Skip to main content
SpringerLink
Log in

Demonstration of transverse ligament on 3D SPACE MRI in whiplash-associated disorder and nontraumatic conditions

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

This study aims to delineate the three-dimensional (3D) SPACE MRI findings of the transverse ligament (TL) in whiplash-associated disorder (WAD) patients, and to compare them with those from a nontraumatic group.

Methods

A retrospective analysis was performed on cervical spine MRI scans obtained from 46 patients with WAD and 62 nontraumatic individuals. Clinical features, including the WAD grade and stage, were recorded. The TL’s morphological grade and the symmetricity of the lateral atlantodental interval was assessed using axial 3D T2-SPACE images. The morphological grading was evaluated using a four-point scale: 0 = homogeneously low signal intensity with normal thickness, 1 = high signal intensity with normal thickness, 2 = reduced thickness, 3 = full-thickness rupture or indistinguishable from surrounding structures. Additionally, the number of cervical levels exhibiting degeneration was documented.

Results

When comparing the WAD and nontraumatic groups, a significant difference was observed in the proportion of high-grade TL changes (grade 2 or 3) and the number of degenerated cervical levels. Logistic regression analysis revealed that high-grade TL changes and a lower number of degenerative levels independently predicted the presence of WAD. Within the WAD group, the subset of patients with high-grade TL changes demonstrated a significantly higher mean age than the low-grade group (grade 0 or 1).

Conclusion

High-grade morphological changes in the TL can be detected in patients with WAD through the use of 3D SPACE sequences.

Clinical relevance statement 3D SPACE MRI could serve as an instrumental tool in the assessment of TL among patients with WAD. Integrating MRI findings with patient history and symptomology could facilitate the identification of potential ligament damage, and may help treatment and follow-up planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

WAD:

Whiplash-associated disorder

3D:

Three-dimensional

SPACE:

Sampling perfection with application-optimized contrasts using flip angle evolution

TL:

Transverse ligament

AL:

Alar ligament

References

  1. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine 20:1S-73S

    CAS  PubMed  Google Scholar 

  2. Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C (2015) Imaging of atlanto-occipital and atlantoaxial traumatic injuries: what the radiologist needs to know. Radiographics 35:2121–2134. https://doi.org/10.1148/rg.2015150035

    Article  PubMed  Google Scholar 

  3. Ivancic PC, Panjabi MM, Ito S (2006) Cervical spine loads and intervertebral motions during whiplash. Traffic Inj Prev 7:389–399. https://doi.org/10.1080/15389580600789127

    Article  PubMed  Google Scholar 

  4. Macnab I (1964) Acceleration injuries of the cervical spine. J Bone Joint Surg Am 46:1797–1799

    Article  CAS  PubMed  Google Scholar 

  5. Krakenes J, Kaale BR, Moen G, Nordli H, Gilhus NE, Rorvik J (2002) MRI assessment of the alar ligaments in the late stage of whiplash injury–a study of structural abnormalities and observer agreement. Neuroradiology 44:617–624. https://doi.org/10.1007/s00234-002-0799-6

    Article  CAS  PubMed  Google Scholar 

  6. Kwan O (2003) MRI assessment of the alar ligaments in the late stage of whiplash injury. Neuroradiology 45:195–196. https://doi.org/10.1007/s00234-002-0905-9

    Article  CAS  PubMed  Google Scholar 

  7. Myran R, Kvistad KA, Nygaard OP, Andresen H, Folvik M, Zwart JA (2008) Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: a case-control study. Spine 33:2012–2016. https://doi.org/10.1097/BRS.0b013e31817bb0bd

    Article  PubMed  Google Scholar 

  8. Ulbrich EJ, Eigenheer S, Boesch C, Hodler J, Busato A, Schraner C, Anderson SE, Bonel H, Zimmermann H, Sturzenegger M (2011) Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects. AJR Am J Roentgenol 197:961–967. https://doi.org/10.2214/AJR.10.6321

    Article  PubMed  Google Scholar 

  9. Dullerud R, Gjertsen O, Server A (2010) Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects. Acta Radiol 51:207–212. https://doi.org/10.3109/02841850903321617

    Article  PubMed  Google Scholar 

  10. Krakenes J, Kaale BR, Nordli H, Moen G, Rorvik J, Gilhus NE (2003) MR analysis of the transverse ligament in the late stage of whiplash injury. Acta Radiol 44:637–644. https://doi.org/10.1080/02841850312331287739

    Article  CAS  PubMed  Google Scholar 

  11. Kaale BR, Krakenes J, Albrektsen G, Wester K (2005) Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:466–475. https://doi.org/10.1089/neu.2005.22.466

    Article  PubMed  Google Scholar 

  12. Lummel N, Zeif C, Kloetzer A, Linn J, Bruckmann H, Bitterling H (2011) Variability of morphology and signal intensity of alar ligaments in healthy volunteers using MR imaging. AJNR Am J Neuroradiol 32:125–130. https://doi.org/10.3174/ajnr.A2255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Peters B, Parizel PM, Van Goethem JW (2020) Age-related changes to the craniocervical ligaments in asymptomatic subjects: a prospective MR study. Eur Spine J 29:1029–1035. https://doi.org/10.1007/s00586-020-06302-0

