CERVICAL WHIPLASH 1997-8

Article References & Abstracts
(see also Therapy, Litigation, Prognosis)

PATHOLOGY
Article References & Abstracts
 
1.  AUTHOR Panjabi MM; Cholewicki J; Nibu K; Babat LB; Dvorak J
INSTITUTIONDepartment of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
TITLE Simulation of whiplash trauma using whole cervical spine specimens.
SOURCE Spine 1998 Jan 1;23(1):17-24 ISSN 0362-2436
ABSTRACTSTUDY DESIGN: Whiplash injuries were studied in an experiment using whole cervical spine specimen. OBJECTIVES: To develop a whiplash trauma model that uses a whole cervical spine specimen, and to show the feasibility and unique features of such a model. SUMMARY OF BACKGROUND DATA: Whiplash trauma has been simulated in biomechanical experiments using volunteers, whole body cadavers, animals, anthropometric dummies, and mathematic models. These experiments require large facilities, are expensive, and provide limited information about cervical spine injuries. METHODS: An alternate approach, in which a bench-top sled accelerating apparatus is used to produce whiplash trauma, has been developed to study such trauma in whole cervical spine specimens. Several transducers were developed to monitor soft tissue injuries during the trauma. The model also provides quantification of injuries to the cervical spine. RESULTS: To assess the feasibility and usefulness of the model, a specimen was traumatized, and the following parameters were monitored during the trauma: linear acceleration of the sled, linear and angular acceleration of the head surrogate, displacements of the head surrogate, loads at T1 and C1 vertebrae, and linear deformations of capsular ligaments and vertebral artery. CONCLUSIONS: This model, which incorporates a fresh cadaveric whole human cervical spine specimen, can simulate whiplash trauma effectively and is useful in providing a comprehensive set of clinically relevant information during the trauma. This model gives insight into the complex events and interactions that cause the injuries that occur during whiplash trauma.
2.  AUTHOR Grauer JN; Panjabi MM; Cholewicki J; Nibu K; Dvorak J
INSTITUTIONDepartment of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
TITLE Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels.
SOURCE Spine 1997 Nov 1;22(21):2489-94 ISSN 0362-2436
ABSTRACTSTUDY DESIGN: A bench-top trauma sled was used to apply four intensities of whiplash trauma to human cadaveric cervical spine specimens and to measure resulting intervertebral rotations using high-speed cinematography. OBJECTIVES: To determine the cervical spine levels most prone to injury from whiplash trauma and to hypothesize a mechanism for such injury. SUMMARY OF BACKGROUND DATA: Whiplash injuries traditionally have been ascribed to hyperextension of the head, but other mechanisms such as hypertranslation also have been suggested. METHODS: Six occiput to T1 (or C7) fresh cadaveric human spines were studied. Physiologic flexion and extension motions were recorded with an Optotrak motion analysis system by loading up to 1.0 Nm. Specimens then were secured in a trauma sled, and a surrogate head was attached. Flags fixed to the head and individual vertebrae were monitored with high-speed cinematography (500 frames/sec). Data were collected for 12 traumas in four classes defined by the maximum sled acceleration. The trauma classes were 2.5 g, 4.5 g, 6.5 g, and 8.5 g. Significance was defined at P 0.01. RESULTS: In the whiplash traumas, the peak intervertebral rotations of C6-C7 and C7-T1 significantly exceeded the maximum physiologic extension for all trauma classes studied. The maximum extension of these lower levels occurred significantly before full neck extension. In fact, the upper cervical levels were consistently in flexion at the time of maximum lower level extension. CONCLUSIONS: In whiplash, the neck forms an S-shaped curvature, with lower level hyperextension and upper level flexion. This was identified as the injury stage for the lower cervical levels. A subsequent C-shaped curvature with extension of the entire cervical spine produced less lower level extension.
