The Cervical Facet Capsule and Its Role in Whiplash Injury

Winkelstein, Beth A.; Nightingale, Roger W.; Richardson, William J.; Myers, Barry S.

doi:10.1097/00007632-200005150-00007

Cited by 186 publications

(157 citation statements)

References 28 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…Mykelbust et al (1988) reported failure forces of 112±30 N and 72±18 N for 20 tensile loading of isolated C3/C4 and C5/C6 ligaments, respectively. Likewise, 21 Winkelstein et al (2000) reported ligament failure at similar forces of 94.3±44.4 N and 22 82.5±33.0 N for these same joints. In that study, maximum ligament distraction at failure 23 was 5.10±0.73 mm and 6.40±0.66 mm, respectively, producing maximum principal 24 strains of 103.6±80.9% in the facet capsule (Winkelstein et al 2000).…”

Section: Introductionmentioning

confidence: 68%

“…Likewise, 21 Winkelstein et al (2000) reported ligament failure at similar forces of 94.3±44.4 N and 22 82.5±33.0 N for these same joints. In that study, maximum ligament distraction at failure 23 was 5.10±0.73 mm and 6.40±0.66 mm, respectively, producing maximum principal 24 strains of 103.6±80.9% in the facet capsule (Winkelstein et al 2000). In tensile failure 25 tests of lower cervical spine specimens (C5-T1), Yoganandan et al (2000) reported 26 stresses of 7.4±1.3 MPa and strains of 116.0±19.6%, with corresponding stiffness and 27 energy to failure of 36.9±6.06 N/mm and 1.5±0.4 Nm, respectively.…”

Section: Introductionmentioning

confidence: 68%

“…The cervical facet joint has been identified as a source of neck pain (Aprill and 2 Bogduk, 1992;Barnsley et al 1994) and a likely candidate for painful whiplash injury, in 3 both clinical and biomechanical studies (Bogduk and Marsland, 1988;Kaneoka et al 4 1999;Luan et al 2000;Ono et al 1997;Panjabi et al 1998a,b;Pearson et al 2004;5 Siegmund et al 2001;Winkelstein et al 1999Winkelstein et al , 2000Yoganandan and Pintar, 1997;6 Yoganandan et al 1998a6 Yoganandan et al , 2002. Studies of cadaveric head-neck preparations using high-7 speed imaging have demonstrated that the facet joint and its capsular ligament can 8 experience excessive motions and ligament strains during whiplash simulations (Panjabi 9 et al 1998a,b;Pearson et al 2004;Sundararajan et al 2004;Yoganandan et al 2001Yoganandan et al , 10 2002).…”

Section: Introductionmentioning

confidence: 99%

“…Studies of cadaveric head-neck preparations using high-7 speed imaging have demonstrated that the facet joint and its capsular ligament can 8 experience excessive motions and ligament strains during whiplash simulations (Panjabi 9 et al 1998a,b;Pearson et al 2004;Sundararajan et al 2004;Yoganandan et al 2001Yoganandan et al , 10 2002). Studies of isolated cervical spinal motion segments have also documented that 11 these cervical spine kinematics can induce facet capsule stretch and possible minor 12 ligament ruptures below the mechanical thresholds for gross failure of the ligament 13 (Siegmund et al 2001;Winkelstein et al 2000). However, while these mechanical 14 studies suggest that the facet capsular ligament may be at mechanical risk for painful 15 injury during some neck motions, the physiologic consequence of these injuries and their 16 relationship to the tensile mechanical response of the joint is undefined.…”

Section: Introductionmentioning

confidence: 99%

“…Tensile failure properties of the human cervical facet capsular ligament have been 18 previously defined (Mykelbust et al 1988;Winkelstein et al 1999Winkelstein et al , 2000Yoganandan et 19 al. 2000).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Tensile cervical facet capsule ligament mechanics: Failure and subfailure responses in the rat

Lee

Franklin

Davis

et al. 2006

Journal of Biomechanics

Self Cite

View full text Add to dashboard Cite

Clinical, epidemiological, and biomechanical studies suggest the involvement of the cervical facet joint in neck pain. Mechanical studies have suggested the facet capsular ligament to be at risk for subfailure tensile injury during whiplash kinematics of the neck. Ligament mechanical properties can be altered by subfailure injury and such loading can induce cellular damage. However, at present, there is no clear understanding of the physiologic context of subfailure facet capsular ligament injury and mechanical implications for whiplashrelated pain. Therefore, this study aimed to define a relationship between mechanical properties at failure and a subfailure condition associated with pain for tension in the rat cervical facet capsular ligament. Tensile failure studies of the C6/C7 rat cervical facet capsular ligament were performed using a customized vertebral distraction device. Force and displacement at failure were measured and stiffness and energy to failure were calculated. Vertebral motions and ligament deformations were tracked and maximum principal strains and their directions were calculated. Mean tensile force at failure (2.96±0.69 N) was significantly greater (p<0.005) than force at subfailure (1.17±0.48 N). Mean ligament stiffness to failure was 0.75±0.27 N/mm. Maximum principal strain at failure (41.3±20.0%) was significantly higher (p=0.003) than the corresponding subfailure value (23.1±9.3%). This study determined that failure and a subfailure painful condition were significantly different in ligament mechanics and findings provide preliminary insight into the relationship between mechanics and pain physiology for this ligament. Together with existing studies, these findings offer additional considerations for defining mechanical thresholds for painful injuries.

show abstract

Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tensile cervical facet capsule ligament mechanics: Failure and subfailure responses in the rat

Lee

Franklin

Davis

et al. 2006

Journal of Biomechanics

Self Cite

View full text Add to dashboard Cite

show abstract

Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography

Anderst

2015

Journal Orthopaedic Research

View full text Add to dashboard Cite

Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.

show abstract

Whiplash: Pathophysiology, diagnosis, treatment, and prognosis

2004

View full text Add to dashboard Cite

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.

show abstract

The Cervical Facet Capsule and Its Role in Whiplash Injury

Cited by 186 publications

References 28 publications

Tensile cervical facet capsule ligament mechanics: Failure and subfailure responses in the rat

Tensile cervical facet capsule ligament mechanics: Failure and subfailure responses in the rat

Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography

Whiplash: Pathophysiology, diagnosis, treatment, and prognosis

Contact Info

Product

Resources

About