Efficacy of open-door laminoplasty for cervical hyperextension injury accompanied with or without spinal cord-canal mismatch / 中华创伤杂志

Objective:To explore the clinical efficacy of open-door laminoplasty in treatment of cervical spinal hyperextension injury accompanied with or without spinal cord-canal mismatch.Methods:A retrospective case-control study was performed to analyze the clinical data of 42 patients with cervical spine hyperextension in Shanghai Ninth People’s Hospital，Shanghai Jiaotong University School of Medicine from January 2016 to June 2019. There were 31 males and 11 females at age range of 40-78 years［（59.7 ± 9.9）years］. All patients underwent open-door laminoplasty.Preoperative Japanese Orthopaedic Association score（JOA）was（10.2 ± 3.8）points，and American Spinal Injury Association（ASIA）spinal cord injury score was（260.4 ± 47.5）points. Those with spinal cord occupation rate（SCOR）equal to or more than 70% were classified as spinal cord-canal mismatched group（n=21），and those with SCOR less than 70% were classified as spinal cord-canal matched group（n=21）. ASIA total score，ASIA upper and lower limb motor scores，ASIA sensory score，JOA score，surgical improvement rates and complications were compared between the two groups before operation，at postoperative one week and at the latest follow-up.Results:All patients were followed up for 12-26 months［（19.1 ± 2.3）months］. Both groups had significantly improved ASIA total score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. The two groups showed no significant difference in ASIA total score at postoperative one week（ P > 0.05）. ASIA total score in unmatched group was（307.6 ± 9.9）points at the latest follow-up，significantly lower than that in matched group［（315.4 ± 8.7）points］（ P < 0.01）. ASIA upper limb motor score in mismatched group was（29.1 ± 7.0）points and（36.6 ± 6.5）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（42.0 ± 5.7）points，（47.4 ± 2.5）points］（ P < 0.01），while there was no significant difference in ASIA lower limb motor score and sensory score between the two groups（ P > 0.05）. Both groups showed significantly improved JOA score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. JOA score in mismatched group was（11.5 ± 3.0）points and（12.5 ± 3.0）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（13.5 ± 2.4）points，（15.0 ± 2.0）points］（ P < 0.01）. Postoperative improvement rate in matched group was 95%（20/21），and was 85%（18/21）in mismatched group（ P < 0.05）. Cervical axial pain occurred in 3 patients in each group and C 5 nerve root palsy in 2 patients in matched group，all of which were relieved after conservative treatment. No implant loosening or breakage occurred during follow-up. Conclusions:Open-door laminoplasty can improve part of the nerve function of patients with cervical hyperextension injury. However，the overall improvement degree of nerve function especially recovery of upper limb motor function in patients with spinal cord-canal mismatch is inferior to those in spinal cord-canal matched patients.

Whiplash Injury Mechanisms Of Car Rear Occupants: A Review

@#Whiplash injury due to low severity vehicles crash is a global problem. The injury has long-term clinical and biomechanical implications. Since the mid-1960s, injury statistics have continuously revealed that females face a higher risk of suffering the injury category compare to males. Besides, in a frontal crash, the injury measures from the adult rear dummies were mainly higher than the same size dummies located in driver and front occupant seat. However, most regulations and user crash tests have focused on vehicle drivers and front-seat passenger due to high occupancy and mortality rates in the front seat. In this paper, mechanisms of whiplash injury were reviewed to contribute a further inclusive understanding of human impact reaction, variability quantification, validation, and prevention. The objective of this study is to develop a new design of head restraint (HR) for car rear occupants. In order to raise consideration whiplash injury and prevention mechanisms, impacts are simulated with computer modelling (Ls-Dyna simulation) and validated using Matlab. Therefore, a review of these injury mechanisms indicates the development of new anti-whiplash technology in the automotive safety area is necessary.