3.  AUTHOR Nibu K; Cholewicki J; Panjabi MM; Babat LB; Grauer JN; Kothe R; Dvorak J
INSTITUTIONDepartment of Orthopaedics, Yamaguchi University School of Medicine, Japan.
TITLE Dynamic elongation of the vertebral artery during an in vitro whiplash simulation.
SOURCE Eur Spine J 1997;6(4):286-9 ISSN 0940-6719
ABSTRACTClinical signs of whiplash are presently not well understood. Vertebral artery (VA) stretch during trauma is a possible pathomechanism that could explain some aspects of the whiplash symptom complex. This study quantified the VA elongation during whiplash simulation using an in vitro model. Seven fresh human cadaveric specimens (occiput to C7 or T1) were carefully dissected, preserving the osteoligamentous structures. The right VA was replaced with a thin nylon-coated flexible cable. This cable was fixed at one end to the occipital bone and at the other end to a specially designed VA transducer. Physiological motion of the occiput and physiological elongation of the VA were measured with a standard flexibility test. Next the specimen was mounted on a specially designed sled and subjected to 2.5, 4.5, 6.5, and 8.5 g (1 g = 9.81 m/s2) horizontal accelerations. Elongation of the VA was continuously recorded from the start of the trauma. The average (standard deviation) physiological VA elongation was 5.8 (1.6) mm in left lateral bending and 4.7 (1.8) mm in left axial rotation. Flexion and extension did not result in any appreciable elongation of the VA. The maximum VA elongation during the whiplash trauma significantly correlated with the horizontal acceleration of the sled (R2 = 0.7, P 0.05). The VA exceeded its physiological range by 1.0 (2.1), 3.1 (2.6), 8.9 (1.6), and 9.0 (5.9) mm in the 2.5-, 4.5-, 6.5-, and 8.5-g trauma classes respectively.
4.  AUTHOR Otte A; Ettlin TM; Nitzsche EU; Wachter K; Hoegerle S; Simon GH; Fierz L; Moser E; Mueller-Brand J
INSTITUTIONDepartment of Nuclear Medicine, University Hospital, Freiburg, Germany.
TITLE PET and SPECT in whiplash syndrome: a new approach to a forgotten brain?
SOURCE J Neurol Neurosurg Psychiatry 1997 Sep;63(3):368-72 ISSN 0022-3050
ABSTRACTWhiplash associated disorders are a medicolegally controversial condition becoming increasingly worrisome in the western world. This study was designed to evaluate perfusion and glucose metabolism in whiplash brain. Using Tc-99m-bicisate (ECD) single photon emission computed tomography (SPECT) and F-18-fluorodeoxyglucose (FDG) PET, six clinically and neuropsychologically controlled patients (patient group) with whiplash syndrome and 12 normal controls (control group) were investigated. Standardised elliptical regions of interest (ROIs) were determined in three adjacent transaxial slices in the frontal, parietal, temporal, and parieto-occipital cortex, cerebellum, brain stem, basal ganglia, and thalamus. For PET, the glucose metabolic index (GMI; =ROI uptake/global uptake at the level of the basal ganglia) and, for SPECT, the perfusion index (PI; =ROI/global) were calculated. In the patient group there was significant hypometabolism and hypoperfusion in the parieto-occipital regions (on the right (R) and left (L) side) compared with the control group: PET data: GMI parieto-occipital R: control 1.066 (0.081) (mean (SD)), patient 0.946 (0.065); P=0.0092, Mann Whitney. GMI parieto-occipital L: control 1.034 (0.051), patient 0.922 (0.073); p=0.0067. SPECT data: PI parieto-occipital R: control 1.262 (0.066), patient 1.102 (0.063); P=0.0039. PI parieto-occipital L: control 1.226 (0.095), patient 1.098 (0.075); P=0.0273. In some patients there was hypometabolism ( 2 SD of control) in regions other than the parieto-occipital region. It is hypothesised that parieto-occipital hypometabolism may be caused by activation of nociceptive afferent nerves from the upper cervical spine.
