Whiplash, Cervical - Medical Research Abstracts - Medicolegal

1. AUTHOR	Seckmeyer-M.
INSTITUTION	Abteilung Kraftschaden, Wiesbaden.
TITLE	(Detection of so-called "cervical whiplash trauma"). TT Zum Nachweis des sogenannten "HWS-Schleudertraumas".
SOURCE	Versicherungsmedizin 1997 Apr 1, VOL: 49 (2), P: 48-51, ISSN: 0933-4548.
ABSTRACT	For the evidence of causality of an accident for a cervical injury without any contact with the interior, it is necessary to provide a interdisciplinary expert's opinion. According to the state of experts knowledge for reconstruction of accidents a slight cervical injury can be precluded if the alteration of speed of the pushed car ist less than 15 km/h. Medical diagnoses are only valid if they have been proved by objective results. A diagnose based only on a subjective information is to be considered as a suspicious diagnose. Author.

2. AUTHOR	Jenzer-G.
TITLE	(Clinical aspects and neurologic expert assessment in sequelae of whiplash injury to the cervical spine). TT Klinische Aspekte und neurologische Begutachtung beim Zustand nach Beschleunigungsmechanismus an der Halswirbelsaule.
SOURCE	Nervenarzt 1995 Oct, VOL: 66 (10), P: 730-5, ISSN: 0028-2804 30 Refs.
ABSTRACT	Whiplash injury to the cervical spine and its possible long-term sequelae, the late (or chronic) whiplash syndrome, are analysed based on a clearly defined accident mechanism and an initial battery of investigations to exclude lesions other than those affecting the soft tissue of the neck region (i.e. the consequences of strain and sprain). Predictors are discussed that may point to a delayed and complicated recovery, with development of a complex array of symptoms. The pattern of this symptomatology, as reviewed on the basis of different neuropsychological investigations, appears inhomogeneous. Comparison with other non-traumatic conditions, such as the chronic fatigue syndrome, the fibromyalgia syndrome and chronic daily headache, as well as with chronic disturbances of cervical origin, reveals striking similarities. In cases of litigation, these circumstances require careful assessment of the patient's previous history and an extensive differential diagnosis. Whiplash injury to the cervical spine rarely results in disability and, if so, is only minor. Author.

3. AUTHOR	Kortschot-H-W, Oosterveld-W-J.
INSTITUTION	Academisch Medisch Centrum, Poliklinik fur Vestibulare Erkrankungen, Amsterdam.
TITLE	(Otoneurologic disorders after cervical whiplash trauma). TT Otoneurologische Storungen nach HWS-Schleudertrauma.
SOURCE	Orthopade 1994 Aug, VOL: 23 (4), P: 275-7, ISSN: 0085-4350.
ABSTRACT	An extensive vestibular examination was conducted in 462 patients suffering from the after-effects of a cervical whiplash trauma. Vertigo and dizziness were mentioned by 318 (68%) of the subjects, among a variety of other complaints. The examination revealed the existence of central-vestibular lesions in 258 (56%) of the patients. Author.

4. AUTHOR	Dvorak-J, Ettlin-T, Jenzer-G, Murner-J, Radanov-B-P, Walz-F.
TITLE	(Determining the status of the cervical spine after whiplash injury). TT Standortbestimmung zum Zustand nach Beschleunigungsmechanismus an der Halswirbelsaule.
SOURCE	Z-Unfallchir-Versicherungsmed 1994 Jul, VOL: 87 (2), P: 86-90, ISSN: 0040-3603 11 Refs.
ABSTRACT	The results of medical investigations following acceleration mechanism to the cervical spine (so called "soft tissue neck injury") are to be described in common diagnostic terms. Biomechanical and legal considerations are beyond medical competence. In certain cases, the clinical examination must be completed in cooperation with specialists. Within the entire medical context, the neuropsychological and neuropsychiatric assessment may contribute to a comprehensive understanding of the consequences. In cases of litigation, the full array of facts, like the patients' previous history, and differential diagnoses, have to be drawn to attention. At present, compensation takes place only exceptionally and in a limited range, if an impairment by an accompanying brain injury is excluded. Author.

