Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, Grades I-II - A case-control study using a new measurement protocol

Study Design. Case-control study comparing sagittal plane segmental motion in women (n = 34) with chronic whiplash-associated disorders, Grades I - II, with women ( n = 35) with chronic insidious onset neck pain and with a normal database of sagittal plane rotational and translational motion. Objective. To reveal whether women with chronic whiplash-associated disorders, Grades I - II, demonstrate evidence of abnormal segmental motions in the cervical spine. Summary of Background Data. It is hypothesized that unphysiological spinal motion experienced during an automobile accident may result in a persistent disturbance of segmental motion. It is not known whether patients with chronic whiplash-associated disorders differ from patients with chronic insidious onset neck pain with respect to segmental mobility. Methods. Lateral radiographic views were taken in assisted maximal flexion and extension. A new measurement protocol determined rotational and translational motions of segments C3-C4 and C5-C6 with high precision. Segmental motion was compared with normal data as well as among groups. Results. In the whiplash-associated disorders group, the C3-C4 and C4-C5 segments showed significantly increased rotational motions. Translational motions within each segment revealed a significant deviation from normal at the C3-C4 segment in the whiplash-associated disorders and insidious onset neck pain groups and at the C5-C6 segment in the whiplash-associated disorders group. Significantly more women in the whiplash-associated disorders group (35.3%) had abnormal increased segmental motions compared to the insidious onset neck pain group (8.6%) when both the rotational and the translational parameters were analyzed. When the translational parameter was analyzed separately, no significant difference was found between groups, or 17.6% ( whiplash-associated disorders group) and 8.6% ( insidious onset neck pain group), respectively. Conclusion. Hypermobility in the lower cervical spine segments in 12 out of 34 patients with chronic whiplash-associated disorders in this study point to injury caused by the accident. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.