With a whiplash injury, the cervical spine is over-expanded. But not every “whip stroke” happens in the exact “nodding axis of the head”. If you collide with an obstacle e.g. by car in a rather lateral way, or if cars collide on a crossing, then it is absolutely possible that the whip stroke is triggered a little displaced from the normal nodding axis and that it includes a kind of “head shaking”.
So it is indeed possible that twists also occur in the cervical spine. And not only this: We know from the cervical spine’s anatomy that the cervical spine has a network of ligaments and arteries. Furthermore there is a joint connection (head joint) between the Atlas (C1) and the Axis (C2). This is the most flexible, but also the most unstable part of the spinal column.
The Dens is a kind of “buttress” and prevents the head from over-flexion. All other movements like head shaking, nodding, turning the head etc. are secured by the ligaments and capsules. In a whiplash injury sometimes a rather violent and not consciously controllable over-flexion of the head occurred. That way it is possible that the head joint consisting of Atlas and Axis is “opened” more than its anatomical limits allow. Exactly this opening has to be prevented on the Axis by the three ligaments Ligamenta alaria right and left and Ligamenta cruciforme, as well as the Membrana atlantooccipitalis anterior on the Atlas, and they can now at least be over-expanded, but also be partially or completely torn.
There is another ligament that can be abnormally expanded or torn apart: the Ligamenta transversum. This ligament prevents the Dens from touching the spinal cord. A “simple” over-expansion or twist of the cervical spine is normally cured after about six weeks, a ligament injury is not.
And this is exactly where in my opinion an unnecessary and sometimes vehement discussion among physicians begins that is too often carried out to the patient’s disadvantage. The latter will hear an opinion from one doctor and from the other one a different opinion again. Why? The solution of the mystery lies in the exact examination of the patient’s passage from neck to head. Some physicians think that a whiplash injury is a rather light injury. If a damage of the cervical spine were existent, it would be visible on the X-ray images. If there is none, then it is just a whiplash injury. The other physicians have the point of view that the cervical spine can not only become injured in the middle section, but that the head joint and/or the ligaments can also be injured and that this has to be examined.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article Injuries at the passage from head to neck.
