Astrup Jens, Gyntelberg Finn
Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Front Neurol. 2022 Mar 10;13:821097. doi: 10.3389/fneur.2022.821097. eCollection 2022.
The natural course of the whiplash disease is reconsidered in relation to the predominant view of its cause. It is assumed that a whiplash-type trauma is causing an acute tissue injury such as a distortion or sprain in the neck followed by neck pain and headache, which then tends to become a chronic pain condition. We conclude that the whiplash disease typically evolves following a minor trauma without any signs of a tissue injury. It presents with central neuromotor dysfunction, such as electromyography (EMG) hyperactivity and abnormal activation patterns associated with dyscoordination of the involved and adjacent muscle groups. This indicates a central neurological rather than a peripheral traumatic pathology. This view places the cause of the whiplash disease within the central nervous system, and, in concordance with the EMG abnormalities and motor dyscoordination, we suggest the term cervical spinal dyssynergia for this pathology. It provides a new paradigm for further investigations of this disease as well as a window for possible specific neuropharmacological therapy directed towards dysfunctional neuromotor control.
基于对挥鞭样损伤病因的主流观点，重新审视了挥鞭样损伤疾病的自然病程。假定挥鞭样创伤会导致急性组织损伤，如颈部扭曲或扭伤，继而引发颈部疼痛和头痛，随后往往会发展为慢性疼痛状态。我们得出的结论是，挥鞭样损伤疾病通常在轻微创伤后演变，且无任何组织损伤迹象。它表现为中枢神经运动功能障碍，如肌电图（EMG）活动亢进以及与受累和相邻肌肉群协调障碍相关的异常激活模式。这表明是中枢神经系统病变而非外周创伤性病理改变。这一观点将挥鞭样损伤疾病的病因定位在中枢神经系统，并且，与肌电图异常和运动协调障碍相一致，我们建议将这种病理状态称为颈椎失协同。它为该疾病的进一步研究提供了新的范例，也为针对功能失调的神经运动控制进行可能的特异性神经药理学治疗提供了一个窗口。