    Article  PubMed  Google Scholar 

  14. Wenz H, Kerl HU, Maros ME, Wenz R, Kalvin K, Groden C, Nolte I (2015) Signal changes of the alar ligament in a healthy population: a dispositional or degenerative consequence? J Neurosurg Spine 23:544–550. https://doi.org/10.3171/2015.1.SPINE141214

    Article  PubMed  Google Scholar 

  15. Li Q, Shen H, Li M (2013) Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders: a meta-analysis of case-control studies. Eur Spine J 22:14–20. https://doi.org/10.1007/s00586-012-2490-x

    Article  PubMed  Google Scholar 

  16. Kwon JW, Yoon YC, Choi SH (2012) Three-dimensional isotropic T2-weighted cervical MRI at 3T: comparison with two-dimensional T2-weighted sequences. Clin Radiol 67:106–113. https://doi.org/10.1016/j.crad.2011.06.011

    Article  CAS  PubMed  Google Scholar 

  17. Baumert B, Wortler K, Steffinger D, Schmidt GP, Reiser MF, Baur-Melnyk A (2009) Assessment of the internal craniocervical ligaments with a new magnetic resonance imaging sequence: three-dimensional turbo spin echo with variable flip-angle distribution (SPACE). Magn Reson Imaging 27:954–960. https://doi.org/10.1016/j.mri.2009.01.012

    Article  PubMed  Google Scholar 

  18. Barnaure I, Galley J, Fritz B, Sutter R (2022) Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE. Skeletal Radiol 51:1453–1462. https://doi.org/10.1007/s00256-022-03988-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Chung BMKS, Yim Y, Lee GY (2023) Comparison between 2D TSE and 3D SPACE in the evaluation of craniocervical ligaments. Eur Spine J 32:361–367. https://doi.org/10.1007/s00586-022-07459-6

    Article  PubMed  Google Scholar 

  20. Krakenes J, Kaale BR (2006) Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 31:2820–2826. https://doi.org/10.1097/01.brs.0000245871.15696.1f

    Article  PubMed  Google Scholar 

  21. Tameem A, Kapur S, Mutagi H (2013) Whiplash injury. Contin Educ Anaesth Crit Care Pain 14:167–170. https://doi.org/10.1093/bjaceaccp/mkt052

    Article  Google Scholar 

  22. Kang Y, Lee JW, Koh YH, Hur S, Kim SJ, Chai JW, Kang HS (2011) New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol 197:W134-140. https://doi.org/10.2214/AJR.10.5560

    Article  PubMed  Google Scholar 

  23. Vetti N, Krakenes J, Eide GE, Rorvik J, Gilhus NE, Espeland A (2009) MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1–2: high-signal changes by age, gender, event and time since trauma. Neuroradiology 51:227–235. https://doi.org/10.1007/s00234-008-0482-7

    Article  PubMed  Google Scholar 

  24. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220. https://doi.org/10.1037/h0026256

    Article  CAS  PubMed  Google Scholar 

  25. Grifka J, Hedtmann A, Pape HG, Witte H, Bar HF (1998) Biomechanics of injury of the cervical spine. Orthopade 27:802–812. https://doi.org/10.1007/pl00003467

    Article  CAS  PubMed  Google Scholar 

  26. Vetti N, Krakenes J, Ask T, Erdal KA, Torkildsen MD, Rorvik J, Gilhus NE, Espeland A (2011) Follow-up MR imaging of the alar and transverse ligaments after whiplash injury: a prospective controlled study. AJNR Am J Neuroradiol 32:1836–1841. https://doi.org/10.3174/ajnr.A2636

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Vetti N, Krakenes J, Damsgaard E, Rorvik J, Gilhus NE, Espeland A (2011) Magnetic resonance imaging of the alar and transverse ligaments in acute whiplash-associated disorders 1 and 2: a cross-sectional controlled study. Spine 36:E434-440. https://doi.org/10.1097/BRS.0b013e3181da21a9

    Article  PubMed  Google Scholar 

  28. Bussières AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, Hendrickson B, Hincapié C, Pagé I, Passmore S, Srbely J, Stupar M, Weisberg J, Ornelas J (2016) The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther 39:523-564.e527. https://doi.org/10.1016/j.jmpt.2016.08.007

    Article  PubMed  Google Scholar 

  29. Yadla S, Ratliff JK, Harrop JS (2008) Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med 1:65–68. https://doi.org/10.1007/s12178-007-9008-x

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea

    Jung Joo Hong, Sujin Kim & Bo Mi Chung

  2. Department of Radiology, Chung-Ang University Gwangmyeong Hospital, 110, Deokan‑ro, Gwangmyeong‑si, Gyeonggi‑do, Republic of Korea

    Guen Young Lee

Authors
  1. Jung Joo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sujin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guen Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bo Mi Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bo Mi Chung.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, J.J., Kim, S., Lee, G.Y. et al. Demonstration of transverse ligament on 3D SPACE MRI in whiplash-associated disorder and nontraumatic conditions. Eur Spine J 33, 1171–1178 (2024). https://doi.org/10.1007/s00586-023-08079-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-08079-4

Keywords

Search

Navigation