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. 2015:1:15024.
doi: 10.1038/scsandc.2015.24. Epub 2015 Oct 8.

Potential associations between chronic whiplash and incomplete spinal cord injury

Andrew C Smith  1 , Todd B Parrish  2 , Mark A Hoggarth  3 , Jacob G McPherson  4 , Vicki M Tysseling  3 , Marie Wasielewski  3 , Hyosub E Kim  5 , T George Hornby  5 , James M Elliott  3
Affiliations

Potential associations between chronic whiplash and incomplete spinal cord injury

Andrew C Smith et al. Spinal Cord Ser Cases. 2015.

Erratum in

Abstract

Study design: This research utilized a cross-sectional design with control group inclusion.

Objectives: Preliminary evidence suggests that a portion of the patient population with chronic whiplash may have sustained spinal cord damage. Our hypothesis is that in some cases of chronic whiplash-associated disorders (WAD), observed muscle weakness in the legs will be associated with local signs of a partial spinal cord injury of the cervical spine.

Setting: University based laboratory in Chicago, IL, USA.

Methods: Five participants with chronic WAD were compared with five gender/age/height/weight/body mass index (BMI) control participants. For a secondary investigation, the chronic WAD group was compared with five unmatched participants with motor incomplete spinal cord injury (iSCI). Spinal cord motor tract integrity was assessed using magnetization transfer imaging. Muscle fat infiltration (MFI) was quantified using fat/water separation magnetic resonance imaging. Central volitional muscle activation of the plantarflexors was assessed using a burst superimposition technique.

Results: We found reduced spinal cord motor tract integrity, increased MFI of the neck and lower extremity muscles and significantly impaired voluntary plantarflexor muscle activation in five participants with chronic WAD. The lower extremity structural changes and volitional weakness in chronic WAD were comparable to participants with iSCI.

Conclusion: The results support the position that a subset of the chronic whiplash population may have sustained partial damage to the spinal cord.

Sponsorship: NIH R01HD079076-01A1, NIH T32 HD057845 and the Foundation for Physical Therapy Promotion of Doctoral Studies program.

Keywords: central activation; chronic WAD; magnetic resonance imaging; muscle fat infiltration; spinal cord injury; whiplash.

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Figures

Figure 1
Figure 1
(a) Group means and s.e.m. of the reduced and contralateral lateral spinal cord magnetization transfer ratios for the control and chronic WAD groups. A significant difference was found on one side (P<0.01), but not on the other side (P=0.80). (b) A magnetization transfer image at the C6 level with a region of interest targeting the lateral corticospinal tract area.
Figure 2
Figure 2
(a) Group means and s.e.m. of the multifidus-semispinalis cervicus MFI on the reduced and contralateral sides, for the control and chronic WAD groups. A significant difference was found on both the reduced (P=0.02) and contralateral sides (P<0.01). (b) Fat-saturated images of the multifidus-semispinalis cervicus MFI regions of interest, at the C6 level, for one uninjured matched-control participant (left) and a participant with chronic WAD (right). (c) Group means of the plantarflexor MFI on both the reduced and contralateral sides, for all three groups. Differences between the control and chronic WAD mean values were non-significant on the reduced side following Bonferroni correction (P=0.04), while the other comparisons were not significant (P range: 0.15–0.85).
Figure 3
Figure 3
(a) Group means and s.e.m. of the plantarflexion central activation ratios on the reduced side, for the control, chronic WAD and iSCI groups. A significant difference was found comparing control with chronic WAD (P<0.01), but not comparing chronic WAD with iSCI (P=0.07). (b) Plantarflexion torque traces for central activation testing for one uninjured control participant, one representative with chronic WAD and one representative with iSCI.
See this image and copyright information in PMC

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