Advance in Whiplash-associated Disorders (review) / 中国康复理论与实践

Whiplash-associated disorders usually appear as symptoms of neck pain, headache, and limited cervical spine activities, etc. Its mechanism is complicated, which is related with the sudden acceleration-deceleration mechanism conducted to the cervical vertebral joint, ligaments, muscles and nerves. Recently, it was found that low capacity of cerebrospinal fluid, fibromyalgia, and injury of central nervous system are also associated with those symptoms. The focus of exercise on equal length contraction and endurance of neck deep muscles can significantly improve the symptoms of patients without neurological injury. Ultrasound can be used to dynamically detect deformation and deformation rate patterns of both deep and shallow muscle in the exercise group and the conservative observation group. It is suggested that exercise can improve muscle movement patterns and repair damaged neck muscles at the same time.

Muscle activity during low-speed rear impact / 中华创伤杂志(英文版)

PURPOSE@#Whiplash associated disorders remain a major health problem in terms of impact on health care and on societal costs. Aetiology remains controversial including the old supposition that the cervical muscles do not play a significant role. This study examined the muscle activity from relevant muscles during rear-end impacts in an effort to gauge their influence on the aetiology of whiplash associated disorders.@*METHODS@#Volunteers were subjected to a sub-injury level of rear impact. Surface electromyography (EMG) was used to record cervical muscle activity before, during and after impact. Muscle response time and EMG signal amplitude were analysed. Head, pelvis, and T1 acceleration data were recorded.@*RESULTS@#The activities of the cervical muscles were found to be significant. The sternocleidomastoideus, trapezius and erector spinae were activated on average 59 ms, 73 ms and 84 ms after the impact stimulus, respectively, prior to peak head acceleration (113 ms).@*CONCLUSION@#The cervical muscles reacted prior to peak head acceleration, thus in time to influence whiplash biomechanics and possibly injury mechanisms. It is recommended therefore, that muscular influences be incorporated into the development of the new rear-impact crash test dummy in order to make the dummy as biofidelic as possible.

Audiología y Mareo de Origen Cervical / Audiology and dizziness of cervical origin

En la presente revisión sistemática se discute la relación entre la etiología del mareo de origen cervical, el uso de pruebas vestibulares y el rol del especialista en audiología en el abordaje de esta patología. La búsqueda de artículos se realizó a través de bases de datos electrónicas. Se usaron términos libres como mareo de origen cervical, vértigo cervicogénico, cervicogenic dizziness, dolor cervical, latigazo cervical y espondilosis cervical. La valoración de la calidad de los estudios incluidos se realizó con la guía de análisis crítico de calidad metodológica propuesta por (Carvajal C, 2004). Los resultados de la revisión muestran las evidencias etiológicas del mareo de origen cervical reportadas en la literatura y si el especialista en audiología, por su formación, puede abordar esta condición de acuerdo con los procedimientos hallados para su manejo actualmente. Las evidencias sugieren que la afectación de las estructuras musculo esqueléticas del cuello puede derivar en sensaciones de mareo. Adicionalmente, a partir de la revisión se concluye que, aunque la literatura no reporte el rol específico del especialista en audiología en el abordaje del mareo de origen cervical, es pertinente que este lo aborde desde su fase diagnóstica y de inter vención

This systematic review discusses the relationship between the etiology of cervical dizziness, the use of ear canal testing, and the role of the audiology specialist in approaching this pathology. An electronic database was used in researching articles that utilized open terminologies such as cervical dizziness, cervicogenic vertigo, cervicogenic dizziness, sharp cervical pain, and cervical spondylosis. The studies included were evaluated for quality by using the critical analysis guide of methodological quality. The results of the review show reported etiological evidence of cervicogenic dizziness in literature and whether an audiology specialist, through their training, is able to address and handle this condition in accordance with the most up-to-date procedures. The evidence suggests that the affectation of the musculoskeletal framework in the neck can be derived from dizziness symptoms. Additionally, it could be concluded from the review that although the literature does not report the specific role of the audiology specialist in approaching cervical dizziness, it is pertinent to address this role as early as the diagnostic and intervention phases

Advance in Prediction for Outcome of Cervical Whiplash-associated Disorders (review) / 中国康复理论与实践

@#Whiplash-associated disorders of the cervical vertebrae develop unevenly after the injury, and the recovery process is complicated and non-linear. It is important to identify factors related with poor recovery in the early stages, to select proper treatment and rehabilitation. However, there are too many prognostic factors related to the clinical outcome, while the Clinical Prediction Rules (CPR) are used to help decision-making. Now there are only Whiplash CPR, Assessment Tool for Whiplash Injuries Developed from A Prospective Observational Study and CPR-like Tool undergone the clinical trials.

