Whiplash, Cervical - Medical Research Abstracts

12. AUTHOR	Ernst-E.
INSTITUTION	Postgraduate Medical School, University of Exeter, United Kingdom.
TITLE	(The cervical spine whiplash trauma). TT Das Hals-Wirbelsaulen-Schleudertrauma.
SOURCE	Acta-Med-Austriaca 1993, VOL: 20 (5), P: 115-9, ISSN: 0303-8173 49 Refs.
ABSTRACT	The whiplash injury is a classical injury of the upper spine following a car crash. It results from hyperextension and hyperflexion of the upper spine. In most cases no morphological changes can be verified. Thus the diagnosis has to be clinical, based on subjective symptoms. The prognosis is often good; the true problem are those few patients who develop chronic complaints. Therapy consists of initial immobilisation, analgetics and physiotherapy. Reasonable driving, safe cars and head rests should help to prevent whiplash injuries. Author.

13. AUTHOR	Huber-A, Beran-H, Trenkler-J, Hager-A, Witzmann-A, Fischer-J.
INSTITUTION	Neurochirurgische Abteilung Wagner-Jauregg-Krankenhaus Linz.
TITLE	(Whiplash trauma of the cervical spine from the neurosurgical, traumatologic and psychologic viewpoint). TT Das Schleudertrauma der HWS aus neurochirurgischer, traumatologischer und psychologischer Sicht.
SOURCE	Neurochirurgia (Stuttg) 1993 Mar, VOL: 36 (2), P: 51-5, ISSN: 0028-3819.
ABSTRACT	Since the early 50's, whiplash injury has been a subject of intensive study in order to find out the genesis of this disease. Unfortunately, most of the studies were planned retrospectively and were based on inhomogeneous groups of patients. In our prospective study, we tried to keep the patient group homogeneous. 62 patients were examined neurologically and radiologically immediately after the accident. Furthermore, they underwent a psychological test, the so- called Freiburg personality profile. 6 months later the patients were checked again. On the basis on our findings, the suspected psychological influence has to be confirmed. Preexisting degenerative lesions of the cervical spine, also, are undoubtedly prognostic for longer-lasting symptoms. Author.

14. AUTHOR	Pressman-B-D, Shellock-F-G, Schames-J, Schames-M.
INSTITUTION	Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA.
TITLE	MR imaging of temporomandibular joint abnormalities associated with cervical hyperextension/hyperflexion (whiplash) injuries.
SOURCE	J-Magn-Reson-Imaging 1992 Sep-Oct, VOL: 2 (5), P: 569-74, ISSN: 1053-1807.
ABSTRACT	Patients often have temporomandibular joint (TMJ) dysfunction-related symptoms after cervical hyperextension/hyperflexion injuries ("whiplash") caused by rear-end motor-vehicle collisions. To determine abnormalities of the TMJ associated with these injuries, 33 consecutive symptomatic patients (66 joints) with no direct trauma to the jaw, mouth, head, or face due to the accident and no prior history of TMJ dysfunction underwent magnetic resonance (MR) imaging, and the images were retrospectively analyzed. Overall, 29 (88%) patients had some type of TMJ abnormality related to whiplash injury. Displacement of the disk was seen in 37 (56%) of the TMJs as follows: 21 (32%) had anterior displacement with reduction, nine (14%) had anterior displacement without reduction, six (9%) had lateral or medial displacement, and one (2%) had posterior displacement. On T2- weighted images, 43 (65%) TMJs had abnormal joint fluid or edema, predominantly affecting the joint capsule and/or lateral pterygoid muscles. The finding that many of the patients had joint fluid and/or soft-tissue edema indicates that T2-weighted images are especially useful for assessment of patients with a history of whiplash injury. Author.

