June 2004

ARTICLE: Patients With Cervical Spine Hypermobility May Need Intervention for Whiplash

Spine. 2003;28:2215-2221

Laurie Barclay, MD

Oct. 22. 2003 A new measurement protocol, reported in the Oct. 01 issue of Spine , may distinguish a subgroup of patients with cervical spine hypermobility associated with whiplash.

Unphysiological spinal motion experienced during an automobile accident may result in a persistent disturbance of segmental motion, writes Eythor Kristjansson, PT, BSc, from the University of Iceland in Reykjavik , and collegues. 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.

In this case-control study, the investigators compared sagittal plane segmental motion in 34 women with grade I-II chronic whiplash-associated disorders to that of 35 women with chronic insidious-onset neck pain and to a normal database of sagittal plane rotational and translational motion. Lateral radiographic views were taken in assisted maximal flexion and extension, and a new, precise measurement protocol determined rotational and translational motions of segments C3-C4 and C5-C6.

Compared with the other groups, the whiplash-associated disorders group had significantly increased rotational motions in the C3-C4 and C4-C5 segments. Compared with control patients, translational motions were abnormal at the C3-C4 segment in the whiplash group and in the group with chronic neck pain, and at the C5-C6 segment only in the whiplash group.

Analyzed together, rotational and translational segmental motions were abnormal in 35.3% of the whiplash-associated disorders group an in 8.6% of the insidious-onset neck pain group. When analysed separately, the translational parameter was not significantly different between these groups (17.6% in the whiplash group and 8.6% in the insidious-onset neck pain group).

Study limitations include analysis of only three segments and cross-sectional design.

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, the authors write. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.

The Icelandic Traffic Safety Research Council and Foundation funds helped support this study.