Longitudinal magnetic resonance imaging study on whiplash injury patients: minimum 10-year follow-up.
BACKGROUND
We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms.


METHODS
A total of 133 patients with acute whiplash injury between 1993 and 1996 participated in this follow-up study. They underwent neurological examinations by spine surgeons and second MRI scans of the cervical spine were obtained. They also filled out a questionnaire regarding cervical symptoms and the accident details. The items evaluated by MRI were (1) a decrease in the signal intensity of the intervertebral disc; (2) anterior compression of the dura and the spinal cord; (3) posterior disc protrusion; (4) disc space narrowing; and (5) foraminal stenosis. Relations between the presence/absence of degenerative changes on MRI, accident details, and patients' symptoms were assessed by calculating the adjusted odds ratio (OR).


RESULTS
Progression of some degenerative changes was recognized on MRI in 98.5% of the 133 whiplash injury patients, and clinical symptoms diminished in more than a half of the 133 patients. There were no statistically significant associations between MRI findings and changes in clinical symptoms. The prognosis for neck pain tended to be poor after accidents with double collisions (rear-end collision followed by frontend collision) [adjusted OR 5.83, 95% confidence interval (CI) 1.15-29.71] and accidents with serious car damage (2.87, 1.03-7.99). The prognosis for stiff shoulders tended to be poor in women (2.83, 1.23-6.51); and the prognosis for numbness in the upper extremities tended to be poor after accidents with serious car damage (3.39, 1.14-10.06).


CONCLUSIONS
This study demonstrated that progression of degenerative changes of the cervical spine on MRI was not associated with clinical symptoms during the 10-year period after whiplash injury.
Department of Orthopaedic Surgery, School of Medicine, Keio University, Shinjukuku, Tokyo, Japan.
Daisuke
D
Ichihara
Eijiro
E
Okada
Kazuhiro
K
Chiba
Yoshiaki
Y
Toyama
Hirokazu
H
Fujiwara
Suketaka
S
Momoshima
Yuji
Y
Nishiwaki
Takeshi
T
Hashimoto
Jun
J
Ogawa
Masahiko
M
Watanabe
Takeshi
T
Takahata
Morio
M
Matsumoto
D000063:Accidents, Traffic / Q000145:classification; D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D019636:Neurodegenerative Diseases / Q000175:diagnosis* / Q000209:etiology*; D016017:Odds Ratio; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D014911:Whiplash Injuries / Q000150:complications*; D055815:Young Adult