This preliminary work focused on imaging of the cervical
spinal cord at the rostral aspect of C5, as it is often identified as
a potential area of injury following whiplash. 37-39 The authors
recognize that the disparate nature of symptoms associated
with WAD implies that an injury to peripheral or central tissues may not be obvious at any one vertebral level. Currently,
work is under way to examine and provide a more detailed view
of the entire cervical spinal cord that could be used to map
and locate potential injuries involving peripheral and central
nervous system tissues and their relationship with risk factors
known to influence whiplash recovery rates.
While it is too soon to completely understand the impact of
these preliminary findings, they may prove to be an important
prognostic factor for a subset of high-risk patients, and this
may have theranostic implications.15-17 Given the complex
and costly clinical picture of whiplash, advanced imaging is
most certainly not necessary for all people reporting neck pain
after a MVC. Some patients, however, especially those demonstrating signs suggestive of poor functional recovery, 22-23
may greatly benefit from a more informed and objective assessment for quantifying the biological consequences of the
injury event. Future work is warranted to determine when such
testing should be performed following the whiplash event.
This work is supported by the National Institutes of Health
(NIH) (NICHD/NCMRR) through Grant Number 1 R01
HD079076-01A1. This work was partially funded by the National Institute of Biomedical Imaging and Bioengineering, of
the National Institutes of Health. Grant Number T32EB009406.
1. Naumann RB, Dellinger AM, Zaloshnja E, Lawrence B, Miller TR.
Incidence and total lifetime costs of motor vehicle-related fatal
and nonfatal injury by road user type, United States. Traffic Injury
Prevention. 2010; 11( 4):353-60.
2. Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and
prognostic factors for neck pain in the general population: results
of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain
and Its Associated Disorders. Spine. 2008; 33( 4 Suppl): S75-82.
3. Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP,
Winkelstein B. The role of tissue samage in whiplash associated
disorders: discussion paper 1. Spine. 2011; 36(( 25 Suppl)): S309-15.
4. Elliott JM, Noteboom JT, Flynn T W, Sterling M. Characterization
of acute and chronic whiplash-associated disorders. J Orthop
Sports Phys Ther. 2009; 39( 5):312-23.
5. Sterling M, McLean SA, Sullivan MJ, Elliott JM, Buitenhuis J,
Kamper S. Potential processes involved in the initiation and
maintenance of whiplash-associated disorders: discussion paper
3. Spine. 2011; 36( 25 Suppl):S322-9.
6. Anderson SE, Boesch C, Zimmermnn H, et al. Are there
cervical spine findings at MR imaging that are specific to acute
symptomatic whiplash injury? A prospective controlled study with
four experienced blinded readers. Radiology. 2012;262( 2):567-75.
7. Matsumoto M, Ichihara D, Okada E, et al. Modic changes of the
cervical spine in patients with whiplash injury: a prospective 11-
year follow-up study. Injury. 2013; 44( 6):819-24.
8. Matsumoto M, Okada E, Ichihara D, et al. Prospective ten-year
follow-up study comparing patients with whiplash-associated
disorders and asymptomatic subjects using magnetic resonance
imaging. Spine. 2010; 35( 18):1684-90.
9. Pettersson K, Hildingsson C, Toolanen G, et al. Disc pathology
after whiplash injury: a prospective magnetic resonance imaging
and clinical investigation. Spine. 1997;22:283-8.
10. Pettersson K, Hildingsson C, Toolanen G, Fagerlund M,
Bjornebrink J. MRI and neurology in acute whiplash trauma.
No correlation in prospective examination of 39 cases. Acta
Orthopaed Scand. 1994;65( 5):525-8.
11. Elliott J, Pedler A, Kenardy J, Galloway G, Jull G, Sterling M. The
temporal development of fatty infiltrates in the neck muscles
following whiplash injury: an association with pain and
posttraumatic stress. PLoS One. 2011; 6( 6):e21194.
12. Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM,
Parrish T. The rapid and progressive degeneration of the cervical
multifidus in whiplash: an MRI study of fatty infiltration. Spine.
2015; 40( 12):E694-700.
13. Matsumoto M, Ichihara D, Okada E, et al. Cross-sectional area of
the posterior extensor muscles of the cervical spine in whiplash
injury patients versus healthy volunteers - 10 year follow-up MR
study. Injury. 2012; 43( 6):912-6.
14. Ulbrich EJ, Aeberhard R, Wetli S, et al. Cervical muscle area
measurements in whiplash patients: acute, 3, and 6 months of
follow-up. J Magn Reson Imaging. 2012; 36( 6):1413-20.
15. Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M. Management of
acute whiplash: A randomized controlled trial of multidisciplinary
stratified treatments. Pain. 2013;154( 9):1798-806.
16. Lamb SE, Gates S, Williams MA, et al. Emergency department
treatments and physiotherapy for acute whiplash: a pragmatic,
two-step, randomised controlled trial. Lancet. 2013;381(9866):546-
17. Michaleff ZA, Maher CG, Lin CW, et al. Comprehensive
physiotherapy exercise programme or advice for chronic whiplash
Current Concepts | Section Feature Article
Figure 3: A comparison of the MTR homogeneity across the
cervical spinal cord at C5, between controls, those who recovered,
and those that transitioned to chronic WAD, illustrates differences
between the latter and the two former. Those subjects that recovered
demonstrated similar values to control subjects.