5.  AUTHOR Karlsborg M; Smed A; Jespersen H; Stephensen S; Cortsen M; Jennum P; Herning M; Korfitsen E; Werdelin L
INSTITUTIONDepartment of Neurology, University Hospital of Hvidovre, Copenhagen, Denmark.
TITLE A prospective study of 39 patients with whiplash injury.
SOURCE Acta Neurol Scand 1997 Feb;95(2):65-72 ISSN 0001-6314
ABSTRACTINTRODUCTION: The acute symptoms after whiplash traumas can be explained by the neck sprain, but the pathogenesis of the "late whiplash syndrome" and the reason why only some people have persistent symptoms more than 6 months is still unknown. MATERIAL AND METHODS: Thirty-four consecutive cases of whiplash injury were examined clinically three times; within 14 days, after 1 month and finally 7 months postinjury. In addition, MRI of the brain and the cervical spine, neuropsychological tests and motor evoked potentials (MEP) were done one month postinjury and repeated after 6 months, if abnormalities were found. RESULTS: The total recovery rate (asymptomatic patients) was 29% after 7 months. MRI was repeated in 6 patients. The correlation between MRI and the clinical findings was poor. Cognitive dysfunction as a symptom of brain injury was not found. Stress at the same time predicted more symptoms at follow-up. All MEP examinations were normal. CONCLUSION: In this study, long-lasting distress and poor outcome were more related to the occurrence of stressful life events than to clinical and paraclinical findings.
 
6. AUTHOR Voyvodic F; Dolinis J; Moore VM; Ryan GA; Slavotinek JP; Whyte AM; Hoile RD; Taylor GW
INSTITUTIONNational Injury Surveillance Unit, Bedford Park, South Australia.
TITLE MRI of car occupants with whiplash injury.
SOURCE Neuroradiology 1997 Jan;39(1):35-40 ISSN 0028-3940 
ABSTRACTOur purpose was to document and investigate the prognostic significance of features seen on MRI of patients with whiplash injury following relatively minor road traffic crashes. MRI was obtained shortly and at 6 months after the crash using a 0.5 T imager. The images were assessed independently by two radiologists for evidence of fracture or other injury; loss of lordosis and spondylosis were also recorded. Clinical examinations were used to assess the status of patients initially and at 6 months. The results of the independent MRI and clinical investigations were then examined for association using statistical tests. Initial MRI was performed on 29 patients, of whom 19 had repeat studies at 6 months; 48 examinations were thus examined. Apart from spondylosis and loss of lordosis, only one abnormality was detected: an intramedullary lesion consistent with a small cyst or syrinx. There were no statistically significant associations between the outcome of injury and spondylosis or loss of lordosis. No significant changes were found when comparing the initial and follow-up MRI. It appears that MRI of patients with relatively less severe whiplash symptoms reveals a low frequency of abnormalities, apart from spondylosis and loss of lordosis, which have little short-term prognostic value. Routine investigation of such patients with MRI is not justified in view of the infrequency of abnormalities detected, the lack of prognostic value and the high cost of the procedure.
7.  AUTHOR Bicik I; Radanov BP; Schafer N; Dvorak J; Blum B; Weber B; Burger C; von Schulthess GK; Buck A
INSTITUTIONDepartment of Medical Radiology, University of Zurich, Switzerland.
