in particular with a view to the whiplash trauma – a pathoanatomical and imaging study)
By Lars Uhrenholt
Summary:
A significant issue with pain in the back of the head following road accidents, including whiplash traumas, is the lack of objectifiable tissue injuries in the majority of the cases. A number of studies have shown that the bottom cervical spine facet joints play a central role in patients with chronic pain in the back of the head following a whiplash trauma. Therefore, a detailed description of potential tissue injuries in the cervical spine is necessary in order to be able to improve diagnostic and therapeutic initiatives.
The purpose of this study was to examine whether discrete injuries in the bottom cervical spine facet joints can be identified in people killed on the road in cars as opposed to non-traumatised control persons using conventional X-ray, CT scanning, MRI scanning and a histological method. An additional purpose was to examine the facet joints histomorphologically (qualitatively and quantitatively) based on microscopic observations.
The study was designed as a cross-sectional autopsy study including a total of 19 traffic fatalities and 21 control persons, all aged 20-49 years.
A number of non-lethal bone and soft tissue injuries of the cervical spine facet joints such as fractures, cartilage lesions and bleedings in joints and soft tissue were identified in victims of fatal traffic accidents and were significantly correlated to trauma. The lesions were most easily identified by means of microscopy whereas imaging did not identify all lesions, including fractures and soft tissue injuries. A number of gender and age-related changes in the joint cartilage and the underlying bone were detailed based on the histomorphological examination. Age-related changes were observed from the age of 20 and were more common in men than in women.
This study describes the pathology in people killed on the road and thus not, by definition, injuries following a whiplash trauma or another accident. For this reason, the results cannot be extrapolated uncritically to clinical practice. However, the study raises the possibility that some people may have discrete injuries in their cervical spine facet joints following non-lethal road accidents. This is supported, among other things, by the lack of sensitivity of the imaging techniques and the fact that the thresholds for onset of injury for the respective types of tissue injuries are not well-defined. However, the potential clinical significance of the individual identified lesions is not known and further studies are required.