MRI IN ACUTE-PHASE OF WHIPLASH INJURY

A prospective MRI study of 39 whiplash patients was performed and the results were compared with the clinical findings. The inclusion criter ia were: (1) automobile accident, (2) noncontact cervical spine trauma , (3) no skull injury, (4) conscious patients, (5) no previously known cervical pain before the accident, (6) plain X-ray of the cervical sp ine without fracture and (7) MRI within 15 days after trauma. All MR i mages were obtained blinded with no previous knowledge of the patient' s symptoms or findings. The MRI parameters included disc bulging eithe r with impingement on the anterior epidural space or with medullary co mpression, foraminal stenosis, dorsal ligament thickening, osteophyte extension and intramedullary or paravertebral soft tissue injury. All changes were graded visually on a four-point scale (no, some, moderate or extensive changes). After the MRI evaluation was made the clinical findings were analysed by two orthopaedic surgeons using a specially designed protocol. With MRI 29 patients (74%) showed no or only slight changes, and were thus regarded as normal variations. Of these, 10 to 29 patients (34%) had as the only symptom pain in the head or in the neck, 19 of 29 patients (66%) showed nuerological changes, either pare sthesias, sensory deficits or weakness of upper extremities. In 10 (26 %) patients with moderate or extensive MRI changes, 3 of 10 (33%) had only head or neck pain, or both, and 7 of 10 (66%) had neurological ch anges. Use of MRI in whiplash injury is helpful, but it is not the fir st-choice radiological examination method. Despite neurological change s, the frequency of true traumatic lesions is low. There is no clear c orrelation between the patients' subjective symptoms or clinical signs and the findings with MRI. However, MRI can be used to find patients with disk herniation that can be treated surgically.