In the industrialised world we nowadays live in, a lot of accidents happen, partly due to heavy traffic, partly due to the mechanised work environment. An accident can certainly cause injuries of the bones, vertebral bodies or parts thereof, but it can also lead to torn or overexpanded ligaments with corresponding after-effects.
Probably the best-known and most controversial injury is the whiplash injury, called “distortion of the cervical spine” by physicians. ((The German term “Schleudertrauma” is the not very successful translation of “whiplash injury”. Actually it should be called “Peitschenhiebunfall”.)) In fact this means that no impact of the head is involved in it. But due to modern car technology
(headrests) a head impact mostly occurs. The collision forces do not necessarily have to leave external damages on the head, rather they lead to compact brain injuries. In lethal cases, which appear seldom, greater bleedings of the head callosity can be found during the post mortem examination, even though no injuries can be seen from the outside. Then a whiplash injury by a rear impact accident with a compact brain injury is not an absolute whiplash injury. But also an absolute whiplash injury without head impact can lead to cerebral injuries. This could be proved in 1968 by Ommaya et al. in an experiment with monkeys. So a whiplash injury is a “distortion of the cervical spine with or without cerebral involvement”. According to the Quebec Task Force on Whiplash-Associated Disorders (Spitzer et al. 1995),
peripheral disorders such as pain or stiffness in the neck and cerebral disorders such as headache, dizziness, hearing dysfunctions, ringing in the ears (tinnitus), concentration and memory disorders, deglutition dysfunctions and temporomandibular dysfuncions (functional disturbances in the area of the lower jaw at the passage to the temple) are symptomatic. A fibrillating or blurred sense of vision also appear frequently. These symptoms appear with a characteristic latency (time delay) of 0 to 72 hours. The cerebral symptoms mentioned above are relevant in order to chronify a disease. Unfortunately just these symptoms provoke heavy controversies among physicians during the assessment of the connection with the accident (causality). A whiplash injury can emerge almost everywhere: During a traffic accident, while doing sports or at work. Yes, it can even happen while skiing or in an airplane, although it has to be said that car accidents are by far the most frequent reason for a whiplash injury.
Injuries at the passage from head to neck
With a whiplash injury, the cervical spine is over-expanded. But not every “whip stroke” happens in the exact “nodding axis of the head”. If you collide with an obstacle e.g. by car in a rather lateral way, or if cars collide on a crossing, then it is absolutely possible that the whip stroke is triggered a little displaced from the normal nodding axis and that it includes a kind of “head shaking”. So it is indeed possible that twists also occur in the cervical spine.
How can an injury at the passage from neck to head be determined then?
As you have perhaps already noticed, the diagnosis and therapy of injuries at the passage from head to neck is my special field, which I would like to explain a bit more closely below.
This situation applies also to modern examination, like e.g. computed tomography or magnetic resonance imaging because these are not functional examinations. With a patient lying still, of course no torn ligaments can be detected. This can be compared with a tear-off of the ligaments at the knee-joint. If the knee-joint ligaments are torn, the patient is not capable of walking. But the X-ray images performed while lying do not result in an abnormal statement. If the knee and also the entire leg were examined by a neurologist because the patient could not walk, then no neurological changes at all would be recognizable here either. But if a stress image of this knee-joint, i.e. a functional one, is taken, a dysfunction of the knee-joint, that is, the enlargement of the knee-joint gap in an abnormal form, can immediately be determined and documented. So the conclusion can be drawn that the ligament on the knee-joint or on the ankle must be injured, since otherwise the gap at the joint would not allow such a wide spread.
The ligaments on the Axis and the Atlas hold the head joint in a way that there is always a gap with constant dimensions between Dens and Atlas. If now the respective regions on the X-ray image are examined more closely, it can be noticed that the gaps on the right and left of the Dens are asymmetric! The left gap is wider. Similar to the knee-joint you can now conclude from this image that here a ligament injury on the left side is existent. Due to the relatively wide gap on the left it can be assumed that the left lateral ligament (Lig. alaria left) is torn.
That means there is a so-called instability at the craniocervical passage which causes the disorders already mentioned above. Of course this diagnosis can still be confirmed by a functional MRI or CT.
In this case an adequate operation for stabilization can help. The patients with an instability at the passage from head to neck often show the symptoms already mentioned like headache, decrease of memory, partial signs of paralysis, prickle in the arms or legs, frequent dizziness, ringing in the ears, dysfunctions and pain in the area of the jaw joints, of the ears and eyes. These symptoms confirm the suspicion of a structural instability of the passage from head to neck. In order to judge these symptoms better, we have developed a form in which the patient can describe his disorders. That way I am also able to determine changes of the symptoms in the course of time.
In the area of the middle cervical vertebrae (from the 2nd cervical vertebra up to and including the 1st thoracic vertebra) fractures can of course occur after accidents, but also over-expansions, dysfunctions or even injuries of the intervertebral discs and the corresponding ligaments, which happens very frequently. The patients complain about permanent pain in the neck, in the shoulder-neck area, also about pain in the neck and back of the head that increase substantially during stress. They can also temporarily involve pain in the arms or prickle. If a whiplash injury of the cervical spine with the mentioned symptoms is existent that does not become better with conservative treatment, a conversation and an examination appointment is advisable, since with the special examination procedure where the cervical vertebrae are examined in motion, such instabilities (like e.g. also at the knee-joint) can be recognized and the necessary stabilizing operation can finally be done.
A whiplash injury can also cause similar damage in the area of the lumbar spine which can then be clarified and treated the same way.