FINDINGS AND OUTCOME IN WHIPLASH-TYPE NECK DISTORTIONS

Study Design. The authors assessed the clinical and imaging findings a nd late outcome in 50 patients with whiplash-type neck distortions (17 men, 33 women, mean,age 33 years). Summary of Background Data. Early symptoms are neck pain, stiffness, and sometimes radiating pain; later ,bizarre symptomatology poses intricate clinical and: medicolegal pro blems. Pathoanatomic studies indicate that soft tissue injuries may be overlooked. Methods, Repeated clinical and radiographic examinations (plain and flexion-extension radiograms and ;contrast magnetic resonan ce imaging evaluated-with a new:grading system); surgical findings; fo llow-up:were performed after 1 and 5 years by an independent observer neurologist. Results, Neck pain persisted in 24 patients; radiating pa in developed within 6 weeks in 19 patients, Two patients with segmenta l instability had posterior fusions and complete pain relief. Eight pa tients with severe radiating diating pain and large disc protrusions o n magnetic resonance had nine surgically confirmed fresh disc herniati ons. Discectomy and fusion alleviated pain in these patients, whereas symptoms largely persisted in-the conservatively treated patients. Con clusions. A high incidence of discoligamentous injuries was found in w hiplash-type distortions. Most patients with severe persisting radiati ng pain had large disc protrusions on MRI that were confirmed as herni a; herniations at surgery. Neck and radiating pain were alleviated by early disc excision and fusion.