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400.000 rear-end collisions occur in Germany every year. In approximately 4000 cases traumas in the cervical spine area arise, out of which there are 2000 cases where lasting damage can be proven.

The patient in this case sustained in June 2005 a considerable whiplash injury. A MRI examination carried out 4 weeks after the accident had shown a bone bruise in the area of C2 and C3 on the left. An appraisal of the ligamenta alaria and the ligamentum transversum was not possible at this examination.

Due to persistent serious problems, functional MR imaging in the Upright™ MRI was carried out a year later to look for a possible lesion of the ligament alaria or the lig. transversum.

Functional Imaging in the natural weight-bearing state
Coronar images, sitting, bending left, neutral, bending right.
By means of the functional imaging in natural weight-bearing state, the lig. alaria and the lig. transversum can be reliably assessed and a rupture roled out here.
Transverse images, sitting, head rotated left, head neutral, head rotated right.
In the functional image with the head rotated, the contact of the capsuloligamentous structure with the spinal cord was noticeable.

The diagnosis:

By the mean of the diagnosis, upright in the natural weight-bearing state in Upright™ MRI, no evidence was found by analysis of the cervicooccipital junction of a lesion of the lig. alaria, however a subluxation condition of the right vertebral joint between C1 and C2 with an indicated wedgeshaped vertebra form as a moderate effusion formation were found. This indicated the presence of a capsule irritation caused by trauma with the result of a capsule dilatation, which finally explains the now existent subluxation and dilatation of the joint cavity.

Furthermore a very small distance was to be found between the lig.transversum and the spinal cord, in particular in the rotation position and can be considered as an indication that in whiplash injuries with rotation components, a cervical-spinal cord syndrome and/or a cervicocephal syndrome can occur through the impact of the spinal cord in the area of the dens axis.