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The value of functional computed tomography in the evaluation of soft-tissue injury in the upper cervical spine

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Summary

A functional rotatory computed tomography (CT) study of 423 whiplash patients with cervical spine soft-tissue injury was undertaken to determine its diagnostic value. The results are correlated with previous CT studies on normal subjects, and an evaluation of paradox motion, in which the lower vertebra rotates more than the vertebra immediately superior to it, is given. Asymmetrical left/right rotation reached the pathological value in 36% of the patient population at the level of CO-1. Twice as many patients had hypermobile rotation to the left as compared with the right, perhaps indicating that the right alar ligament is more often damaged in injuries involving the whiplash mechanism. A higher percentage of pathological values for hypermobile rotation was found at the level of CO-1 than at Cl-2. Patients exhibiting paradox rotation had a significantly higher amount of rotation to the contralateral side than did those who exhibited no paradox rotation. These findings validate the use of functional rotatory CT in the evaluation of soft-tissue damage of the upper cervical spine resulting from whiplash injury.

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References

  1. Buetti-Bäuml C (1954) Funktionelle Roentgendiagnostik der Halswirbelsäule. Archiv Atlas 70:19–23

    Google Scholar 

  2. Chazal J, Tangui A, Bourges M (1985) Biomechanical properties of spinal ligaments and histological study of the supraspinal ligament in traction. J Biomech 18:167–176

    Article  PubMed  Google Scholar 

  3. Crisco JJ, Panjabi MM, Dvorak J (1991) A model of the alar ligaments of the upper cervical spine in axial rotation. J Biomech 24:607–614

    Article  PubMed  Google Scholar 

  4. Dvorak J, Panjabi M (1987) Functional anatomy of the alar ligaments. Spine 12:183–188

    PubMed  Google Scholar 

  5. Dvorak J, Panjabi MM, Gerber M, Wichmann W (1987) CT-functional diagnostics of the rotatory instability of upper cervical spine. I. An experimental study on cadavers. Spine 12: 195–205

    Google Scholar 

  6. Dvorak J, Hayek J, Zehnder R (1987) CT-functional diagnostics of the rotatory instability of upper cervical spine. 2. An evaluation of healthy adults and patients with suspected instability. Spine 12:726–731

    PubMed  Google Scholar 

  7. Dvorak J, Penning L, Hayek J, Panjabi MM, Grob D, Zehnder R (1988) Functional diagnostics of the cervical spine using computer tomography. Neuroradiology 30:132–137

    Article  PubMed  Google Scholar 

  8. Dvorak J, Panjabi MM, Novotny JE, Antinnes JA (1991) In vivo flexion extension of the normal cervical spine. J Orthop Res 9:828–834

    Article  PubMed  Google Scholar 

  9. Dvorak J, Antinnes JA, Panjabi MM, Loustalot D, Bonomo M (1992) Age and gender related normal motion of the cervical spine. Spine 17:393–398

    Google Scholar 

  10. Dvorak J, Panjabi MM, Grob D, Novotny JE, Antinnes JA (1993) A clinical validation of functional flexion/extension radiographs of the cervical spine. 18:120–127

    Google Scholar 

  11. Frank C, Amiel MS, Woo SY, Akeson W (1985) Normal ligament properties and ligament healing. Clin Orthop 196:15–25

    PubMed  Google Scholar 

  12. Hinz P (1970) Die Verletzung der Halswirbelsäule durch Schleuderung und durch Abknickung. Hippokrates, Stuttgart

    Google Scholar 

  13. Hohl M (1974) Soft-tissue injuries of the neck in automobile accidents. Factors influencing prognosis. J Bone Joint Surg [Am] 56:8:1675–1682

    Google Scholar 

  14. Hohl M (1990) Soft tissue neck injuries. Chir Orthop 76:16–25

    Google Scholar 

  15. Kennedy JC, Hawkins RJ, Willis RB, Danylchuk KD (1976) Tension studies of human knee ligaments. J Bone Joint Surg [Am] 58:350–355

    Google Scholar 

  16. Oda T, Panjabi MM, Crisco JJ, Bueff HU, Grob D, Dvorak J (1992) Role of tectorial membrane in the stability of the upper cervical spine. Clin Biomech 7:201–207

    Article  Google Scholar 

  17. Ommaya AR (1985) The head: kinematics and brain injury mechanisms. In: The biomechanics of impact trauma. Elsevier, Amsterdam

    Google Scholar 

  18. Panjabi MM, Dvorak J, Crisco JJ, Oda T, Hilibrand A, Grob D (1991) Flexion, extension and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord 4:157–167

    PubMed  Google Scholar 

  19. Panjabi MM, Dvorak J, Crisco JJ, Oda T, Wang P, Grob D (1991) Effects of alar ligament transection on upper cervical spine rotation. J Orthop Res 9:584–593

    Article  PubMed  Google Scholar 

  20. Panjabi M, Dvorak J, Crisco J, Oda T, Wang P, Grob D (1991) Effects of alar ligament transection on upper cervical spine rotation. J Orthop Res 9:548–593

    Article  Google Scholar 

  21. Panjabi MM, Dvorak J, Crisco J, Oda T, Grob D (1991) Alar ligament instability: a biomechanical model. Orthopade 20: 112–120

    PubMed  Google Scholar 

  22. 22. Penning L, Wilmink JT (1987) Rotation of the cervical spine. A CT study in normal subjects. Spine 12:732–738

    PubMed  Google Scholar 

  23. 23. Saldinger P, Dvorak J, Rahn BA, Perren SM (1990) Histology of the alar and transverse ligaments. Spine 15:257–261

    PubMed  Google Scholar 

  24. 24. Saternus K, Thrun C (1987) Zur Traumatologie der Ligamenta alaria. Aktuel Traumatol 17:214–218

    PubMed  Google Scholar 

  25. White AA, Panjabi MM (1990) Clinical biomechanics of the spine. Lippincott, Philadelphia

    Google Scholar 

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Authors and Affiliations

  1. The Pennsylvania State School of Medicine, Milton S. Hershey Medical Center, Hershey, Penn., USA

    J. A. Antinnes

  2. Department of Neurology, Spine Unit, Schulthess Hospital, Neumünsterallee 3, CH-8008, Zürich, Switzerland

    J. A. Antinnes & J. Dvorák

  3. Neurology Practice, CT Institute, Zürich, Switzerland

    J. Hayek

  4. Yale University Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

    M. M. Panjabi

  5. Department of Orthopaedics, Spine Unit, Schultbess Hospital, Zürich, Switzerland

    D. Grob

Authors
  1. J. A. Antinnes
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  2. J. Dvorák
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  3. J. Hayek
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  4. M. M. Panjabi
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  5. D. Grob
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Antinnes, J.A., Dvorák, J., Hayek, J. et al. The value of functional computed tomography in the evaluation of soft-tissue injury in the upper cervical spine. Eur Spine J 3, 98–101 (1994). https://doi.org/10.1007/BF02221447

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