MRI in acute phase of whiplash injury

Abstract

A prospective MRI study of 39 whiplash patients was performed and results were compared with the clinical findings. The inclusion criteria were: (1) automobile accident, (2) noncontact cervical spine trauma, (3) no skull injury, (4) conscious patient, (5) no previously known cervical pain before the accident, (6) plain X-ray of the cervical spine without fracture and (7) MRI within 15 days after trauma. All MR images were obtained blinded with no previous knowledge of the patient's symptoms or findings. The MRI parameters included disc bulging either with impingment on the anterior epidural space or with medullary compression, foraminal stenosis, dorsal ligament thickening, osteophyte extension and intramedullary or paravertebral soft tissue injury. All changes were graded visually on a four-point scale (no, some, moderate or extensive changes). After the MRI evaluation was made the clinical findings were analysed by two orthopaedic surgeons using a specially designed protocol. With MRI 29 patients (74%) showed no or only slight changes, and were thus regarded as normal variations. Of these, 10 of 29 patients (34%) had as the only symptom pain in the head or in the neck, 19 of 29 patients (66%) showed neurological changes, either paresthesias, sensory deficits or weakness of upper extremities. In 10 (26%) patients with moderate or extensive MRI changes, 3 of 10 (33%) had only head or neck pain, or both, and 7 of 10 (66%) had neurological changes. Use of MRI in whiplash injury is helpful, but it is not the first-choice radiological examination method. Despite neurological changes, the frequency of true traumatic lesions is low. There is no clear correlation between the patient's subjective symptoms or clinical signs and the findings with MRI. However, MRI can be used to find patients with disk herniation that can be treated surgically.