Documenting Cervical Spine Injuries Following Negative MRI Findings: Clinical and Medico-Legal Overview of Dynamic Imaging

Because of the lack of uniformity in describing injuries to the cervical spine following trauma, such as motor vehicle accidents, the Government of Quebec convened a multidisciplinary task force in the 1990s to attempt to standardize the terminology for the classification, management, and prognosis for such injuries. The term "whiplash-associated disorders" (WAD) was adopted and has become the universally recognized umbrella term for the myriad of symptoms caused by severe acceleration and deceleration forces applied to the head, craniocervical junction, and cervical spine following trauma. Obtaining an accurate diagnosis and prognosis for individuals with WAD is challenging, especially when magnetic resonance imaging and computed tomography findings are negative. This becomes more critical when litigation is involved. However, the often overlooked and underutilized imaging modality of video fluoroscopy/dynamic imaging is essential for the diagnosis of ligament instability, which can lead to hypolordosis of the cervical spine and has a long list of potential clinical consequences. The review highlights the usefulness of the cervical curve as a clinical indicator of the severity of vertebral column injuries.