Daimon Kenshi, Fujiwara Hirokazu, Nishiwaki Yuji, Okada Eijiro, Nojiri Kenya, Shimizu Kentaro, Ishihama Hiroko, Fujita Nobuyuki, Ichihara Daisuke, Tsuji Takashi, Nakamura Masaya, Matsumoto Morio, Watanabe Kota
Dept. of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, #160-8582, Japan.
Dept. of Diagnostic Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, #160-8582, Japan.
J Orthop Sci. 2019 Jul;24(4):579-583. doi: 10.1016/j.jos.2018.11.011. Epub 2018 Dec 12.
Some patients suffer from long-lasting symptoms after whiplash injury. However, there are few reports on the long-term changes in the cervical spine after whiplash injury using imaging tests. The purpose of this longitudinal study was to determine the changes on MRI of the cervical spine 20 years after whiplash injury, and to examine the relationships between changes in the cervical spine on MRI and changes in related clinical symptoms.
Eighty-one subjects finally participated in this study (follow-up rate 16%). The mean follow-up duration was 21.7 years. All subjects filled out a questionnaire about their clinical symptoms. The MRI findings were assessed using numerical grading system applied in the original study. Statistic analyses were used to investigate whether the progression of each MRI finding was associated with the severity of neck pain, stiff shoulders, dizziness and tinnitus.
All subjects had complained of some clinical symptoms in the original study: 71 had neck pain, 53 stiff shoulders, and others. In the present study, 66 subjects (81.5%) complained of some clinical symptoms: 57 had stiff shoulders, 20 neck pain, and others. The progression of degeneration on MRI was observed in 95% of the subjects, with C4/5 and 5/6 being the most frequently involved levels. Changes in the severity of neck pain, stiff shoulders, dizziness and tinnitus over 20 years were not significantly associated with the progression of degenerative changes in the cervical spine on MRI.
Twenty years after whiplash injury, 95% of the subjects showed a progression of degeneration in the cervical spine. The progression of the intervertebral disc degeneration in the cervical spine on MRI after whiplash injury was not significantly associated with changes in the severity of related clinical symptoms, indicating that the degenerative changes on MRI may reflect the physiological aging process rather than post-traumatic sequelae.
一些患者在挥鞭样损伤后会出现长期症状。然而，使用影像学检查对挥鞭样损伤后颈椎的长期变化进行报道的却很少。这项纵向研究的目的是确定挥鞭样损伤20年后颈椎MRI的变化，并研究颈椎MRI变化与相关临床症状变化之间的关系。
最终81名受试者参与了本研究（随访率16%）。平均随访时间为21.7年。所有受试者填写了关于其临床症状的问卷。MRI结果采用原始研究中应用的数字评分系统进行评估。采用统计分析来研究每个MRI结果的进展是否与颈部疼痛、肩部僵硬、头晕和耳鸣的严重程度相关。
在原始研究中，所有受试者均有一些临床症状：71人有颈部疼痛，53人有肩部僵硬，还有其他症状。在本研究中，66名受试者（81.5%）有一些临床症状：57人有肩部僵硬，20人有颈部疼痛，还有其他症状。95%的受试者在MRI上观察到退变进展，C4/5和C5/6是最常受累的节段。20年间颈部疼痛、肩部僵硬、头晕和耳鸣严重程度的变化与颈椎MRI退变变化的进展无显著相关性。
挥鞭样损伤20年后，95%的受试者颈椎出现退变进展。挥鞭样损伤后颈椎MRI上椎间盘退变的进展与相关临床症状严重程度的变化无显著相关性，表明MRI上的退变变化可能反映生理老化过程而非创伤后后遗症。
