Loss of cervical lordosis from a car accident

Ross Hauser, MD

Can a car accident cause straightening of your cervical spine? According to clinical research and empirical evidence. Yes. Can the straightening of the cervical spine lead to a worsening or delayed development of whiplash-related symptoms. The answer is also yes. As you are reading this article, you likely have a problem with your cervical spine brought on by a whiplash-type injury. In most cases that injury was brought on by car accident or sports injury. You may have been told that your problems stem from the stretching of the cervical ligaments that is now allowing hypermobile or neck instability to occur. This neck instability can also lead to or worsen injury to the facet joint of the cervical vertebrae.

The Lordotic to Kyphotic curve

Let’s take a moment to look at the various curvatures of the neck. In the image below are x-rays of a lordotic curve (correct neck curvature) and the gradual loss of lordosis to a straightening or military curve, an eventual reverse curve or Kyphotic curve, and eventual reverse of the reverse curve the “S” curve signifying cervical spine instability.

The straight spine controversy

There is some controversy as to whether a straight spine or military neck cervical spinal alignment is the cause of a patient’s whiplash-associated problems following the injury. A paper published in The British Journal of Radiology (1) suggested “straightening of the C-spine alignment in MDCT (as seen in a multidetector (MDCT) CT scan) alone is not a definitive sign of injury. (However) Craniocervical instability has a straightening effect on the cervical alignment.”

What does this mean? It is a chicken or egg statement. The researchers are suggesting that people who suffer from whiplash injuries may have more of a worsening or onset of symptoms than others because their neck was already in a compromised shape. Such displayed above, they had a military or straight spine shape before the accident, and many of those people had no previous neck-related symptoms. In other words, some people may be walking around with loss of their cervical curve and it is completely asymptotic. That is until something happens to them.

Some people may be walking around with loss of their cervical curve and it is completely asymptotic. That is until something happens to them.

As we see at our center and as noted in many research papers including this paper published in March 2020 in the Journal of Spine Surgery, (2) from which we will quote: “The cervical spine takes one of five distinct sagittal (the line that separates the body in left and right parts or considered the “side” view) profiles—lordosis, neutral, kyphosis, S-shaped, and inverted S-shaped. Whether or not lordosis should be the expected finding in the cervical spine is still under question. Several studies have investigated the cervical spine alignment in asymptomatic subjects and have found that significant proportions did not have lordotic cervical spines.” To reiterate, in other words, some people may be walking around with loss of their cervical curve and it is completely asymptotic. That is until something happens to them.

In this image, we see the reversal of the cervical lordosis and the characteristic disc narrowing of disc thinning at the C3-C4, C4-C5, and C5-C6.

Traumatic reversal of cervical lordosis

In stories, we hear from people, those diagnosed with craniocervical instability following a car accident that caused the whiplash-associated reversal of cervical lordosis, are the stories that suggest something was already going on in their neck and the car accident was the “final straw.” The person will tell us about a head-on car accident that initially did not cause them any problems at all. They in fact felt fine and had no symptoms, then as a year or two passed their symptoms became progressively worse. Further testing revealed hEDS and joint hypermobility (please see my article Whiplash injury in the Ehlers-Danlos Syndrome patient for more discussion). Clearly, these people had asymptomatic neck issues which were now made symptomatic because of the whiplash.

Of course, there are also stories from people who have a long history of neck problems and their car accident/whiplash injury turned occasional neck pain, dizziness, vertigo, and radiating pain into a daily event. There are those people who report numerous whiplash injuries and cannot even remember if they had neck issues before the first of the whiplash injuries or not. What they do know is that they are getting a lot of injections and adjustments and nothing seems to be helping them.

Then there are the people whose car accident was the clear onset of traumatic reversal of their cervical lordosis. They tell the story of a bad whiplash that reversed their cervical spine lordosis. Along with this injury came the new onset of symptoms of headaches, vertigo, vision problems, anxiety, blood pressure problems, and other neurologic and cardiovascular-like symptoms.

Angles and tilt

The loss of cervical lordosis and the symptomology it can cause can be understood and expressed in the understanding of degrees and angles. In the illustration below we see the various measurements and “landmarks” that help doctors and patients understand their cervical spine instability.

The significance of cervical sagittal alignment in people who did not recover well or at all from a whiplash injury

A paper in the Spine Journal (3) examined the significance of cervical sagittal alignment in people who did not recover well or at all from a whiplash injury and found the existence of an association between the constitutional (the functioning) sagittal alignment of the cervical spine and the outcome after whiplash injuries. This is what the study authors wrote:

“Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables (the change of the angle of the cervical spine as in lesser angle degree manifest as straightening or loss of lordosis) are suggested to have constitutional (impacting the neck and the whole body) characteristics, that is, them being minimally influenced by body positioning (the neck curvature has become its own world, the movements of the body no longer impact a neck with significant curve problems). However, the association between these variables and pain conditions remains poorly understood.” What these researchers did then was to examine all these factors to see if they could figure out what type of problems the curvature of the cervical spine could create in whiplash victims. What they found was “the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.” In other words, the curvature of the cervical spine is a factor in if patients would recover from a whiplash injury.

Treatment of Whiplash associated disorders

At our center, we see many patients with chronic whiplash symptoms. They usually have taken a long medical journey bouncing from one clinician to another looking for answers to problems that seemingly evade all treatments. In this article, we will present our clinical findings and observations on how the treatment of cervical ligament damage may be the answer that has eluded them. To continue on with this discussion, please see my article Treatment of Whiplash associated disorders.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Whiplash associated disorders, Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain. . . Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

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References

1 Linsenmaier U, Deak Z, Krtakovska A, Ruschi F, Kammer N, Wirth S, Reiser M, Geyer L. Emergency radiology: straightening of the cervical spine in MDCT after trauma—a sign of injury or normal variant?. The British journal of radiology. 2016 May;89(1061):20150996. [Google Scholar]
2 Teo AQ, Thomas AC, Hey HW. Sagittal alignment of the cervical spine: do we know enough for successful surgery?. Journal of Spine Surgery. 2020 Mar;6(1):124. [Google Scholar]
3 Rydman E, Elkan P, Eneqvist T, Ekman P, Järnbert-Pettersson H. The significance of cervical sagittal alignment for nonrecovery after whiplash injury. The Spine Journal. 2020 Aug 1;20(8):1229-38.