Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment

J Manipulative Physiol Ther. Nov-Dec 2002;25(9):550-5. doi: 10.1067/mmt.2002.128371.


Objective: To reveal whether women with chronic whiplash-associated disorder (WAD) symptoms, grade I-II, demonstrate regional and/or segmental radiographic signs of altered cervical lordosis.

Design: Case-control study.

Setting: Radiography department at a university hospital.

Participants: Three age-balanced groups comprising 120 women. The case group included women with chronic whiplash syndrome (n = 41), and the control group included women with chronic insidious onset neck pain (n = 39) and an asymptomatic group (n = 40), who were given baseline data. The sample was referred from informed doctors and physiotherapists.

Intervention: The women sat in a standardized sitting position and radiographs were taken in a lateral position with fluoroscopic control for alignment.

Outcome measures: Two distinct measurements were taken; 1 of the angles of the upper and lower cervical curvatures, respectively, and 1 of the angles between the inferior borders of each pair of vertebrae in the lower cervical spine. The 3 groups were compared on the ratio of the lower to upper cervical spine angles and on the mean angular values for each segment in the cervical spine.

Results: The whiplash group showed a decreased ratio between the lower versus upper cervical spine but comparisons between groups were not statistically significant. The whiplash group was in a significantly more flexed position at the C4-C5 level compared with the asymptomatic group (P =.007). The reliability measures have to be strengthened to render these results definitely conclusive.

Conclusion: The whiplash group exhibited a different configuration of cervical lordosis. This is clinically important and needs to be studied more closely.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / physiopathology
  • Female
  • Humans
  • Lordosis / diagnostic imaging*
  • Neck Pain / diagnostic imaging*
  • Radiographic Image Interpretation, Computer-Assisted* / methods
  • Range of Motion, Articular
  • Rotation
  • Whiplash Injuries / diagnostic imaging*
  • Whiplash Injuries / physiopathology