Magnetic Resonance Imaging Assessment of Craniovertebral Ligaments and Membranes After Whiplash Trauma

In Brief Study Design. Review article. Objectives. To review the literature on soft tissue lesions of the upper cervical spine in whiplash trauma with focus on imaging. Summary of Background Data. Whiplash injury is associated with chronic impairment in a substantial number of patients. There are different opinions as to the nature and prognosis of this condition, and the role of diagnostic imaging is debated. Methods. Review the literature on the anatomic source of the chronic whiplash syndrome. Review the literature on imaging of the upper cervical spine, emphasizing on the author's own research. Results. MRI shows structural changes in ligaments and membranes after whiplash injury, and such lesions can be assessed with reasonable reliability. Lesions to specific structures can be linked with specific trauma mechanisms. There is a correlation between clinical impairment and morphologic findings. Conclusion. Whiplash trauma can damage soft tissue structures of the upper cervical spine, particularly the alar ligaments. Structural lesions in this area contribute to the understanding of the chronic whiplash syndrome. Ligamentous lesions of the craniovertebral joints can be visualized and classified with reasonable reliability by use of high-resolution MRI. High-grade lesions occur far more frequently in a whiplash injured than in a noninjured population. Pain and disability are associated with the extent of morphologic abnormality, particularly for the alar ligaments.