Increased Sagittal Plane Segmental Motion in the Lower Cervical Spine in Women With Chronic Whiplash-Associated Disorders, Grades I–II: A Case-Control Study Using a New Measurement Protocol

Study Design. Case-control study comparing sagittal plane segmental motion in women (n = 34) with chronic whiplash-associated disorders, Grades I–II, with women (n = 35) with chronic insidious onset neck pain and with a normal database of sagittal plane rotational and translational motion. Objective. To reveal whether women with chronic whiplash-associated disorders, Grades I–II, demonstrate evidence of abnormal segmental motions in the cervical spine. Summary of Background Data. It is hypothesized that unphysiological spinal motion experienced during an automobile accident may result in a persistent disturbance of segmental motion. It is not known whether patients with chronic whiplash-associated disorders differ from patients with chronic insidious onset neck pain with respect to segmental mobility. Methods. Lateral radiographic views were taken in assisted maximal flexion and extension. A new measurement protocol determined rotational and translational motions of segments C3–C4 and C5–C6 with high precision. Segmental motion was compared with normal data as well as among groups. Results. In the whiplash-associated disorders group, the C3–C4 and C4–C5 segments showed significantly increased rotational motions. Translational motions within each segment revealed a significant deviation from normal at the C3–C4 segment in the whiplash-associated disorders and insidious onset neck pain groups and at the C5–C6 segment in the whiplash-associated disorders group. Significantly more women in the whiplash-associated disorders group (35.3%) had abnormal increased segmental motions compared to the insidious onset neck pain group (8.6%) when both the rotational and the translational parameters were analyzed. When the translational parameter was analyzed separately, no significant difference was found between groups, or 17.6% (whiplash-associated disorders group) and 8.6% (insidious onset neck pain group), respectively. Conclusion. Hypermobility in the lower cervical spine segments in 12 out of 34 patients with chronic whiplash-associated disorders in this study point to injury caused by the accident. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.

[1]  E Schneider,et al.  Biomechanics of the craniocervical region: The alar and transverse ligaments , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[2]  Gwendolen Jull,et al.  Deep Cervical Flexor Muscle Dysfunction in Whiplash , 2000 .

[3]  L. Claes,et al.  Load-displacement properties of the normal and injured lower cervical spine in vitro , 2000, European Spine Journal.

[4]  L. Penning.  Normal movements of the cervical spine. , 1978, AJR. American journal of roentgenology.

[5]  Sean P. F. Hughes,et al.  Instantaneous Center of Rotation and Instability of the Cervical Spine: A Clinical Study , 1997, Spine.

[6]  A. Söderlund,et al.  Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology , 2000, Clinical rehabilitation.

[7]  J. Cholewicki,et al.  Whiplash Produces an S‐Shaped Curvature of the Neck With Hyperextension at Lower Levels , 1997, Spine.

[8]  J Cholewicki,et al.  Biomechanical basis for stability: an explanation to enhance clinical utility. , 2001, The Journal of orthopaedic and sports physical therapy.

[9]  S. Mercer,et al.  Biomechanics of the cervical spine. I: Normal kinematics. , 2000, Clinical biomechanics.

[10]  H. van Mameren,et al.  Cervical spine motion in the sagittal plane (I) range of motion of actually performed movements, an X-ray cinematographic study. , 1990, European journal of morphology.

[11]  R. Lin,et al.  Characteristics of Sagittal Vertebral Alignment in Flexion Determined by Dynamic Radiographs of the Cervical Spine , 2001, Spine.

[12]  K. Hayashi,et al.  Motion analysis of cervical vertebrae during whiplash loading. , 1999, Spine.

[13]  Bone graft translation of four upper cervical spine fixation techniques in a cadaveric model , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  M. Panjabi,et al.  Thoracolumbar burst fracture. A biomechanical investigation of its multidirectional flexibility. , 1994 .

[15]  J. Cholewicki,et al.  Whiplash injuries and the potential for mechanical instability , 1998, European Spine Journal.

[16]  K. Kaneda,et al.  Dynamic motion analysis of normal and unstable cervical spines using cineradiography. An in vivo study. , 1999, Spine.

[17]  Ken Niere,et al.  Clinicians' perceptions of minor cervical instability. , 2004, Manual therapy.

