Nerve Root Injury without Disc Herniation
Cerebral Spinal Fluid (CSF) Compression of Nerves after Whiplash
Symptoms Objectified
In a recent paper by Yao et al (2018), the authors wrote, “In a vehicle collision, the torso of an occupant is constrained by the seat so that it moves along the collision direction, whereas the head that is not suitably supported lags behind. The lagging intro- duces rapid bending to the neck, called the whiplash motion, which results in whiplash-associated disorders (WAD).” (pg 416)
This mechanism of injury puts the ligaments, intervertebral discs and nerves of the cervical spine at risk of injury.
The authors continue by reporting, “The potential WAD sites in the neck include the facet joint, the intervertebral disc, the spinal ligament, the vertebral artery, the dorsal root ganglion (DRG) and the muscle” (pg 416) Understanding what portions of the spine can be injured and how to demonstrate them objectively takes specialized training and understanding of the anatomy of the spine.
The authors continue by writing, “The dorsal root ganglion (DRG) that is embedded in the foramen of the cervical vertebra can be injured during a whiplash motion. A potential cause is that whilst the neck bends in the whiplash motion, the changes of spinal canal volume induce impulsive pressure transients in the venous blood outside the dura mater (DM) and in the cerebrospinal fluid (CSF) inside the DM. The fluids can dynamically interact with the DRG and DM, which are deformable.” (pg 416)
This type of injury is often times associated with non-herniated intervertebral discs on MRI and takes a greater clinical awareness of injury to diagnose. It is critically important to be able to associate ALL symptoms to the mechanism of injury while understanding the effects of internal pressure on the nerves of the spine. It is this compressive injury that can lead to long lasting symptoms and chronic pain.
Finally, the authors conclude, “This indicates that the most hazardous condition for the DRG is the pulling process.” What this actually means is the client can have a traumatic nerve injury without VISIBLE compression of the nerve. Working with doctors that understand the biomechanics of neural tissue is critically important to achieving an accurate diagnosis, prognosis and treatment plan in relation to causally related injury in the absence of disc herniation.
Reference:
1. Yao, H. D., Svensson, M. Y., & Nilsson, H. (2018). Deformation of dorsal root ganglion due to pressure transients of venous blood and cerebrospinal fluid in the cervical vertebral canal. Journal of biomechanics.
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