TITLE PET with 18fluorodeoxyglucose and hexamethylpropylene amine oxime SPECT in late whiplash syndrome [see comments]
SOURCE Neurology 1998 Aug;51(2):345-50 ISSN 0028-3878 
ABSTRACTBACKGROUND: Many patients have cognitive abnormalities and psychological problems after whiplash injury to the cervical spine. To our knowledge, neuroradiologic imaging has not depicted brain damage that explains the symptoms. Parietotemporo-occipital perfusion deficits on hexamethylpropylene amine oxime (HMPAO) SPECT studies have been described among patients who have sustained whiplash injury. METHODS: We examined 13 patients with typical late whiplash syndrome (study group) using HMPAO SPECT, 18fluorodeoxyglucose (FDG) PET, and MRI of the brain and compared the findings with those for 16 control subjects who underwent FDG PET. RESULTS: In the study group, statistical parametric mapping revealed significantly decreased FDG uptake in the frontopolar and lateral temporal cortex and in the putamen. The frontopolar hypometabolism correlated significantly with scores of the Beck Depression Inventory. However, in individual cases, reliability in the depiction of hypometabolic areas was relatively low. No alterations were found in the parietotemporo-occipital area. In these areas, decreased uptake of HMPAO and FDG correlated with cortical mass. CONCLUSION: FDG PET did not allow reliable diagnosis of metabolic disturbances for individual patients. Therefore, we do not recommend FDG PET or HMPAO SPECT as a diagnostic tool in routine examinations of patients with late whiplash syndrome.
8.  AUTHOR Brault JR; Wheeler JB; Siegmund GP; Brault EJ
INSTITUTIONBiomechanics Research & Consulting, Inc., El Segundo, CA 90245, USA.
TITLE Clinical response of human subjects to rear-end automobile collisions.
SOURCE Arch Phys Med Rehabil 1998 Jan;79(1):72-80 ISSN 0003-9993 
ABSTRACTOBJECTIVE: Forty-two persons were exposed to controlled low-speed rear-end automobile collisions to assess the relation between both gender and impact severity and the presence, severity, and duration of whiplash-associated disorders (WAD). Individual measures were also assessed for their potential to predict the onset of WAD. DESIGN: Experimental study subjecting individuals to a speed change of 4 km/h and 8 km/h and utilizing pretest and posttest physical examinations (immediately after and 24 hours after impact) to quantify subjects' clinical response. RESULTS: Approximately 29% and 38% of the subjects exposed to the 4 km/h and 8 km/h speed changes, respectively, experienced WAD symptoms, with cervical symptoms and headaches predominating. Objective clinical deficits consistent with WAD were measured in both men and women subjects at both 4 km/h and 8 km/h. At 4 km/h, the duration of symptoms experienced by women was significantly longer when compared with that in men (p .05). There were no significant differences in the presence and severity of WAD between men and women at 4 km/h and 8 km/h or in the duration of WAD at 8 km/h. There was also no significant difference in the presence, severity, and duration of WAD between 4 km/h and 8 km/h. No preimpact measures were predictive of WAD. CONCLUSION: The empirical findings in this study contribute to establishing a causal relationship between rear-end collisions and clinical signs and symptoms.
9.  AUTHOR Giacomini P; Magrini A; Sorace F
INSTITUTIONClinica ORL, Universita di Roma Tor Vergata.
TITLE [Changes in posture in whiplash evaluated by static posturography] Vernacular Title [Alterazioni della strategia posturale nel "colpo di frusta" valutate mediante posturografia statica.]
