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Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

A meta-analysis of case–control studies

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European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A meta-analysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs.

Methods

A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced.

Results

Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80–2.94). Heterogeneity was present (I 2 = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87–1.86, I 2 = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49–4.21). Heterogeneity was present (I 2 = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49–1.28, I 2 = 0 %).

Conclusion

MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

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Authors and Affiliations

  1. Department of Orthopedics, Changhai Hospital, 168 Changhai Road, Yangpu District, Shanghai, 200433, China

    Quan Li, Hongxing Shen & Ming Li

Authors
  1. Quan Li
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Corresponding author

Correspondence to Ming Li.

Appendix: Search terms

Appendix: Search terms

PUBMED

((((“Ligaments” [Mesh] OR “Ligaments, Articular” [Mesh]) OR ligament*) AND (alar OR transverse)) OR (craniovertebral OR craniocervical OR (Atlanto*Occipital) OR cervical* OR neck)) AND (MRI OR (Magnetic Resonance) OR (“Magnetic Resonance Imaging” [Mesh])) AND ((whiplash) OR (“Whiplash Injurie” [Mesh]))

EMBASE

craniovertebral OR craniocervical OR cervical* OR ‘neck’/exp OR neck OR atlanto*occipital OR ‘cervical spine’/exp OR (‘alar’/exp OR alar OR transverse AND (‘ligament’/exp OR ‘ligament’ OR ligament*)) AND (‘mri’/exp OR mri OR (magnetic AND resonance AND (‘imaging’/exp OR imaging))) AND (‘whiplash injury’/exp OR whiplash)

Cochrane library

(ligament* OR craniovertebral OR craniocervical OR (cervical spine) OR neck OR (Cervical Vertebrae) OR (Atlanto*Occipital)) AND (MRI OR (Magnetic Resonance Imaging)) AND whiplash

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Li, Q., Shen, H. & Li, M. Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders. Eur Spine J 22, 14–20 (2013). https://doi.org/10.1007/s00586-012-2490-x

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  • DOI: https://doi.org/10.1007/s00586-012-2490-x

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