The Effect of Soft and Rigid Cervical Collars on Head and Neck Immobilization in Healthy Subjects

STUDY DESIGN: Whiplash injury is a prevalent and often destructive injury of the cervical column, which can lead to serious neck pain. Many approaches have been suggested for the treatment of whiplash injury, including anti-inflammatory drugs, manipulation, supervised exercise, and cervical collars. Cervical collars are generally divided into two groups: soft and rigid collars. PURPOSE: The present study aimed to compare the effect of soft and rigid cervical collars on immobilizing head and neck motion. OVERVIEW OF LITERATURE: Many studies have investigated the effect of collars on neck motion. Rigid collars have been shown to provide more immobilization in the sagittal and transverse planes compared with soft collars. However, according to some studies, soft and rigid collars provide the same range of motion in the frontal plane. METHODS: Twenty-nine healthy subjects aged 18–26 participated in this study. Data were collected using a three-dimensional motion analysis system and six infrared cameras. Eight markers, weighing 4.4 g and thickened 2 cm² were used to record kinematic data. According to the normality of the data, a paired t-test was used for statistical analyses. The level of significance was set at α=0.01. RESULTS: All motion significantly decreased when subjects used soft collars (p<0.01). According to the obtained data, flexion and lateral rotation experienced the maximum (39%) and minimum (11%) immobilization in all six motions using soft collars. Rigid collars caused maximum immobilization in flexion (59%) and minimum immobilization in the lateral rotation (18%) and limited all motion much more than the soft collar. CONCLUSIONS: This study showed that different cervical collars have different effects on neck motion. Rigid and soft cervical collars used in the present study limited the neck motion in both directions. Rigid collars contributed to significantly more immobilization in all directions.

Whiplash Injury

STUDY DESIGN: Review of the literature. OBJECTIVES: To present an overview of current research on whiplash injury. SUMMARY OF LITERATURE REVIEW: There are controversies over the definition, symptoms, and treatment of whiplash injury. MATERIALS AND METHODS: Review of the relevant literature. RESULTS: Symptoms of whiplash injury caused by an acceleration-deceleration force may present as widespread pain involving the neck or trapezius muscles, the interscapular area, the shoulders and arms, or as suboccipital headaches. Accompanying symptoms may include neurologic symptoms such as sensory dysfunction, motor weakness, or deep tendon reflex loss; non-specific symptoms such as dysphagia, dizziness, visual disturbances, tinnitus, deafness, memory loss, or temporo-mandibular joint disorders; and psychological symptoms such as depression, acute stress syndrome, or fear avoidance. The most important factor that facilitates spontaneous resolution of whiplash injury, which is a self-limiting disorder, has been shown to be prevention of the acute-to-chronic pain transition. Yet in spite of this knowledge the efficacy of several treatment methods for whiplash injury remains controversial. CONCLUSIONS: The appropriateness of treatment for whiplash injury should be evaluated on the basis of up to date academic research on its diagnosis and natural history.

Usefulness of K-Point Injection for the Nonspecific Neck Pain in So-Called K-Point Syndrome

