Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

Abstract

Neck pain is the cardinal symptom following whiplash injuries. The trauma mechanism could theoretically lead to both soft tissue and bone injury that could be visualised by means of MRI. From previous quite small trials it seems that MRI does not demonstrate significant tissue damage. Large prospectively followed cohorts are needed to identify possible clinically relevant MRI findings. The objective of this trial was to evaluate (1) the predictive value of cervical MRI after whiplash injuries and (2) the value of repeating MRI examinations after 3 months including sequences with flexion and extension of the cervical spine. Participants were included after rearend or frontal car collisions. Patients with fractures or dislocations diagnosed by standard procedures at the emergency unit were not included. MRI scans of the cervical spine were performed at baseline and repeated after 3 months. Clinical follow-ups were performed after 3 and 12 months. Outcome parameters were neck pain, headache, neck disability and working ability. A total of 178 participants had a cervical MRI scan on average 13 days after the injury. Traumatic findings were observed in seven participants. Signs of disc degeneration were common and most frequent at the C5-6 and C6-7 levels. Findings were not associated with outcome after 3 or 12 months. The population had no considerable neck trouble prior to the whiplash injury and the non-traumatic findings represent findings to be expected in the background population. Trauma-related MRI findings are rare in a whiplash population screened for serious injuries in the emergency unit and not related to a specific symptomatology. Also, pre-existing degeneration is not associated with prognosis.

The influence of age, anthropometrics and range of motion on the morphometry of the synovial folds of the lateral atlanto-axial joints: a pilot study

“…To date, it has not been possible to visualise specific morphological changes using standard cervical MR imaging in patients with neck pain [32,43]. Recent MR studies have described the possible presence of visible changes to muscles and ligaments in neck pain patients after whiplash [9,36].…”

Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma

“…One study of 93 adult patients with negative CT finding but persistent cervical tenderness after blunt trauma found no cases of clinically significant injury to the cervical spine on MRI. 12 Kongsted et al 13 conducted a prospective cohort study of 173 adults with acute neck pain and negative ED imaging results that showed traumatic disc bulge or protrusion in 0.5% of patients but no injuries requiring operative intervention.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…The paper by Kongsted et al [33] is of great importance in a year where the Eurospine has devoted two supplements to whiplash injury. They ask the question ''Are early MRI findings correlated with long-lasting symptoms following whiplash injury?''…”