Author: John R. Alexander & Richard H. Adler

Published in the prestigious medical journal, Spine, by renowned researcher and author, Dr. Manohar M. Panjabi, is an article describing the results of a kinematic analysis of cervical intervertebral disc deformation during simulated whiplash using the whole cervical spine with muscle force replication model.¹

The current study “demonstrated that excessive 150° fiber and disc shear strain occurred during simulated whiplash. These strains were greatest at the posterior region of the C5-6, and clinical date suggests that this is the most common location for disc herniation in whiplash patients.” The authors further state that “while disc injury may be the cause of acute pain and muscle spasm during the trauma, it could also lead to disc degeneration, facet osteoarthritis, and chronic neck pain.” ²

Of equal interest in this article are the extensive references by the authors to other articles and studies. For example:

• Following rear collision impact, the lower cervical spine experiences complex loading consisting of an extension moment and posterior shearing and compressive forces.³
• "Clinical evidence suggests that disc injury and accelerated degeneration are common in whiplash patients." ⁴
• Cervical disc injury is the only lesion that has been consistently documented in radiographic studies of whiplash patients. In a prospective study, MRI [was used] to demonstrate that 25% of whiplash patients had herniated cervical discs, likely resulting from the whiplash trauma. A similar study demonstrated that 20% of whiplash patients had had severe disc herniations that correlated with radicular symptoms.⁵
• The authors reference three studies that "suggest whiplash patients are at an increased risk of premature disc degeneration." One study "demonstrated that 39% of whiplash patients without initial radiographic signs of disc degeneration had developed degenerative changes within 5 to 10 years." ⁶Another study found that the incidence required cervical fusion surgery in whiplash patients was twice that of control patients, and that whiplash patients required fusion 8 years earlier than the controls.⁷
• “Approximately 50% of whiplash patients reported chronic neck pain 15 years after the trauma.”⁸

Panjabi et al concluded that:

“While acute injury to the cervical disc appears to cause immediate herniation in a minority of whiplash patients, a greater number of patients are vulnerable to accelerated disc degeneration over 5 to 10 years following the whiplash trauma. [footnote omitted] The mechanism of degeneration in these patients is unknown; however, animal studies have demonstrated that small tears in the anulus fibrosus can initiate that disc degeneration process. [footnote omitted] It seems likely that a similar mechanism may underlie disc degeneration in whiplash patients: that trauma may produce a small tear in the anulus that triggers the biochemical cascade leading to degeneration. [footnote omitted]”

In a medical-legal and forensic context, this article reaffirms the importance and need of healthcare practitioners and attorneys to better understand the anatomy, physiology, and mechanism of traumatic injury. When traumatic injuries can have long lasting implications for a person's overall health and welfare it is important for the healthcare and legal professionals to have a strong and rich knowledge base to best serve the patient/client. The healthcare professional and attorney can then form the first line of defense between the victim and debilitating physical injury and financial loss. The legal-medical connection is natural and best serves the interests of the patient-turned-client when both healthcare and legal communities work together to serve the public. The law firm of Adler Giersch PS is committed to providing the highest quality legal representation and legendary service to those injured by others and will work closely with their clients' healthcare providers.

Manohar M. Panjabi, PhD, Shigeki Ito, MD, et al, “Injury Mechanisms of the Cervical Intervertebral Disc During Simulated Whiplash” Spine Volume 29(11) June 1, 2004 pp 1217-1225

Id at p. 1224.

Luan F, Yang KH, Deng B, et al. Qualitative analysis of neck kinematics during low-speed rear-end impact. Clin Biomech. 2000; 15:649-657. Panjabi MM, Cholewicki J, Nibu K, et al. Simulation of whiplash trauma using whole cervical spine specimens. Spine. 1998; 23:17-24.

Pettersson K, Hildingsson C, Toolanen G, et al. Disc pathology after whiplash injury: a prospective magnetic resonance imaging and clinical investigation. Spine. 1997;22:283-287. Jonsson H Jr, Cesarini K, Sahlstedt B, et al. Findings and outcome in whiplash-type neck distortions. Spine. 994; 19:2733-2743. Hohl M. Soft-tissue injuries of the neck in automobile accidents: factors influencing prognosis. Bone Joint Surg Am. 1974;56:1 675-1682. Watkinson A, Gargan MF, Bannister GC. Prognostic factors in soft tissue injuries of the cervical spine. Injury. 1991; 22:307-309.

Pettersson K, Hildingsson C, Toolanen G, et al. Disc pathology after whiplash injury: a prospective magnetic resonance imaging and clinical investigation. Spine. 1997;22:283-287. Jonsson H Jr, Cesarini K, Sahlstedt B, et al. Findings and outcome in whiplash-type neck distortions. Spine. 1 994; 1 9:2733-2743.

Id at p. 1217.

Hohl M. Soft-tissue injuries of the neck in automobile accidents: factors influencing prognosis. J Bone Joint Surg Am. 1974;56:1675-1682. Hamer AJ, Gargan MF, Bannister GC, et al. Whiplash injury and surgically treated cervical disc disease. Injury. 1993;24:549-550. Watkinson A, Gargan MF, Bannister GC. Prognostic factors in soft tissue injuries of the cervical spine. Injury. 1991;22:307-309.]

Bunketorp L, Nordholm L, Carlsson J. A descriptive analysis of disorders inpatients 17 years following motor vehicle accidents. Eur Spine J. 2002; 11:227-234. Squires B, Gargan MF, Bannister GC. Soft-tissue injuries of the cervical spine: 15-year follow-up. J Bone Joint Surg Br. 1996; 78:955-957