FPIT059
Free Paper (Infection + Trauma)
Long-Term Cervical MRI Changes After Whiplash-Associated Disorders: Twenty-Year Findings and Expectations at Thirty Years
Kota Watanabe1, Kenshi Daimon2, Morio Matsumoto1, Masaya Nakamura1
1Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan 2Department of Orthopedic Surgery, JCHO Saitama Medical Center, Eijiro Okada / Setagaya Okada Orthopaedic Surgery Clinic
Background: The long-term prognosis of whiplash- associated disorders (WAD) is generally considered favorable; however, objective longitudinal MRI data extending beyond two decades are limited. Whether WAD accelerates cervical degenerative changes or contributes to persistent symptoms later in life remains unclear.
Methods: This prospective longitudinal study compared cervical MRI findings and clinical symptoms over 20 years between an inception cohort of patients with WAD and asymptomatic controls. Baseline assessments were performed in 1995, with follow-up evaluations at 10 and 20 years. Cervical degeneration was graded using five MRI parameters: decreased disc signal intensity, anterior compression of the dura or spinal cord, posterior disc protrusion, disc space narrowing, and foraminal stenosis. Degenerative progression was defined as a one-grade or greater increase in any parameter. Longitudinal
symptom trends and their associations with MRI progression were analyzed.
Results: At 20 years, cervical degenerative changes were highly prevalent in both groups, with no significant difference between the WAD and control cohorts (95.1% vs 95.3%). The most frequently progressive findings were decreased disc signal intensity, anterior compression, and posterior disc protrusion, most commonly at the C5–C6 level. Neck pain and headache decreased over time in both groups, whereas shoulder stiffness increased, particularly among controls, consistent with age- related changes. By 20 years, differences in symptom prevalence between groups had largely disappeared, and a history of WAD was no longer a significant risk factor for neck pain. No significant correlation was identified between MRI degenerative progression and symptom worsening.
Conclusions: Cervical degenerative changes progress over time regardless of prior whiplash injury, and long-term symptoms appear to be driven primarily by aging rather than WAD history. Structural MRI degeneration showed no meaningful association with late symptom severity. The planned 30-year follow-up is expected to further distinguish normal aging from injury-related effects and to clarify whether functional outcomes diverge despite similar degenerative changes.