BACKGROUND: Shoichi Kokubun introduced his successful experience with local anesthetic injection at the occipital insertion of the sternocleidomastoid muscle in K-point syndrome. The purpose of this study was to evaluate the short-term and long-term effectiveness of K-point injection and investigate factors affecting treatment results. METHODS: K-point injection was performed in 58 patients with K-point syndrome at Yeungnam University Medical Center. The syndrome was associated with cervical whiplash injury in 10 patients and was of nonspecific origin in the rest. One milliliter of 2% lidocaine mixed with 1 milliliter of dexamethasone was injected in 50 patients and 2 milliliters of 1% lidocaine alone in the rest. Initially, the severity of local tenderness at the K-point and other tender points was examined and the degree of immediate pain relief effect was assessed within 1 hour after injection. Early effect within 1 month after the injection and current effect were evaluated in 27 patients using a modified Kim's questionnaire with regard to the duration of improvement, degree of improvement in pain and daily living activities, and satisfaction. RESULTS: Of the total 58 patients, 44 (75.8%) apparently had immediate pain relief after K-point injection. The only factor associated with successful immediate pain relief was the whiplash injury associated with traffic accident (TA). The early pain control effect was associated with the immediate effect. The current effect was associated with the early effect alone. Satisfaction with the K-point injection was related to early successful pain relief. CONCLUSIONS: K-point injection would be useful for early pain relief in nonspecific neck pain syndrome so called K-point syndrome, but not for current pain relief. Especially, it was very effective for early pain control in the whiplash injury associated with TA.

Whiplash Injury Analysis of Cervical Vertebra by Finite Element Method / 法医学杂志

Finite element method (FEM) is an effective mathematical method for stress analysis, and has been gradually applied in the study of biomechanics of human body structures. This paper reviews the construction, development, materials assignment and verification of FEM model of cervical vertebra, and it also states the research results of injury mechanism of whiplash injury and biomechanical re-sponse analysis of the cervical vertebra using FEM by researchers at home and abroad.

Whiplash syndrome and forensic approach. A case report / Síndrome de latigazo cervical y abordaje forense: reportaje de un caso

The same day as being involved in a traffic incident as a pedestrian hit by a car, a middle-aged woman accessed emergency medical care and was later discharged. After two days the patient returned to emergency with complaints of neck pain. X-rays were conducted was immobilized with a cervical collar. Since the pain persisted, she was examined a few days later by physiatry, where a limitation in the arc of motion of the neck was found and whiplash was considered a possibility. This type of cases related to chronic posttraumatic pain are relatively common in clinical consultation and represent a great challenge for physicians, mainly in the forensic field, since there are often many symptoms and very few signs to identify the damage. Therefore, a forensic doctor must recur to the clinical history and carefully examine the mechanism of injury and the evolution of the clinical presentation, in addition to calling on other disciplines such as orthopedics, physiatry, psychiatry and pain medicine to issue a definitive concept.

Una mujer de edad mediana sufrió un accidente de tránsito como peatón al ser arrollada por un automóvil, este mismo día recibió atención mediante el servicio médico de urgencias dándosele de alta posteriormente. A los dos días la mujer consultó nuevamente el servicio de urgencias por dolor cervical, le realizaron radiografías y le inmovilizaron con cuello ortopédico. Dada la persistencia de dolor cervical, días después fue valorada por fisiatría, donde encontraron limitación para arcos de movimiento del cuello y se consideró posible síndrome de latigazo cervical. Este tipo de casos relacionados con dolor crónico postraumático es relativamente frecuente en la consulta clínica y reviste un gran reto para los médicos, principalmente en el campo forense, ya que con frecuencia hay muchos síntomas y muy pocos signos que logren objetivar el daño. De esta manera, el médico forense debe recurrir a la historia clínica y escudriñar detalladamente el mecanismo de lesión y la evolución del cuadro clínico, además de pedir el concepto de varias disciplinas como ortopedia, fisiatría, psiquiatría y medicina del dolor, para emitir su concepto definitivo.