15. AUTHOR	Ettlin-T-M, Kischka-U, Reichmann-S, Radii-E-W, Heim-S, Wengen-D, Benson-D-F.
INSTITUTION	University Clinics, Basel, Switzerland.
TITLE	Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury (see comments).
SOURCE	J-Neurol-Neurosurg-Psychiatry 1992 Oct, VOL: 55 (10), P: 943-8, ISSN: 0022-3050.
CM	Comment in: J-Neurol-Neurosurg-Psychiatry 1993 Dec; 56(12):1328-9.
ABSTRACT	Twenty one unselected patients with an acute whiplash injury of the neck had neurological and neuropsychological assessment, cervical x rays, EEG, BAEP, MRI, and an otoneurological examination within two weeks of the injury. Subjectively, 13 patients reported concentration deficits, 18 reported sleep disturbances, 9 had symptoms of depression, and 7 female patients told of menstrual irregularities. Neuropsychological examination revealed significantly lower performance in tests related to attention and concentration compared to sex, age and educational matched control subjects. Otoneurological examination showed abnormalities in 9 of 17 whiplash subjects. EEG showed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in all patients. Repeat neuropsychological testing in 15 patients at three months showed that attention deficits had improved but were still shown in 12 of 14 and the concentration deficits in 8 of 13 patients. At one year all patients had returned to work, 16 to full and 5 to part time employment. In 4, cognitive dysfunction remained the only significant problem. These findings are discussed as being compatible with possible damage to basal frontal and upper brain stem structures after whiplash injury of the neck. Author.

16. AUTHOR	Ramseier-E-W.
INSTITUTION	Abteilung Unfallmedizin, Schweizerischen Unfallversicherungsanstalt SUVA Luzern.
TITLE	(Street traffic accident--whiplash injury of the cervical spine from the viewpoint of insurance medicine). TT Strassenverkehrsunfall--Das Schleudertrauma der Halswirbelsaule aus versicherungsmedizinischer Sicht.
SOURCE	Z-Unfallchir-Versicherungsmed 1991, VOL: 84 (2), P: 101-9, ISSN: 0040-3603.
ABSTRACT	The Swiss Accident Insurance Institute (SUVA), as the largest mandatory insurer against accidents in Switzerland, handles approximately 3000 cases of injury to the cervical spine every year, half of which are the result of traffic accidents. A considerable proportion of these involve whiplash injuries to the cervical spine. Epidemiological and statistical results according to this medical definition and based on material collected over a period of several years are presented. The assessment of these cases from the medical insurance point of view is discussed. Mild whiplash injuries are very common and as a rule they heal without sequelae. Severe whiplash injuries with massive soft-tissue damage and fractures are rare and present few problems for the causality assessment. Problemtical, on the other hand, are the not infrequent cases of whiplash injuries which initially seem to be ordinary sprains but which subsequently develop into lasting clinical syndromes that are very difficult to objectify. Further, the assessment and care of these problem cases in particular are discussed from the medical insurance point of view. In these patients, who suffer severe pain and discomfort, it is in most cases not possible to obtain any objective findings with the classical diagnostic measures of radiology, orthopaedics and neurology. They can very soon be suspected of malingering, exaggeration or pension neurosis. Only with the very sophisticated, modern diagnostic methods of neuropsychology, chiropraxis and functional computed tomography is it sometimes possible to objectify these syndromes in a reproducible manner and possibly to establish a post-traumatic instability as the cause. This then again opens up promising possibilities for the treatment of these patients. The SUVA supports research aimed at developing and testing such promising new methods of examination. However, it at the same time warns against the uncritical use of these expensive methods of examination, the informative value and the scientific validity of which are in some respects still not sufficiently well established. Author.

17. AUTHOR	Jenzer-G, Walz-F.
INSTITUTION	Arbeitsgruppe fur Unfallmechanik, Gerichtlich-Medizinisches Institut Universitat Zurich.
TITLE	(The "severity" of "whiplash injury of the cervical spine"). TT Die "Schwere" des "Schleudertraumas der Halswirbelsaule".
SOURCE	Z-Unfallchir-Versicherungsmed 1991, VOL: 84 (1), P: 7-19, ISSN: 0040-3603 40 Refs.
ABSTRACT	The severity of the so called "whiplash injury of the neck" ("soft tissue neck injury") and the condition thereafter depends on the chosen angle of view: impact dynamics, biomechanics, pathological- anatomical considerations, clinical and apparative findings, medicolegal aspects and subjective assessment. The impact itself may not serve as a diagnosis, which latter has to be founded on the results of the medical examination. These findings seem to be appropriate for the resolution of questions in the course of litigation. At present, a universal severity may not be defined. Author.

