Cervical sprain

The neck is made up of muscles, ligaments, fascia, intervertebral discs, and vertebrae. These structures have a support function, neck mobility, and protection of the spinal cord.

To show the cervical anatomy it is necessary to take into account two pillars and two segments:

• Anterior pillar: Vertebral bodies, intervertebral discs, anterior longitudinal ligament, posterior longitudinal ligament. 
• Posterior pillar:Posterior bony structures of the neural arch, facet joints and ligamentum fravum, interspinous ligament and supraspinous ligament, and musculature. 
• Upper segment (C1-C2): Provides mobility for flexion, extension, and rotations. 
• Lower segment (C3-C7): mobility in flexion, extension and rotations, as well as support and transmission of axial load. 

When the cervical spine is viewed from the front (anteroposterior view), a straight configuration is appreciated, but in lateral projection it presents a curvature with anterior convexity (lordosis), providing the spine with more harmonious and elastic mobility.

It should be noted that the area of the C4 and C5 vertebrae is one of the areas that suffer the most tension and, therefore, tends to become the level that leads to the greatest number of injuries.

When whiplash is produced by a mechanism of cervical hyperextension (backward neck) or hyperflexion (forward neck) the ligaments, muscles, and joint capsules can be elongated or overstretched and the annular fibers of the intervertebral disc can be compressed or ruptured. These strains to the neck structures sometimes lead to injuries that cause the symptoms of a cervical sprain.

Cervical sprain or neck sprain is the most frequent consequence of rear-end traffic accidents.

Cervical sprain (neck sprain)grades: 

The recovery time for a cervical sprain or neck sprain will depend on its severity. There are different degrees of this pathology. In order from least to greatest severity, they are as follows:

• Grade zero: The patient does not have neck pain. 
• Grade I: Mild pain in the neck and head may occur, which does not affect daily life. 
• Grade II: Cervical pain or moderate cervicalgia occurs, where the patient may have difficulties with cervical movement and pain at some points. 
• Grade III: The patient has a neurological injury. 
• Grade IV: This last link is diagnosed when there is a fracture or dislocation, usually caused by serious trauma. 

The main symptoms of cervical sprain are neck pain and painful limitation of cervical mobility ،which can evolve into cervical stiffness, accompanied by vertigo or dizziness. In cases where there is a rupture of the annulus fibrosus, the nucleus pulposus can herniate and compress a nerve root causing pain radiating to the arm and hand (cervicobrachialgia) or neurological alterations with abnormal sensations of tingling or changes in temperature (paresthesia).

Age, sex, and constitutional morphotype can determine a worsening of the symptoms. Two examples of this are the lower muscle mass of women or degenerative changes in the spine (cervical osteoarthritis) in people over 50-55 years of age, which can cause the pain to worsen and last longer

The symptoms can be established early but it is more frequent that they appear over the days. The duration of these varies depending on each case but it is common for some of the alterations to improve progressively over the course of weeks or months. In longer processes, a psychological discouragement can be implanted that leads to a depressive picture

Finally, when high-energy trauma occurs, more extensive tears can occur in the ligaments and joint capsules, leading to subluxations of the vertebrae or fractures of the vertebral bodies. These are more serious injuries that require urgent specialist review.

As in any other pathology, a detailed clinical history and a complete examination carried out by our traumatologists specializing in a cervical sprain in Madrid are required.

The following complementary diagnostic tests are usually necessary: 

Simple radiology: a posteroanterior, lateral projection is performed. Sometimes we also require an oblique and transoral projection. You can find: 

• Changes in the physiological curvature of the spine such as rectification of cervical lordosis, and cervical kyphosis. 
• Arthritic degenerative signs can exacerbate the clinical picture. 
• We must rule out subluxations or vertebral fractures that imply an urgent evaluation by a specialist. 

Magnetic Resonance: provides information on whether there is involvement in the soft parts of the neck (muscles, ligaments, joint capsules, or intervertebral discs). It is possible to discriminate if there is a structural compression of a nerve due to herniated disc, soft tissue inflammation, or edema in the vertebral bodies. 

Electromyography: studies through electrodes the functioning of peripheral nerves and the muscles to which they transmit stimuli. It suggests compression of the exit of a peripheral nerve, fundamentally due to a cervical hernia. When there is a compressive nerve injury, it is also used as a follow-up of the recovery from the compressive nerve involvement. 

Computerized axial tomography (CT): is a test that we use to evaluate alterations in the bone, such as fractures or dislocations. Provides multiple millimetre cuts in different axes (sagittal, coronal, and axial) and 3-dimensional reconstruction of the vertebral column. 

Vertiginous studies: when the patient suffers from vertiginous alterations or dizziness, evaluation with vestibular tests by the otorhinolaryngologist is necessary. 

It is important to make a clear differentiation of the different terms related to this pathology. 

Cervicalgia is a symptomatic concept and means cervical pain. The patient indicates it to us, and it does not correspond to a specific lesion. There is the possibility of suffering from chronic cervicalgia, which is pain that occurs continuously in the neck, head or surroundings. 

Whiplash indicates that a flexo-extension mechanism has occurred on the cervical spine, but does not allow a diagnosis of the injuries produced. Generally, the origin is post-traumatic from a car accident. When whiplash occurs and as a consequence cervical pain, neck stiffness or dizziness are experienced, it is very complex to distinguish which anatomical alteration has occurred and is causing the discomfort. 

The most common symptoms of a whiplash injury are mainly a stiff neck or dizziness. It is very complex to distinguish which anatomical alteration has occurred and is the cause of the discomfort. Cervical whiplash does not present sequelae in most cases, the patient will have to follow a treatment for his prosperous recovery. 

Another pathology that can lead to confusion is a cervical degenerative disc, which occurs when a disk in the spine is damaged, causing pain in the patient.

The patient's attitude in these types of processes is very important. The good spirit to overcome the symptoms and the patient's involvement in the recovery is a very important point to achieving rapid clinical improvement. 

When there are no serious injuries such as additional dislocations or cervical fractures, rest should be avoided or not exceed two days. Generally, the use of neck braces does more harm than good, since immobilization of the neck muscles can lead to wasting failure. We must try to lead a normal life, maintain the activities that we have been doing regularly, and gradually recover neck mobility.

If you have cervical or muscle contractures, the medical treatment used is with anti-inflammatories - analgesics and muscle relaxants. Likewise, the local heat acts by relaxing the muscles and increasing blood injection by vasodilation, helping to eliminate substances accumulated by soft tissue injuries such as histamine and prostaglandins. From the first week we can combine active progressive mobility exercises with physical rehabilitation.

If the process evolves into vertigo or dizziness, it may be necessary to use antivertigo drugs. If this situation continues, evaluation by the otorhinolaryngologist and/or neurologist is important to diagnose or rule out alterations that may have occurred in the vestibular system or in the nervous system.

Antineuritic drugs are only used in case of compression of a peripheral nerve, as can happen due to a cervical hernia that has also occurred in the context of a cervical sprain. These are clinical pictures that evolve with cervicobrachialgia, that is, neck pain and irradiation of pain through the arm or hand, accompanied by neuropathic alterations such as paresthesias, muscle atrophies or loss of strength.

The prolongation of the symptoms and the lack of progressive improvement sometimes lead to discouragement and depression in the patient, making psychological and/or psychiatric treatment necessary.

Come to our spine clinic in Madrid to receive the most innovative techniques in cervical sprain treatments.