The alar ligament restrains excessive axial rotation and lateral flexion and can be damaged in a whiplash-type injury. When this occurs, the damage is typically to the ends of the alar ligament. This tearing of the ends of the alar ligament can be difficult to diagnose as they are deep in the tissue and the ligaments are relatively small. A recent study conducted at the Xiangya School of Medicine in Changsha, Hunan, China investigated how repetitive injury to the alar ligament could lead to chronic neck pain and headaches in elderly patients that experienced a whiplash-type event.
The study involved 134 elderly patients with chronic neck pain, headaches, and a known history of involvement in a whiplash-type occurrence. The participants were given a complete medical examination that included high resolution proton density-weighted imaging with a 3.0 T MRI system. The criteria used to determine positive signs of chronic alar ligament injury were abnormally high signals on MRI in the ligamentous body or vicinity of the occipital condyle involving the ligament’s edge in varying degrees, or adjacent side subdural effusion of cerebrospinal fluid.
After physical examination, the participants were divided into two groups: a clear etiology group (CE) (known neck pain/headaches from whiplash occurrence) and an unknown etiology (UE) group (known neck pain/headaches but unknown whiplash occurrence). The CE group consisted of 96 participants. Of those, 7 of the participants had evidence of positive chronic alar ligament injury (or 7.3% of the CE group). Interestingly, of the remaining 38 participants in the UE group who had no clear etiology for chronic neck pain or headaches, 21 participants (or 55%) had positive signs of chronic alar ligament injury on MR. Of those, 12 participants (or nearly 57%) also had cerebrospinal fluid leakage findings on MR.
The study also pointed out that while the results and findings may be debated as elderly patients can present with different degrees of alar ligament degenerative changes which can occur primarily at the edges of the ligament (the same area that is typically damaged in a whiplash-type injury), 5 of the 21 participants (23.8%) with positive signs of alar ligament injury had abnormal signals located in the body of the ligament.
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 MR investigation in evaluation of chronic whiplash alar ligament injury in elderly patients. Journal of Central South University; Medical Science 2015; Vol. 40; No. 1; pp. 67-71.
 Most MRIs for spinal and musculoskeletal assessments are conducted with a 1.5 Tesla magnet. One of the very unique features of this study is the use of a higher intensity magnet, 3.0 and the clarity of certain anatomical structures that were not as visible with the 1.5 T MRI.
 The remaining 89 participants in the CE group had findings of intervertebral disc protrusion, spinal disease, RA, moderate to severe cervical degenerative disease, tumor, or Spondylitis.