TREATMENT OF A WHIPLASH INJURY

There are 7 bones in the cervical spine (neck), which we name vertebrae. Between each two vertebrae there is a fibrous and elastic tissue, the intervertebral disc, which allows the movement of the spine. Finally, a system of ligaments, tendons and muscles help stabilise the spine and prevent excessive movement, for it could cause injury.

Chronic cervical pain, commonly known as “neck pain”, is a generic term describing the injuries to the cervical spine (neck). It is often the result of a traffic accident in which a vehicle is hit from behind by another, causing a sudden movement of the head in such a way that the neck is first extended and then flexed (bent). These sudden and violent movements often damage the neck’s and sometimes even the vertebrae’s soft tissue. Occasionally, the cervical spinal cord or its roots will be damaged. All these movements become even more severe if the seat does not have a headrests, or if they are not properly adjusted, for there is mechanical restraint that prevents excessive extension.

Traffic collision causing a whiplash injury	1st part of the movement: sharp and forced extension of the head and neck	2nd part of the movement: sharp and forced flexion of the head and neck

Symptoms may include pain in the neck, stiffness and local inflammation, headache, dizziness, blurred vision and nausea. Sometimes the pain spreads to shoulders, inter-scapular region, arms, or up into the back of the head. The symptoms can appear immediately after the accident or 1-2 days after it. Age and pre-existing conditions such as osteoarthritis may increase the severity of injuries. With increasing age, reaction time decreases, muscles lose flexibility and strength and the intervertebral discs and ligaments lose elasticity, so injuries are more common.

Areas to which cervical pain spreads due to a whiplash injury

DIAGNOSIS OF A WHIPLASH INJURY

X-rays, like cervical CT scans, do not usually show lesions. The best diagnostic technique in this case is MRI, because it can highlight the soft tissue injury.

TREATMENT OF A WHIPLASH INJURY

	Treatment usually starts with a cervical collar to immobilise the neck for 2-3 weeks together with the administration of anti-inflammatory agents and muscle relaxants.
Cervical collar to treat a whiplash injury

	If the pain persists, chiropractic manipulation, physiotherapy and rehabilitation might be useful.
Physiotherapy to treat whiplash injury

Depending on the evolution of the lesion, local heat, shortwave, ultrasound, laser and/or magnet therapy can be applied.

In most patients, these conservative treatments are able to control the discomfort. There is, however, a small group of patients in which the pain persists, and in these cases it may be necessary to apply surgical treatments, such as a cervical facet joint denervation. This procedure does not require general anaesthesia, only sedation, and in it the small nerve branches of the neck joints are destroyed, thereby relieving the pain. It is carried out on an outpatient basis, so no admission to a hospital is required, and percutaneously, so it is performed using needles and does not, therefore, involve cuts in the skin.

On very rare occasions it may be necessary to perform a surgery to fuse two or more vertebrae or to replace damaged intervertebral disc(s) by discal prosthesis, but these cases are, however, exceptional.

Cervical facet joint denervation	Cervical facet joint denervation

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