SOURCE Acta Otorhinolaryngol Ital 1997 Dec;17(6):409-13 ISSN 0392-100X
ABSTRACTAnalyzing vestibular-spinal reflex by recording changes in the pressure center over time, static posturography provides precise, repeatable information regarding a person's posture and subsequent postural strategy. Moreover, using the detected postural pattern, this can presage likely genesis of problems in equilibrium. The purpose of the present work was to evaluate posturographic findings in subjects with chronic or persistent whiplash (WL)-induced disequilibrium in order to determine any clear postural pattern able to indicate the likely genesis of the disorder. Fifty young subjects were selected for the study: 28 (6 females) affected with equilibrium problems resulting from WL-type cervical strain and 22 (5 females) normal, age compatible controls (C) (mean age of the groups: WL = 37 +/- 14.3; C = 32.4 +/- 6.7; p = n.s.). The results obtained were statistically processed with a personal computer and specific software (Windows-SPSS). In the analysis of the means (T-test and ANOVA analysis of variance) p 0.05 was considered significant. In the WL group there was an increase in the antero-posterior axis oscillation frequency as compared to the control group. This is indicated by the FFTY parameter in tests performed both with eyes open and closed. Likewise, in both tests, there was a decrease in the LFS value, a parameter correlating length with surface. The surface was increased in the WL group as compared to group C although this increase was significant only when the test was performed with eyes closed. In addition, the average velocity and standard deviation of velocity increased in the WL group but this was only statistically significant when the eyes were open. The results obtained in the present study show that whiplash victims show an increase in antero-posterior oscillation frequency at the pressure center, as found in the open and closed-eye tests. This suggests that in WL subjects there is an evident disturbance of the fine postural system, leading to an increase in the surface parameters, tracing length and a decrease in LFS function. The onset of this partial postural decompensation can be seen in: a) decrease in fine static postural control which is reflected in an increase in body surface oscillation; b) an increase in energy consumption to maintain orthostatism as revealed in the decreased LFS. In conclusion, it appears reasonable to assume that cervical proprioceptive alterations play a preeminent role in the genesis of whiplash-induced chronic postural instability. This would result in an attempt to vary the physiology from an ankle to a hip strategy; incomplete manifestation of this new posture would cause the feeling of instability mentioned by the patients and documented by posturography.
10.  AUTHOR Gimse R; Bjorgen IA; Tjell C; Tyssedal JS; Bo K
INSTITUTIONNorwegian University of Science and Technology, Trondheim, Norway.
TITLE Reduced cognitive functions in a group of whiplash patients with demonstrated disturbances in the posture control system.
SOURCE J Clin Exp Neuropsychol 1997 Dec;19(6):838-49ISSN 1380-3395
ABSTRACTA study was conducted to find out whether in a rear impact Past studies examining whether or not cognitive changes actually have occurred as a result of a whiplash (WL) accident have produced varying results. The aim of this study was to identify possible cognitive dysfunctions in a group with persistent problems after whiplash due to injuries to the posture control system and related structures. The whiplash subjects (n = 23) were selected on the basis of their reduced gain in the Smooth Pursuit Neck Torsion test (SPNT). The WL group differed significantly from a closely matched control group on tests of learning and memory, and prolonged divided attention and concentration. After attempting to rule out other ways of interpreting these differences (such as pain, depression, medication, and premorbid health problems), these data were interpreted as lending support to the notion of a causal connection between the disturbed posture control system and some cognitive malfunctions.
11.  AUTHOR Kessels RP; Keyser A; Verhagen WI; van Luijtelaar EL
INSTITUTIONNICI, Department of Neuropsychology and Rehabilitation, University of Nijmegen, The Netherlands.
TITLE The whiplash syndrome: a psychophysiological and neuropsychological study towards attention.
SOURCE Acta Neurol Scand 1998 Mar;97(3):188-93 ISSN 0001-6314 
ABSTRACTWhiplash patients often have physical, psychosomatic and cognitive complaints, although clear neurological and neuropsychological signs of damage are absent. However, in some studies a functional loss of attention was found. In order to compare attentional dysfunctions in whiplash patients with age-matched controls, attention was measured neuropsychologically with the aid of the PASAT, and psychophysiologically with the aid of the prepulse inhibition paradigm. In addition, the reactivity for intense acoustic stimulation was investigated. The POMS and the SCL-90 were used to evaluate psychological and somatic signs. The results showed that whiplash patients (n=24) had lower scores on the PASAT and higher scores on the questionnaires compared to healthy controls (n=21). However, no group differences could be determined on the psychophysiological variables. Furthermore, the PASAT and prepulse inhibition data did not correlate. The lower PASAT scores indicate that whiplash patients seem to have deteriorated divided attention, but an attention deficit as measured with the prepulse inhibition paradigm is not disclosed. Finally, there were no signs of a heightened reactivity of the auditory system, which casts doubts on a presumed heightened sensitivity for sound in whiplash patients.

 

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