Thursday, October 25, 2007

Backlash in the diagnosis of whiplash

MRI scan
MRI scans of head and neck spine ligaments have been suggested as a remedy against skeptical insurance companies but new MRI research does not dispel doubts but supports them. This is really bad news for victims of whiplash injuries. They suffer from various symptoms due to whiplash trauma but many insurance companies refuse to pay because no damage is visible in the X-ray.

Magnetic resonance imaging (MRI) is superior in displaying soft tissue such as the ligaments that stabilize the spine. Some of these, the alar ligaments, have been suspected to be overstretched or broken in whiplash injury. The alar ligaments connect the first neck vertebra with the head, stabilizing and limiting its movement in various directions.

While an earlier study has described damages of the alar ligaments detected by MRI, a review of recent studies on biomechanics, anatomical and clinical MRI scans has failed to show the usefulness of MRI in whiplash diagnosis: Biomechanical experiments reproducing the impact of whiplash did not cause ruptures in the alar ligaments, and the anatomical survey showed that there are plenty of normal variants in these ligaments with no well-defined "normal" standard that would allow to distinguish a damage.

Some of the authors say that MRI is excellent to visualize the ligaments, others deny. When asked to interpret MRI scans, different experts often came to different conclusions.

This does not sound like good news for all those who suffer from whiplash symptoms and struggle with their insurance companies. It is a backlash, but not necessarily a final one. There may still be hope in the future, due to better MRI scanners with a higher resolution and a better anatomical and functional insight.

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