The Effectiveness of Infrared Thermography in Patients with Whiplash Injury

OBJECTIVE: This study aims to visualize the subjective symptoms before and after the treatment of whiplash injury using infrared (IR) thermography. METHODS: IR thermography was performed for 42 patients who were diagnosed with whiplash injury. There were 19 male and 23 female patients. The mean age was 43.12 years. Thermal differences (DeltaT) in the neck and shoulder and changes in the thermal differences (DeltadT) before and after treatment were analyzed. Pain after injury was evaluated using visual analogue scale (VAS) before and after treatment (DeltaVAS). The correlations between DeltadT and DeltaVAS results before and after the treatment were examined. We used Digital Infrared Thermal Imaging equipment of Dorex company for IR thermography. RESULTS: The skin temperature of the neck and shoulder immediately after injury showed 1-2degrees C hyperthermia than normal. After two weeks, the skin temperature was normal range. DeltaT after immediately injuy was higher than normal value, but it was gradually near the normal value after two weeks. DeltadT before and after treatment were statistically significant (p<0.05). VAS of the neck and shoulder significantly reduced after 2 week (p=0.001). Also, there was significant correlation between DeltadT and reduced DeltaVAS (the neck; r=0.412, p<0.007) (the shoulder; r=0.648, p<0.000). CONCLUSION: The skin temperature of sites with whiplash injury is immediately hyperthermia and gradually decreased after two weeks, finally it got close to normal temperature. These were highly correlated with reduced VAS. IR thermography can be a reliable tool to visualize the symptoms of whiplash injury and the effectiveness of treatment in clinical settings.

Complete Cervical Spine Fracture in Ankylosing Spondylitis Caused by Low Speed Motor Vehicle Collision

Cervical spine fracture can occur in patients with ankylosing spondylitis (AS) by even a minor trauma, which can lead to serious results. We report on the case of a 52-year-old male patient suffering from AS, who was admitted to our hospital with cardiac arrest due to fracture of the upper cervical spine without other organ injuries. A computed tomographic scan showed a cervical 2-3 level fracture and posterior dislocation of the upper cervical column. The patient was admitted to ICU, but died in hospital on day 3.

Postmortem MSCT Diagnosis of Whiplash Injuries in a Traffic Accident：A Case Report and Review of the Literature / 法医学杂志

A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway. He was found to have died after a respiratory and cardiac arrest at the scene. No sign of skin injuries was observed from the external inspection. The autopsy was not permitted by the family members because of the local culture. Multislice computed tomography (MSCT) was applied to the current case, showing dislocation of C3~4 cervical vertebrae with Ⅱ degree, C4 vertebral plate fractures, and spinal stenosis. Post-mortem MSCT confirmed the diagnosis as whiplash injuries. MSCT was verified to be effective in showing the severity of whiplash injuries, thus providing certain objective evidence for medicolegal expertise.

A Study of Impact on Head and Neck Using Human Volunteer Low-Speed Rear Impact Tests / 대한법의학회지

Whiplash injury in low-speed traffic accidents are not objectively verified by medical equipment, thereby creating scope for misuse, which has resulted in huge social losses worldwide. The aim of this study was to examine the influence of low-speed vehicular rear-impact collisions on middle-aged men, and to analyze the head and neck injury criteria for the symptomatic human volunteers. Data was examined from the results of 50 dynamic sled tests, originally performed by Hong et al. (2012). In the previous tests, 50 men aged 30~50 years were exposed to an impulse equivalent to a bumper-to-bumper rear collision under medical supervision, and no resulting whiplash injury was identified. In this study, for 6 subjects who experienced dull aches over their bodies, head injury criteria (HIC15) and neck injury criteria (N(km)) were calculated according to the accelerations, forces, and moments at the occipital condyle measured by motion capture system. Although there were no changes in magnetic resonance imaging findings in all subjects at the pre-/post-test orthopedic examination, 6 subjects revealed mild aches around the shoulder, back, or lumbar area, and their symptoms disappeared within 2 days. The head and neck injury criteria, HIC15 (3.086 +/- 2.942) and N(km) (0.077 +/- 0.064) were obtained, and the maximum HIC15 and N(km) were found to be significantly lower than the critical injury assessment reference values (HIC15: 700, N(km): 0.3). Moreover, even though 2 subjects were exposed to the same level of change of velocity (7.9 km/h), each N(km) was significantly different (0.179, 0.057). One can therefore conclude that N(km) can vary according to voluntary movements in the human subject.

