Skip to main content
SpringerLink
Log in

MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Our aim was to characterise and classify permanent structural changes in the tectorial and posterior atlanto-occipital membranes several years after a whiplash injury, and to evaluate the reliability of our classification. We obtained sagittal proton density-weighted images of the craniovertebral junction of 92 whiplash-injured and 30 uninjured individuals. Structural abnormalities in the two membranes were classified as grades 1–3 independently by three radiologists blinded for clinical information. Grading criteria were based on reduced tectorial membrane thickness, and elongation or rupture of the posterior atlanto-occipital membrane/dura mater complex. The same images were reassessed 4 months later. Image quality was graded good in 104 cases, slightly reduced in 13 and unsatisfactory in five. Of 117 tectorial membranes 31 (26.5%) showed grade 2 or 3 lesions, in the uninjured group none were grade 3 and only three were grade 2. Pair-wise interobserver agreement (weighted kappa) was moderate (0.47–0.50), while the intraobserver agreement was moderate to good (0.51–0.70). Of 117 posterior atlanto-occipital membranes 20 (17.1%) had grade 2 or 3 lesions; there was no grade 3 and only one grade 2 lesion in the uninjured group. Inter- and intraobserver agreement was good (0.61–0.74 and 0.65–0.86, respectively). Reduced image quality was the main reason for disagreement, but partial thinning and lateral tapering, as normal tectorial membrane variations, created difficulties in some cases. This study strongly indicates that whiplash trauma can damage the tectorial and posterior atlanto-occipital membranes; this can be shown on high-resolution MRI. Better knowledge of normal anatomical variations and improved image quality should increase the reliability of lesion classification.

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. 1a–d
Fig. 2a–d
Fig. 3a–g
Fig. 4a–g
Fig. 5a–g
Fig. 6a–d

Similar content being viewed by others

References

  1. Dvorak J, Schneider E, Saldinger P, Rahm B (1988) Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 6: 452–461

    CAS  PubMed  Google Scholar 

  2. Heller JG Amrani J, Hutton WC (1993) Transverse ligament failure; a biomechanical study. J Spinal Disord 6: 162–165

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. Dickman CA, Mamourian A, Sonntag VK, Drayer BP (1991) Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75: 221–227

    CAS  PubMed  Google Scholar 

  5. Soames RW (1995) Skeletal system. In: Gray H et al (eds) Gray's anatomy, 38th edn. Churchill Livingstone, New York, pp 425–736

  6. Harris MB, Duvla MJ, Davis JA Jr, Bernine PM (1993) Anatomical and roentgenographic features of atlantooccipital instability. J Spinal Disord 6: 5–10

    CAS  PubMed  Google Scholar 

  7. Krakenes J, Kaale BR, Rorvik J, Gilhus NE (2001) MRI assessment of normal ligamentous structures in the craniovertebral junction. Neuroradiology 43: 1089–1097

    CAS  PubMed  Google Scholar 

  8. 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 on structural abnormalities and observer agreement. Neuroradiology 44: 617–624 Erratum: Neuroradiology 44: 874–876

    Google Scholar 

  9. Spitzer WO, Skovron ML, Salmi LR, et al (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 

  10. Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New York, pp 212–236

  11. Altman DG (1997) Practical statistics for medical research. Chapman & Hall/CRC, London, pp 396–439

  12. Altman DG (1997) Practical statistics for medical research. Chapman & Hall/CRC, London, pp 229–276

  13. Brennan P, Silman A (1992) Statistical methods for assessing observer variability in clinical measures. Br Med J 304: 1491–1494

    CAS  Google Scholar 

  14. Grabb CB, Frye TA, Hedlund GL, Grabb PA, Royal SA (1999) MRI diagnosis of suspected atlanto-occipital dissociation in childhood. Pediatr Radiol 29: 275–281

    Article  CAS  PubMed  Google Scholar 

  15. Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA (2000) Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg 93 [Suppl 1]: 28–39

    Google Scholar 

  16. Adams VI (1993) Neck injuries: III. Ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation. A pathologic study of 21 traffic fatalities. J Forensic Sci 38: 1097–1104

    CAS  PubMed  Google Scholar 

  17. Grauer JN, Panjabi MM, Cholewicki J, Nibu K, Dvorak J (1997) Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine 22: 2489–94

    CAS  PubMed  Google Scholar 

  18. Grifka J, Hedtmann A, Pape HG, Witte H, Bar HF (1998) Biomechanics of injury of the cervical spine Orthopäde [German] 27: 802–812

    Google Scholar 

  19. Penning L (1998) Backward hypertranslation of the head: participation in the whiplash injury mechanism of the cervical spine? Orthopäde [German] 23: 268–274

    Google Scholar 

  20. Robinson PJ (1997) Radiology's Achilles' heel: error and variation in the interpretation of the Röntgen image. Br J Radiol 70: 1085–1098

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge Grethe Albrektsen PhD, Section of Medical Statistics, for statistical calculations and helpful suggestions; Leif Arve Abildgaard RT, Department of Radiology, for configuring the MRI sequences and Joost Gravendeel MD, Department of Radiology, for technical support with the illustrations.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Bergen and Haukeland University Hospital, 5021, Bergen, Noway

    J. Krakenes, G. Moen, H. Nordli & J. Rorvik

  2. Firda Medical Centre, 6823, Sandane, Norway

    B. R. Kaale

  3. Department of Neurology, University of Bergen and Haukeland University Hospital, 5021, Bergen, Norway

    N. E. Gilhus

Authors
  1. J. Krakenes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. R. Kaale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Moen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Nordli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. E. Gilhus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Rorvik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Krakenes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krakenes, J., Kaale, B.R., Moen, G. et al. MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury. Neuroradiology 45, 585–591 (2003). https://doi.org/10.1007/s00234-003-1036-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-003-1036-7

Keywords

Search

Navigation