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Whiplash, Cervical - Medical Research Abstracts

Dr. John Limbert
E-MAIL: jlimbert@medlit.net

Pathophysiology - Physiology

1-9

10-19

10. AUTHORSchmidt-G.
TITLE(Biomechanics of whiplash injuries of the cervical spine). TT Zur Biomechanik des Schleudertraumas der Halswirbelsaule.
SOURCEVersicherungsmedizin 1989 Jul 1, VOL: 41 (4), P: 121-6, ISSN: 0933-4548 30 Refs.
ABSTRACT1. The whiplash injury of the cervical spine is a typical, but not very often observed injury of occupants of automotive vehicles involved in moderate collisions.

2. There still exist great uncertainties in the elaboration of expertises concerning the minor whiplash injury, so that the great part of the disturbances cannot be objectivated under a clinical point of view. And on the other hand, serious whiplash injuries often are superposed or veiled by secondary injuries.

3. Thus, the aim of the present paper was to point out injury mechanisms, to give a rough scaling of the whiplash severity under biomechanical aspects and finally to set these injury mechanisms in correlation to the following criteria of accident: a) vehicle velocity change (energy equivalent speed--EES); b) deformation of vehicles on the impact-exposed structure; c) loading of occupants by acceleration or deceleration.

4. The tolerance limit of the cervical spine generally decreases to a lower limit, if the cervical spine is changed in a pathological way, e.g. by preexisting diseases.

5. It is evident and important, that the difficult work of giving an expert's opinion on this field must be performed in an interdisciplinary collaboration of engineers for collision-analysis and physicians experienced in accident-traumatology. Author.

  
11. AUTHORSchneider-K, Zernicke-R-F, Clark-G.
INSTITUTIONDepartment of Kinesiology, University of California, Los Angeles 90024-1568.
TITLEModeling of jaw-head-neck dynamics during whiplash.
SOURCEJ-Dent-Res 1989 Sep, VOL: 68 (9), P: 1360-5, ISSN: 0022-0345.
ABSTRACTClinicians report signs and symptoms of temporomandibular joint (TMJ) disorders in many patients who have experienced automobile rear-end collisions involving neck hyperextension (whiplash). In order for relationships between TMJ disorders and rear-end collisions to be explored, the dynamic response of the jaw to hyperextension of the neck associated with automobile rear-end collisions needs to be quantified. To achieve this goal, we extended an existing head-neck model by adding a movable jaw, and performed preliminary computer simulations of the jaw movements during rear-end collisions at 6.71 ms-1 (15 mph) and 13.41 ms-1 (30 mph). The initial computer simulations produced promising kinematic and dynamic results, such as: relative angle between the head and jaw (jaw-opening angle), predicted TMJ torques, and displacement and linear acceleration of the jaw's center of mass. However, the absolute values and time course of our results must be viewed with caution, since the jaw model has not yet been validated with experimental data. Nevertheless, the modeling approach, detailed in this study, shows good promise for eventually providing quantitative dynamic information about the jaw-head-neck system during impulsive loading. Author.
  
12. AUTHORRadanov-B-P, Dvorak-J, Valach-L.
INSTITUTIONPsychiatrische Universitatspoliklinik Bern.
TITLE(Psychological changes following whiplash injury of the cervical vertebrae). TT Psychische Veranderungen nach Schleuderverletzungen der Halswirbelsaule.
SOURCESchweiz-Med-Wochenschr 1989 Apr 29, VOL: 119 (17), P: 536-43, ISSN: 0036-7672.
ABSTRACTTo evaluate the frequently attributed psychogenic origin of symptoms following "whiplash" injury, 66 patients who had suffered such an injury underwent clinical and psychometric examination. Data were collected on subjective symptoms and their possible psychogenic origin and psychopathology. Personality profile, subjective well- being and cognitive impairment were evaluated. The amount of long- lasting psychopathological alterations was comparatively small. The results do not support the notion of a psychogenic origin for symptoms after "whiplash" injury; personality traits and psychopathology do not explain the nature of the complaints. Author.
  
