Whiplash injury determination with conventional spine imaging and cryomicrotomy
Computed tomography; Cryomicrotomy; Soft tissue injury; Whiplash acceleration; Zygopophysial joint
Study Design. Soft tissue-related injuries to the cervical spine structures were produced by use of intact entire human cadavers undergoing rear-end impacts. Radiography, computed tomography, and cryomicrotomy techniques were used to evaluate the injury. Objectives. To replicate soft tissue injuries resulting from single input of whiplash acceleration to whole human cadavers simulating vehicular rear impacts, and to assess the ability of different modes of imaging to visualize soft tissue cervical lesions. Summary of Background Data. Whiplash-associated disorders such as headache and neck pain are implicated with soft tissue abnormalities to structures of the cervical spine. To the authors' best knowledge, no previous studies have been conducted to determine whether single cycle whiplash acceleration input to intact entire human cadavers can result in these soft tissue alterations. There is also a scarcity of data on the efficacy of radiography and computed tomography in assessing these injuries. Methods. Four intact entire human cadavers underwent single whiplash acceleration (3.3g or 4.5g) loading by use of a whole-body sled. Pretest and posttest radiographs, computed tomography images, and sequential anatomic sections using a cryomicrotome were obtained to determine the extent of trauma to the cervical spine structures. Results. Routine radiography identified the least number of lesions (one lesion in two specimens). Although computed tomography was more effective (three lesions in two specimens), trauma was not readily apparent to all soft tissues of the cervical spine. Cryomicrotome sections identified structural alterations in all four specimens to lower cervical spine components that included stretch and tear of the ligamentum flavum, anulus disruption, anterior longitudinal ligament rupture, and zygopophysial joint compromise with tear of the capsular ligaments. Conclusions. These results clearly indicate that a single application of whiplash acceleration pulse can induce soft tissue-related and ligament-related alterations to cervical spine structures. The pathologic changes identified in this study support previous observations from human volunteers observations with regard to the location of whiplash injury and may assist in the explanation of pain arising from this injury. Although computed tomography is a better imaging modality than radiography, subtle but clinically relevant injuries may be left undiagnosed with this technique. The cryomicrotome technique offers a unique procedure to understand and compare soft tissue-related injuries to the cervical anatomy caused by whip-lash loading. Recognition of these injuries may advance the general knowledge of the whiplash disorder.
Yoganandan, N., Cusick, J., Pintar, F., & Rao, R. (2001). Whiplash injury determination with conventional spine imaging and cryomicrotomy. Spine, 26 (22). http://dx.doi.org/10.1097/00007632-200111150-00010