Author: E. Paul Giersch

One of the enduring challenges to research into whiplash injuries from auto accidents is the fact that available technologies do not permit effective pathoanatomical examination of accident survivors. Autopsy of these patients while the surest way to obtain definitive evidence, is, obviously, not feasible.

A group of researchers at the Institute of Sports Science and Clinical Biomechanics at the University of Southern Denmark has produced a literature review which points to the likelihood that subtle cervical spine lesions are unrecognized and under-reported in automobile trauma victims.¹ This review was accomplished by examining studies of traffic fatality autopsies which used surface cryoplaning microtomy techniques (microscopic examination of thinly sliced frozen tissue samples).

In approaching their review of pertinent literature, the authors comment:

"Potentially serious lesions after road traffic accidents may result in minor symptoms only, whereas 'minor' traumas have been reported to result in more severe symptomatology"

The researchers' specific objective was:

"to determine whether occult pathoanatomical lesions in the cervical spine of road traffic fatalities exist and if they can be identified using optimal autopsy techniques"

Of twenty-seven articles reviewed, only three met the researchers' key criteria: the use of surface cryoplaning microtomy techniques, and a control group. Subtle cervical lesions of similar type were detected in all three studies, and involved the intervetebral discs, the cartilaginous endplates, and the articular surfaces and capsules of the facet (zygapophyseal) joints. Specific findings included annular bruising and tearing (including rupture with herniation), articular cartilage damage, hemmorhage into the facet joints from small capsular or synovial tears, and injury to the disc endplates.

Significantly, the lesions were found exclusively in the group of traumatic injury victims. None were found in the non-traumatized control group. Noting that present imaging technologies are insufficient to visualize subtle lesions, the authors of this study concluded:

1. "Cervical spinal injury occurs in road traffic fatalities with a high incidence of injuries to the spinal joints and intervertebral discs";
2. "The injuries documented at autopsy in these studies were not found in any patients in the control groups";
3. "It is reasonable to assume that nonfatal road traffic traumas may result in pathoanatomical lesions similar to those found in fatal road traffic traumas";
4. "Negative clinical and radiographic examinations do not prove the absence of pathoanatomical lesions."

The authors suggest these autopsy findings have relevance in the management of motor vehicle accident trauma victims who may have similar pathoanatomy.

The Spine article is accompanied by commentary from Nikolai Bogduk, M.D., who points out the credibility of this research is enhanced by the convergence of three types of investigation: postmortem studies, biomechanical studies and clinical studies.

Conclusion

Doctors and therapists treating patients with traumatic neck and back injuries are often asked to render expert opinions regarding diagnosis and causation in the context of their personal injury claims. They are also asked to describe and explain the likely mechanisms of injury and pain generation. The absence of "objective" findings, even with modern imaging technologies, has continued to result in excessive caution and reticence on the provider's part. Moreover, insurance companies are quick to conclude that a lack of imaging findings means that a motor vehicle accident did not cause an objectively verifiable neck and back injury.

The Danish study, and similar related research, provide compelling support for the proposition that "subtle" injuries, imperceptible without advanced autopsy techniques, do result from whiplash events. Such research "converges" with the doctor's clinical evaluation and experience to provide a broader basis of support for expert opinion. As such, it should add to the level of comfort and confidence with which key expert opinions are formulated and expressed. In reality, clinical evaluation, combined with practical experience is sufficient to support a medical-legal opinion on causation and injury in the context of personal injury claims.

It is also important your patients be represented by experienced personal injury attorneys well versed in the literature, specifically, this research which demonstrates "normal" radiographic and other imaging studies have little probative value or legal relevance, and reminds us of the fundamental importance of thorough clinical evaluation. The attorneys at Adler Giersch, PS are well versed in all aspects of personal injury, and are available for consultation throughout western Washington through our offices in Seattle, Bellevue, Everett and Kent.

1Urenholt, L. Grunnt-Nilsson, N., et al. Cervical Spine Lesions after Road Traffic Accidents: A systematic review. Spine 2002; 27(17): 1934-1941