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.

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