5. AUTHOR	Meenen-N-M, Katzer-A, Dihlmann-S-W, Held-S, Fyfe-I, Jungbluth-K-H.
INSTITUTION	Abteilung fur Unfall- und Wiederherstellungschirurgie, Universitatskrankenhaus Hamburg-Eppendorf.
TITLE	(Whiplash injury of the cervical spine--on the role of pre-existing degenerative diseases). TT Das Schleudertrauma der Halswirbelsaule--uber die Rolle degenerativer Vorerkrankungen.
SOURCE	Unfallchirurgie 1994 Jun, VOL: 20 (3), P: 138-48; discussion 149, ISSN: 0340-2649.
ABSTRACT	Radiological investigations contribute little in differentiating the problems of patients with whiplash injuries. Nevertheless the more prolonged cases of whiplash injuries must not be attributed to preexisting degenerative disease, despite radiologically-proven medicolegal opinion. In this study, 60 patients who were seen for whiplash injuries in the Department for Trauma and Reconstructive Surgery at the University Hospital Hamburg-Eppendorf for clinical and radiological evaluation, an average of 5.7 years post injury, were divided into two groups (n = 30) depending on radiologically-proven preexisting degenerative changes of the cervical spine. On average the patients with degenerative changes were 11.2 years older than those with healthy vertebral columns and also demonstrated an increase in acute symptoms in the lower cervical spine (cervicobrachial syndrome). The chronicity of individual symptoms such as neck-pain, dizziness, nausea and psychological illness was also observed in both groups. Problems such as paresthesias as well as pain in the shoulder-arm-area appeared to increase in subsequent check-ups, irrespective of the earlier degenerative changes. Patients with typical posterior headaches recovered faster when they had radiologically normal spines. Presenting late, there was a significant accumulation of patients with pre-existing degenerative changes complaining merely of tinnitus. The earlier changes in any individual motion segment do not determine the clinical course of whiplash injuries, but merely represent an area of increased vulnerability to trauma. On the other hand, trauma has not been proven to influence the development or aggravation of degenerative changes in normal or diseased spines. We are not able to differentiate the posttraumatic course from the natural history of the degenerative process, either clinically or radiologically. Considering the involvement of sensitive neurological structures the classical objective organic diagnosis of "whiplash injury" may not be adequate in describing the complaints of patients, and should not be used to justify the rejection of the patients subjective symptoms as mere simulation for financial gains. The evaluation of the patients' X-rays using Arlen's technique sheds no further light on the issue. Author.

6. AUTHOR	Risser-D, Bauer-G.
INSTITUTION	Institut fur gerichtliche Medizin, Universitat Wien.
TITLE	(False positive radiographic findings in expert assessment of whiplash trauma of the cervical spine). TT Zum falsch positiven Rontgenbefund bei der Begutachtung des Schleudertraumas der Halswirbelsaule.
SOURCE	Beitr-Gerichtl-Med 1992, VOL: 50, P: 297-300, ISSN: 0067-5016.
ABSTRACT	It is reported about a possible misdiagnosis after whiplash injuries. Calcifications of the nuchal ligament have been interpreted as fractures. The inappropriate radiological diagnosis has been corrected within the criminal procedure. Prolonged complaints as possible consequences of information about the false positive radiological diagnosis to the patient are discussed. Author.

7. AUTHOR	Jenzer-G, Walz-F.
INSTITUTION	Arbeitsgruppe fur Unfallmechanik, Gerichtlich-Medizinisches Institut Universitat Zurich.
TITLE	(The "severity" of "whiplash injury of the cervical spine"). TT Die "Schwere" des "Schleudertraumas der Halswirbelsaule".
SOURCE	Z-Unfallchir-Versicherungsmed 1991, VOL: 84 (1), P: 7-19, ISSN: 0040-3603 40 Refs.
ABSTRACT	The severity of the so called "whiplash injury of the neck" ("soft tissue neck injury") and the condition thereafter depends on the chosen angle of view: impact dynamics, biomechanics, pathological- anatomical considerations, clinical and apparative findings, medicolegal aspects and subjective assessment. The impact itself may not serve as a diagnosis, which latter has to be founded on the results of the medical examination. These findings seem to be appropriate for the resolution of questions in the course of litigation. At present, a universal severity may not be defined. Author.

8. AUTHOR	Schmidt-G.
TITLE	(Biomechanics of whiplash injuries of the cervical spine). TT Zur Biomechanik des Schleudertraumas der Halswirbelsaule.
SOURCE	Versicherungsmedizin 1989 Jul 1, VOL: 41 (4), P: 121-6, ISSN: 0933-4548 30 Refs.
ABSTRACT	The whiplash injury of the cervical spine is a typical, but not very often observed injury of occupants of automotive vehicles involved in moderate collisions. 2. There still exist great uncertainties in the elaboration of expertises concerning the minor whiplash injury, so that the great part of the disturbances cannot be objectivated under a clinical point of view. And on the other hand, serious whiplash injuries often are superposed or veiled by secondary injuries. 3. Thus, the aim of the present paper was to point out injury mechanisms, to give a rough scaling of the whiplash severity under biomechanical aspects and finally to set these injury mechanisms in correlation to the following criteria of accident: a) vehicle velocity change (energy equivalent speed--EES); b) deformation of vehicles on the impact-exposed structure; c) loading of occupants by acceleration or deceleration. 4. The tolerance limit of the cervical spine generally decreases to a lower limit, if the cervical spine is changed in a pathological way, e.g. by preexisting diseases. 5. It is evident and important, that the difficult work of giving an expert's opinion on this field must be performed in an interdisciplinary collaboration of engineers for collision-analysis and physicians experienced in accident-traumatology. Author.