13. AUTHORWalz-F.
INSTITUTIONGerichtlich-Medizinisches Institut, Universitat Zurich.
TITLE(Whiplash trauma of the cervical vertebrae in traffic: biomechanical and expert-opinion aspects). TT Das Schleudertrauma der Halswirbelsaule im Strassenverkehr: biomechanische und gutachterliche Aspekte.
SOURCESchweiz-Med-Wochenschr 1987 Apr 18, VOL: 117 (16), P: 619-23, ISSN: 0036-7672.
ABSTRACTThe indirect injury mechanisms of the cervical spine should be subdivided into "non-contact injury" of the cervical spine, without head impact, by definition (hyperflexion or hyperextension), sometimes also called whiplash injury mechanism, and bending mechanism due to head contact, i.e. "contact injury" (hyperflexion, hyperextension, lateral bending, axial compression). The term "whiplash" is, in strict biomechanical terms, very often incorrect since it implies a biphasic motion (hyperextension and hyperflexion, or vice versa); in traffic collisions, however, its second phase is insignificant. The terms used for the injuries themselves should be taken from the classic morphology (fracture, luxation, distorsion etc.). The severity of the injury alone offers no hint as to the mechanical severity of the collision, which is established only by a mathematical reconstruction of the collision dynamics also taking into account such criteria as collision angle, seat belts, head restraint position etc. Significant cervical spine injury due to non- contact mechanism is very rare if car damage is only minor; however, head contact inducing cervical bending can lead to severe cervical injuries even with minor car damage. In the latter case the patient should not be treated as a malingerer. Moreover, if more than two vehicles are involved the reconstruction of the accident is greatly facilitated if the lesion can be proven to be a "contact" or "non- contact" injury (legal implications, insurance payments). The (rare) severe cervical spine injuries in seat belt wearers are not caused by the restraining effect of the belt but by bending and injuring of the neck due to head contact which often is not completely avoidable (justification of mandatory seat belt law). Author.
  
14. AUTHORBoismare-F, Boquet-J, Moore-N, Chretien-P, Saligaut-C, Daoust-M.
INSTITUTIONFaculty of Medicine, Department of Pharmacology, University of Rouen, Saint-Etienne du Rouvray, France.
TITLEHemodynamic, behavioral and biochemical disturbances induced by an experimental cranio-cervical injury (whiplash) in rats.
SOURCEJ-Auton-Nerv-Syst 1985 Jun, VOL: 13 (2), P: 137-47, ISSN: 0165-1838.
ABSTRACTTwo days after an experimental whiplash performed on anesthetized Long-Evans female rats, without any direct blow to the head, we observed:
  1. a hypotension (in supine position) (P less than 0.01),
  2. a disturbance of the postural regulation of cerebral blood flow (P less than 0.01),
  3. a disturbance of learning behavior characterized by decreased acquisition and retention (conditioned avoidance response and labyrinth tests),
  4. an increase of the dopamine level (whole brain, cerebellum, thalamus + hypothalamus, corpus striatum and rest),
  5. a decrease of the noradrenaline level in whole brain (P less than 0.05) and in the medulla oblongata but an increase in thalamus plus hypothalamus, hippocampus and corpus striatum,
  6. an increased reactivity of the peripheral alpha and beta receptors, determined by analyzing the hemodynamic consequences of i.v. injection of norepinephrine or isoproterenol,
  7. there was no modification of the brain content of water or of serotonin and
  8. finally, the injured rats displayed a remarkably aggressive behavior, though this was not quantified. These results are in agreement with the hypothesis that a change in brain amines metabolism could explain the different functional effects of whiplash. We therefore believe that the postconcussion syndrome is not subjective and that the neck injury is primary in the determination of the syndrome. Author.
  
15. AUTHORHertz-H, Meng-A, Rabl-V, Kern-H.
INSTITUTIONI. Universitatsklinik fur Unfallchirurgie, Wien.
TITLE(Treatment of whiplash injuries of the cervical spine with acupuncture). TT 'Zur Behandlung des Schleudertraumas der HWS mit Akupunktur'.
SOURCEAktuelle-Traumatol 1983 Aug, VOL: 13 (4), P: 151-3, ISSN: 0044-6173.
ABSTRACT30 patients with whiplash injuries were treated with aural- acupuncture. The points were chosen according to a special programme. Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation. Author.
  
16. AUTHORSaternus-K-S.
INSTITUTIONInstitut fur Rechtsmedizin der Universitat.
TITLE(Writing of expertises on whiplash injuries of the cervical spine (author's transl)). TT Die Begutachtung des Schleudertraumas der Halswirbelsaule.
SOURCEAktuelle-Traumatol 1982 Jan, VOL: 12 (1), P: 4-11, ISSN: 0044-6173.
ABSTRACTReflections on the definition of the term "whiplash injury" are followed by comments on the mechanism of accidents. The author emphasizes the importance of the biphasic course of the trauma, involving a mass contraction, triggered by reflex action, of the initially suddenly overstretched muscle groups with their synergist. Reference is made to the ideas developed by Kummer, who considers the neck as an arcuate tendon construction with tractional tension on the dorsal as well as on the ventral side. In the analysis of the injury pattern of the cervical spine, the special forms of intervertebral disc injury are dealt with, the relationship to degenerative lesions prior to the accident and to secondary lesions (spondylosis deformans and osteochondrosis) are discussed in detail, and the consequences for writing medical expertises are mentioned. Author.
  
