Archive for March, 2010
Vertebral Artery Injury After Cervical Spine Trauma
Vertebral Artery Injury After Cervical Spine Trauma
In a particular study, researchers utilized MRI (magnetic resonance imaging) technology on sixty-one patients who had been admitted to the hospital with a cervical spine trauma. The writer discovered that “total disruption of blood circulation through the vertebral artery was shown… in 12 out of 61 people (19.7% of the patients).” Flexion injuries were discovered to be the most frequent kind of injuries in people who had vertebral artery injury. Blurring of vision that was transient is the symptom that is most commonly reported by these twelve patients.
These are all serious injuries since all of the people involved were admitted into the hospital. People with whiplash injuries have also reported vertebral artery injury as well. According to the study’s authors, the patients who showed neurological symptoms of insufficiency of the vertebral artery (symptoms not correlating with the soft-tissue and bone injuries with which they are presenting via standard imaging techniques) may actually have sustained an injury to the vertebral artery.
Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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Posted in Imaging Whiplash Injuries Radiographs CT scans MRI
Imaging Whiplash Injuries
In this very interesting article, a noteworthy point is made. Occupants of a car that is involved in a collision may experience neck pain, no matter which direction the impact comes from; however, this is far more likely to occur when the impact comes from the rear.
An eight mile per hour rear-end collision that has a 2-g acceleration (2-g = 2 times the gravitational force of earth) of the vehicle could cause a 5-g acceleration of the head. Experiments that used volunteers showed that a ten mile per hour rear-end collision could generate a 9-g acceleration of the neck and 23-g of the frontal cortex.
It has been shown that 10-60% of people in a car accident suffer from sprains in the neck. The ones that did not wear seatbelts have less sprains of the neck than those wearing them.
The incidence of whiplash caused by rear end impacts can be significantly reduced by the use of head restraints. In fact, the reduction is as much as ten percent in cars that have adjustable head restraints and seventeen percent in those with fixed head restraints. Additionally, the authors give good evaluations of the effectiveness of the various imaging techniques.
• Plain Radiographs: They say that plain radiographs should be used first when evaluating a whiplash injury. This is in order to obtain an image for reference of the cervical spine when injured, and in addition, to evaluate possible lesions that are traumatic. Using this method, secondary symptoms like degenerative disease can be assessed objectively, even when they are noted some length of time after the trauma. Additionally, the authors caution that plain radiographs may not be entirely effective in the identification of traumatic cervical spine injuries. In a large series of patients with cervical injuries, the combination of cross-table lateral (CTL), AP and OM-views had the following results: Sixty-one percent of all fractures were missed. Thirty-six percent of subluxations and dislocations were also missed. Additionally, injuries in twenty-three percent of the patients were falsely identified. Half of these patients had unstable cervical injuries, and some had normal cervical spines.
• CT scans: For this reason, when a trauma victim has a plain film that shows cervical injury or a high clinical suspicion of injury, the patient should have an MRI (magnetic resonance imaging) or a CT (computed tomography) scan. This will give a clearer and more definitive evaluation of the condition of the cervical spine. A CT (computed tomography) scan is a good choice for all patients who have experienced acute trauma. This is especially true when the cervical spine cannot be seen well utilizing plain film. This is also true when there is focal neck pain that cannot be explained, or there is a neurological deficit that does not show up on plain film. Additionally, if there is unexplained soft tissue swelling in the pre-vertebral region or if the plain film is abnormal for any other reason, a CT (computed tomography) or MRI (magnetic resonance imaging) is advised. These tests can reveal soft tissue problems like herniated disks, ruptured ligaments, and soft tissue hematoma. However, CT is limited when it comes to its ability in evaluating cervical trauma. It is not as easy to see dislocations, subluxations, abnormal angulations, and intervertebral distances using CT as it is using old-fashioned radiography or the newer, tomography. In one research experiment(3) CT just detected 54% of dislocations and subluxations of trauma victims.
• MRI:
o MRI data of whiplash injuries vary greatly and differ considering the time period between the x-rays and the accident.
o During the chronic phase, the first year after the trauma, usually findings will be non-specific. They will include degenerative disk disease as well as disk protrusions and/or herniation. Very few patients show bony or ligamentous lesions.
o While experiencing the subacute phase, within four months of the whiplash incident, more characteristic results such as separations of the disk from the vertebral end plate, as well as ligamentous lesions are typically reported. When comparing the anterior longitudinal ligament (ALL) and the posterior longitudinal ligament (PLL) or interspinous ligament, the ALL is more frequently injured.
o Often no specific findings will be made during the fifteen days following the original injury. This phase is often referred to as the acute phase.
o If the patient experiences neurological deficit, myelopathy, spinal cord injury, or radiculopathy, an MRI (magnetic resonance imaging) may be indicated. This is especially true if the symptoms surpass what should be expected from findings revealed by a standard radiograph. In cases of whiplash injury, it is wise to use MRI (magnetic resonance imaging) as standard procedure. This is especially true when the patient complains of symptoms specific to whiplash injury or if other investigation reveals significant findings.
Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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Car Accident Injuries Weakens the Neck
Injury From Auto Accident Weakens the Neck
Rear-end collisions, even at low speed, can be extremely violent. Through the use of live subjects in crash tests involving rear-end collisions, scientists discovered that persons who experience head accelerations can experience up to nine G-forces, which is a speed nine times that of the force of gravity. What this implies is a person’s head, which usually weighs approximately 10 pounds, all of a sudden weighs 90 pounds. In its most basic version, whiplash is explained as: a person’s body is pushed one way, while the person’s head is pushed the opposite way. It comes as no surprise that much of the injury occurs in the ligaments that join the vertebrae that lie in-between the torso and the head, in the neck. The truth is, the pressures on the ligaments of the spine are in the upper area.
This issue was viewed specifically by Ivancic and colleagues(1) at Yale University. They discovered that while performing an example collision, the pressure in the lower part of the neck was 269.5 Newtons, or nearly 60 pounds of pressure, in approximately 1/20 of a second. This is the fact: when the strains are concentrated in such a small area, the human spine is not built to handle it. Research has shown that these forces are much more powerful than those that would normally act on the ligaments holding the spine together. There was a closer look at whiplash effects on the ligaments of the spine with a new study(2) by the same researchers at Yale.
The investigators began with 12 spines from cadavers: six of these spines had experienced a simulation of whiplash acceleration, while the others served as the control group. Each facet joint was then tested after being removed from the spines, in order to determine if the laxity of the joints varied between the two groups. This attached graph displays the contrast in joint stretch in the two sections. It’s apparent that the whiplash-damaged ligaments were severely weaker than non-injured ligaments.