[18]  M M Panjabi,et al.  The onset and progression of spinal injury: a demonstration of neutral zone sensitivity. , 1992, Journal of biomechanics.

[19]  C. Wimmer,et al.  Biomechanik der lumbalen Instabilität , 1997 .

[20]  B Llopis Faner,et al.  [Biomechanics of the cervical spine]. , 1968, Revista espanola de reumatismo y enfermedades osteoarticulares.

[21]  M M Panjabi,et al.  Transections of the C1‐C2 Joint Capsular Ligaments in the Cadaveric Spine , 1991, Spine.

[22]  P Brinckmann,et al.  Sagittal plane segmental motion of the cervical spine. A new precision measurement protocol and normal motion data of healthy adults. , 2002, Clinical biomechanics.

[23]  R A Deyo,et al.  Physician Views About Treating Low Back Pain: The Results of a National Survey , 1995, Spine.

[24]  A. Nordwall,et al.  Normal range of motion of the cervical spine. , 1989, Archives of physical medicine and rehabilitation.

[25]  R. Gunnarsson,et al.  Early Intervention in Whiplash-Associated Disorders: A Comparison of Two Treatment Protocols , 2000, Spine.

[26]  S. Tashman,et al.  Qualitative analysis of neck kinematics during low-speed rear-end impact. , 2000, Clinical biomechanics.

[27]  Miller,et al.  CLINICAL STUDY The , 2022 .

[28]  D. Turk.  Customizing Treatment for Chronic Pain Patients: Who, What, and Why , 1990, The Clinical journal of pain.

[29]  N Yoganandan,et al.  Biomechanics of the cervical spine Part 3: minor injuries. , 2001, Clinical Biomechanics.

[30]  W. Rauschning,et al.  Hidden cervical spine injuries in traffic accident victims with skull fractures. , 1991, Journal of spinal disorders.

[31]  J. Cusick,et al.  Whiplash Syndrome: Kinematic Factors Influencing Pain Patterns , 2001, Spine.

[32]  N Yoganandan,et al.  Cervical spine vertebral and facet joint kinematics under whiplash. , 1998, Journal of biomechanical engineering.

[33]  M. Kraemer,et al.  Radio-functional analysis of the cervical spine using the Arlen method. A study of 699 subjects. Part One: Methodology. , 1989, Journal of neuroradiology. Journal de neuroradiologie.

[34]  S. Bohrer,et al.  Cervical spine flexion patterns , 2004, Skeletal Radiology.

[35]  M. Kraemer,et al.  Radio-functional analysis of the cervical spine using the Arlen method. A study of 699 subjects. Part Two: Paradoxical tilting of the atlas. , 1989, Journal of neuroradiology. Journal de neuroradiologie.

[36]  H. van Mameren,et al.  Cervical Spine Motion in the Sagittal Plane II: Position of Segmental Averaged Instantaneous Centers of Rotation -A Cineradiographic Study , 1992, Spine.

[37]  J. Cholewicki,et al.  Capsular ligament stretches during in vitro whiplash simulations. , 1998, Journal of spinal disorders.

[38]  Folke Knutsson,et al.  The Instability Associated with Disk Degeneration in the Lumbar Spine , 1944 .

[39]  Nikolai Bogduk,et al.  Abnormal Instantaneous Axes of Rotation in Patients with Neck Pain , 1992, Spine.

[40]  W. Spitzer,et al.  Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. , 1995, Spine.

[41]  I A Stokes,et al.  Stability increase of the lumbar spine with different muscle groups: a biomechanical in vitro study. , 1995, Spine.

[42]  M. Panjabi,et al.  The value of functional computed tomography in the evaluation of soft-tissue injury in the upper cervical spine , 2005, European Spine Journal.

[43]  D. Grob,et al.  Clinical Validation of Functional Flexion/Extension Radiographs of the Cervical Spine , 1993, Spine.

[44]  N. Gilhus,et al.  MRI assessment of the alar ligaments in the late stage of whiplash injury – a study of structural abnormalities and observer agreement , 2002, Neuroradiology.

[45]  E. Kristjansson,et al.  Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. , 2002, Journal of manipulative and physiological therapeutics.