17. AUTHORBuhring-M.
INSTITUTIONKlinikum der Johann Wolfgang Goethe-Universitat Zentrum der Inneren Medizin.
TITLE(Reflex dystrophy following so-called whiplash injury of the cervical spine). TT Reflexdystrophie nach sogenanntem Schleudertrauma der HWS.
SOURCEZ-Orthop 1984 May-Jun, VOL: 122 (3), P: 281-6, ISSN: 0044-3220.
ABSTRACTIn bad cases of whiplash injury of the cervical spine the post- accidental course is complicated by pain, vegetative dysfunctional syndromes and by psychic and psychiatric disorders over many years. There is no satisfactory concept to understand the pathophysiology of these processes. The paper deals with the possibility of a reflex dystrophy. Sympathetic reflex dystrophy syndromes are seen principally in patients with joint, tendon or vascular lesions. In case of whiplash injury, it would concern the cervical spine itself as well as visceral organs including the central nervous system. For the CNS the lymphostatic encephalopathy is a well defined entity. Above all, a reflex dystrophy develops on the basis of a special personality structure. In case of psychic and psychiatric complaints after whiplash injury patients with a so called Sudeck-personality should not be suspected to aggravate; in contrast, especially in these patients complications by reflex dystrophy are credible. Consequences for the assessment and for rehabilitation are discussed. Author.
  
18. AUTHORSaternus-K-S.
INSTITUTIONInstitut fur Rechtsmedizin der Universitat Koln.
TITLE(The mechanics of whiplash injury of the cervical spine (author's transl)). TT Zur Mechanik des Schleudertraumas der Halswirbelsaule.
SOURCEZ-Rechtsmed 1982, VOL: 88 (1-2), P: 1-11, ISSN: 0044-3433.
ABSTRACTDespite many attempts it has so far not been possible to establish a uniform application of the term "whiplash injury" either for diagnostics, therapy, or medical reports. To obtain a clear, functionally based definition, the most frequently used formulations are compared, taking into account anatomic and mechanical aspects in addition. Whiplash injury is separated from hyperextension injury ("snap" trauma of the cervical spine), even though overlaps in the lesion picture are possible. In the definition suggested, invariable linkage to rear-end collision is dispensed with. Instead, it is emphasized that this accident mechanism is frequent, but can also be substituted. In contrast to other definitions, special emphasis is laid on the biphasic course since a substantial traumatization is to be assumed to occur from the secondary movement. This second movement does not by any means proceed with low energy, but its determined by the mass contraction of the muscle group subject to primary abrupt overextension with their synergists. On the basis of the analysis of the mechanical course and the investigation of a actual accidents, the monosegmental cervical spine injury cannot, therefore, be seen as the characteristic type of damage due to a whiplash injury. Instead of this, the frequent occurrence of multiple injuries is pointed out. Author.
  
19. AUTHORFischer-D, Palleske-H.
INSTITUTIONNeurochirurgischen Klinik Der Universitat Des Saarlandes Homburg /Saar.
TITLE(EEG after so-called whiplash injury of cervical vertebral column (cervicocephalic acceleration trauma)). TT Das EEG nach der sogenannten Schleuderverletzung der Halswirbelsaule (zerviko-zephales Beschleunigungstrauma).
SOURCEZentralbl-Neurochir 1976, VOL: 37 (1), P: 25-35, ISSN: 0044-4251.
ABSTRACTThe results of electroencephalographic examinations made on four groups of patients are compared. These groups include 80 patients with cervicocephalic syndromes due to flinging injuries to the cervical vertebral column, 80 patients with postconcussive syndromes, and 39 patients whose anamneses suggested conditions resulting from the two kinds of injury referred to above. A fourth group of 40 patients with nontraumatic spondylosis deformans cervicalis is compared with the first three groups of patients. The rate (49 percent, 52 percent, and 54 percent), kind, and distribution of electroencephalographically determined abnormalities are in agreement with those obtained for the first three groups. For patients with nontraumatic cervicocephalic syndromes the rate of general alterations determined from records obtained by means of the electroencephalograph is equal to the occurrence of constitutional EEG variants, the rate being of the order of 10 percent. EEG alterations observed in the case of flinging traumata are considered to de due to acceleration injuries to the cranial contents. Author.

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