Presented at the 2013 AAPM Annual Meeting « Back

Prevalence of Spondylolithesis in Whiplash-Injured Patients: A Retrospective Radiographic Review

Mehul J. Desai, MD MPH, mdesai@mfa.gwu.edu¹, Sasha E. Knowlton, MD², Andrew Nava, MD³, (1) GW Spine & Pain Center, Washington, D.C., (2) Lahey Clinic, Burlington, Massachusetts, (3) George Washington University, Washington, D.C.

Background: Whiplash injury is common following traumatic events such as motor vehicle accidents and falls (Kamper, 2008). Patients with whiplash often complain of pain and disability for years after the injury, yet a large gap in knowledge still exists in understanding the etiology of this disorder (Rydevik, 2008). We retrospectively report the radiographic prevalence of cervical spondylolisthesis in patients with prior whiplash injury. Methods and Study Design: Retrospective 2.5-year chart review as approved by the George Washington University Institutional Review Board. Subjects: Thirty patients with a history of whiplash injury and available dynamic cervical radiographs were identified. Images were reviewed for affected cervical levels and spondylolithesis measurements. RESULTS Average age of patients was 44; 36 were female. 29/30 patients demonstrated at least one level of spondylolithesis. Levels primarily affected were C4-C5 (14/30) and C3-C4 (12/30). Other affected levels included C2-C3, C5-C6 and C6-C7. Several patients were affected at ≥ 1 level. Spondylolithesis was most prevalent in the flexion position compared to the neutral or extension positions. Conclusions: The majority of identified patients with whiplash injury demonstrated spondylolisthesis at one or more levels. These identified issues might be mechanistically or causally related to the initial injury particularly given the mean age of patients. Further research is needed to investigate potential correlations between mechanism of injury, etiology of injury, physical examination findings, radiographic data and targeted interventions. References: 1) Kamper SJ et al. (2008). Course and prognostic factors of whiplash: A systematic review and meta-analysis. Pain. 138:617-629. 2) Rydevik B et al. (2008). Whiplash injuries and associated disorders: new insights into an old problem; 3. Pathology. Eur Spine J. 17(Suppl 3): S371-375. OR 359-416.

Funding: None.