this classification still needs improvement.

Cited by 46 publications

References 23 publications

Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis

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