Effect of Depressive Symptoms at Acute Stage on the Course of Disease Progression in Whiplash Patients

OBJECTIVE: To find out the effect of depressive symptoms at acute stage on the course of disease progression in whiplash patients. METHOD: Thirty-eight patients with neck pain after acute whiplash injury were enrolled. The patients were prospectively surveyed within 7 days after whiplash injury and followed up after discharge by telephone interview. Depressive symptoms, self-perceived disability from neck pain, and pain intensity were measured by Center for Epidemiological Studies-Depression Scale (CES-D), neck disability index (NDI), and visual analog scale (VAS), respectively. Depressive group was defined as CES-D scores more than 21. The correlation between duration of total treatment and CES-D score and other variables was investigated by calculating independent t-test, Pearson's correlation coefficient and linear regression analysis. RESULTS: The mean overall score of CES-D was 20.8+/-11.7 and 20 (52.6%) patients were classified as depressive group. Depressive group showed longer duration of total treatment (55.1+/-35.1 vs 38.9+/-16.4, p>0.05) and higher pain intensity after total treatment (37.0+/-21.3 vs 29.4+/-20.1, p>0.05) than non-depressive group, but statistical significance was not sufficient. Duration of total treatment was correlated with NDI score (gamma=0.454, p<0.01) and initial pain intensity (gamma=0.349, p<0.05), but not related with socio-demographic factors - age, gender, marital status - and CES-D score. CONCLUSION: Duration of total treatment was correlated with physical disability and initial pain intensity. Depressive symptoms at acute stage of whiplash injury was correlated with both of them. Depressive symptoms could affect the outcome of whiplash injury indirectly through pain intensity and physical disability.

Shaken baby syndrome.

A 35-day-old male infant with presumed shaken baby syndrome is reported. This first born child to mother educated upto middle school and father tailor by occupation was brought from a remote village 180 kms away from JIPMER. Poor feeding, focal clonic seizures were the initial symptoms. The fundus examination revealed fresh preretinal and vitreous hemorrhages. CT Brain showed right sided subdural hemorrhage with subarachnoid extension and midline shift. He had a normal platelet count and coagulation profile. The sensorium deteriorated and infant expired despite adequate ventilatory support.

Is the use of Digital Infrared Thermal Imaging Useful in Whiplash Injury?

OBJECTIVE: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. METHODS: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (deltaT) in lesion area(neck and shoulder) and also compared thermal difference (deltaT (2wk-I)) after pre- & post- treatment. RESULTS: Initial DITI was 34.28 +/- 2.90 on anterior neck, 34.29 +/- 2.98 on posterior neck, 33.42 +/- 2.93 on right shoulder shoulder (Lt), and 33.59 +/- 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 +/- 2.88 on anterior neck, 33.78 +/- 2.99 on posterior neck, 32.79 +/- 2.78 on right shoulder, and 33.05 +/- 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (deltaT (2wk-I)) was 0.68 +/- 0.45 on anterior neck, 0.51 +/- 0.36 on posterior neck, 0.63 +/- 0.32 on right shoulder, and 0.54 +/- 0.64 on left shoulder, and these result were statistically significant (p < 0.05). Thermal difference (deltaT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below deltaT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 +/- 0.78 and after 2 weeks was 3.6 +/- 1.21 the initial VAS of shoulder was 7.4 +/- 0.52 and after 2 weeks was 3.2 +/- 0.97. There was statistically significant (p=0.001). CONCLUSION: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.

Treatment of cervical whiplash injuries: a report of 88 cases / 中华创伤杂志

Objective To compare the efficacy of operation and non-operatlon in treatment of cervical whiplash injuries. Methods A retrospective sturly was carried out in 88 cases of cervical whiplash injuries, of whom 24 cases were treated with non-operation and 64 with operation. There were 44 cases treated via anterior approach and 20 via posterior approach. NNeural function was evaluated by using Frankh classifications and ASIA (American Spinal Injury Association) grades. Results All cases were followed up for 6-24 months, which showed that neural function was improved significantly in both operation and non-operation groups. However, the neural function was better improved in the operation group compared with the non-operation, with statistical difference. The anterior approach group had significantly better outcome in neural function than the posterior approach group (P<0.05). Conclusion Operation is a better method and anterior approach should be the choice of treatment for treatment of cervical whiplash injuries.