WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

The evaluation process begins with a thorough medical history and physical examination. Particular attention is placed on the assessment of neck range of motion, spinal segment function, muscle function, reflexes and the evaluation of neck (cervical), trunk and extremity sensation. The attending physician will also evaluate for the presence of other conditions commonly associated with whiplash such as head trauma. The evaluation may include spinal X-rays to rule out a fracture and/or spinal segment dislocation. This portion of the workup may also include a computerized tomography (CT) scan of neck. An MRI may also be performed to further evaluate soft tissues of the neck such the intervertebral disc, ligaments, spinal cord, spinal nerve roots and the soft tissues surrounding the neck and upper back. The diagnosis of whiplash syndrome is based on a constellation of sign and symptoms. If there is no history of neck injury, whiplash is unlikely and therefore an improper diagnosis.

NATURAL HISTORY AND PROGNOSIS

Generally, the prognosis for individuals with whiplash is good. In mild cases, neck and head pain often resolves within a few days or weeks. Most patients recover within 3 months after the injury, however, residual neck pain, headaches, pain and numbness in the arms may persist with injuries causing disc herniation. The more extensive the injury, the longer it takes for recovery.

COMPLICATIONS

The complications associated with whiplash injury include:

• Spinal segment instability
• Disc herniation and associated spinal nerve compromise (radiculopathy)
• Chronic pain
• Limited neck mobility
• Accelerated spinal degeneration