18. AUTHOR	Oosterveld-W-J, Kortschot-H-W, Kingma-G-G, de-Jong-H-A, Saatci-M-R.
INSTITUTION	Academisch Medisch Centrum, University of Amsterdam, The Netherlands.
TITLE	Electronystagmographic findings following cervical whiplash injuries.
SOURCE	Acta-Otolaryngol (Stockh) 1991, VOL: 111 (2), P: 201-5, ISSN: 0001-6489.
ABSTRACT	A group of 262 patients suffering from the after-effects of an acceleration trauma of the neck were subjected to an extensive vestibular examination. 85% of the patients complained of some type of vertigo. The visual suppression test conducted during rotation showed pathology in 37% of the cases. Visual pursuit movements were affected in 43% of the cases. In a group of 41 patients the results obtained respectively 1 and 2 years after the accident were compared. There was no significant improvement of the findings. No oculomotor system pathology was found in 99 cases (38%), and no electronystagmographic pathology at all in 55 cases (21%). The study emphasized the fact that nystagmographic examinations are able to detect central vestibular dysfunction and is therefore a suitable method to prove pathology. Author.

19. AUTHOR	Radanov-B-P, Valach-L, Wittlieb-Verpoort-E, Dvorak-J.
INSTITUTION	Psychiatrische Universitatspoliklinik, Bern.
TITLE	(Neuropsychological findings following whiplash injury of the cervical spine). TT Neuropsychologische Befunde nach Schleuderverletzung der Halswirbelsaule.
SOURCE	Schweiz-Med-Wochenschr 1990 May 12, VOL: 120 (19), P: 704-8, ISSN: 0036-7672.
ABSTRACT	58 patients with whiplash injury of the cervical spine underwent formal testing with respect to self-rated cognitive impairment and processing of visual and auditory information. The results indicated disturbances in divided attention for auditory information, particularly in patients with so-called cervicoencephalic syndrome. Impaired attentional control was assumed to be relevant to processes of the working memory. Author.

20. AUTHOR	Walz-F.
INSTITUTION	Gerichtlich-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.
SOURCE	Schweiz-Med-Wochenschr 1987 Apr 18, VOL: 117 (16), P: 619-23, ISSN: 0036-7672.
ABSTRACT	The 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.

21. AUTHOR	Suter-J, Mumenthaler-M.
INSTITUTION	Neurologische Klinik Der Universitat Bern, Schweiz.
TITLE	(Criteria for determining whether to offer compensation in cases of whiplash injury to the spine (neck area). A study of cases in which compensation or cash settlement has been granted (author's transl)). TT Gutachterliche Aspekte bei Schleuderverletzungen der Halswirbelsaule. Eine Studie von Fallen, die eine Rente oder Kapitalabfindung erhielten.
SOURCE	Arch-Orthop-Unfallchir 1977 Dec 27, VOL: 90 (3), P: 325-42, ISSN: 0003-9330.
ABSTRACT	We compared two groups of patients with whplash injury. The first group of 17 patients received a life annuity or a cash settlement, whereas the second group, comprised of 84 people, received no compensation at all. This comparison revealed some considerable differences. However, with regard to statistically significant factors, the 2 groups differ only in neurological symptoms, giddiness, and degenerative changes revealed by X-ray. In the first group, 11 patients who received compensation showed two of the statistically significant factors; 5 patients showed one factor; and 1 showed none. The criteria which govern the granting of compensation are being discussed in detail on the basis of our own cases and the literature. It is an exception when permanent damage due to whiplash is accepted. In individual cases, however, continuous complaints and objective findings years after the trauma are justification for a moderate compensation. Author.

22. AUTHOR	Wiesner-H, Mumenthaler-M.
TITLE	(Whiplash injuries of the cervical spine. A catamnestic study). TT Schleuderverletzungen der Halswirbelsaule. Eine katamnestische Studie.
SOURCE	Arch-Orthop-Unfallchir 1975, VOL: 81 (1), P: 13-36, ISSN: 0003-9330.
ABSTRACT	Whiplash injuries of the cervical spine are due to the rapid sequence of movements in opposite direction. They are mainly following rear- end collisions where the trunk is pushed rapidly forward. Very important forces act therefore on the different segments of the cervical spine and lead to lesions of the perispinal soft tissues, of the ligaments, of the disks and the bony structures. In 24 tables, the signs and symptoms in 104 personal cases observed for a period which lasted more than 4 years are described. Amongst the clinical signs there are cervical strain, cervico brachial pain, headaches, radicular signs as well as symptoms of concussion and cercial medullar lesion. Radiological findings are discrete; functional X- rays sometimes show local diminution of motility in a single segment. The treatments, amongst these immobilisation and local heat, are discussed. The unusually long duration of local disturbance is stressed. Signs of neurasthenia are part of the typical findings and do not at all mean a secondary neurotic development. Author.