Advances In Orthopedics February 28, 2018; No. 4765050

Nobuhiro Tanaka, Kivanc Atesok, Kazuyoshi Nakanishi, Naosuke Kamei, Toshio Nakamae, Shinji Kotaka, Nobuo Adachi: From Hiroshima University, Hiroshima, Japan, and the University of Alabama, Birmingham, AL, USA. This study cites 23 references.


Whiplash Associated Disorders (WAD) have long been recognized as a multifaceted set of conditions resulting from neck trauma, often associated with auto accidents, sports injuries, physical abuse, or other traumatic incidents. Over the years, the understanding of WAD has evolved, encompassing a broader spectrum of symptoms beyond the initial manifestations. This article delves into the intricacies of WAD, examining its historical context, classification, neurological symptoms, and the diverse array of manifestations that can arise from this complex syndrome.

Historical Context:

The initial 1995 Quebec Task Force on Whiplash Associated Disorders set the stage by defining a range of symptoms, including neck pain, headaches, dizziness, numbness, visual disturbances, and more. Recent expansions of WAD now include conditions such as cerebrospinal fluid hypovolemia and fibromyalgia, broadening the scope of the syndrome to encompass a wider array of symptoms.

Understanding Traumatic Cervical Syndrome:

  • Traumatic Cervical Syndrome Definition:
  • Traumatic cervical syndrome is defined as the biological and neurological consequences for the cervical spine and nervous system caused by neck trauma. It comprises various symptoms affecting the motor and nervous systems, as well as mental, neurological, otological, and visual balance dysfunction.
  • Causes of Whiplash:
  • Whiplash injuries can occur in various scenarios, with most incidents arising from rear-end auto accidents. However, sports accidents, physical abuse, or other traumatic events can also lead to these injuries.
  • Invisible Nature of Symptoms:
  • Notably, whiplash symptoms may manifest in the absence of visible injuries, making it challenging to diagnose and treat effectively.

Classification of Whiplash Associated Disorders:

  • Quebec Classification:
  • The Quebec Classification of Whiplash Associated Disorders categorizes injuries into four grades based on clinical presentation, pathology, and timing of symptoms.
  • Neurological Symptoms:
  • Neurological symptoms after a whiplash injury encompass a wide range, including headaches, cognitive and psychological symptoms, dizziness, visual symptoms, paresthesias, weakness, and rare manifestations such as torticollis and tremor.

Factors Influencing the Extent of Injury: 

Various factors, including vehicle speed, impact direction, use of safety equipment, and the prior state of the victim’s cervical spine, influence the extent and location of the injury.

Specific Injuries and Time Lag in Symptom Onset:

  • Muscle, Disc, and Joint Injuries:
  • Injuries may occur to muscles, intervertebral discs, and facet joints, while neurological injuries may affect the dorsal root ganglion, vertebral artery, and sympathetic nervous system.
  • Time Lag in Symptom Onset:
  • A time lag in symptom onset is observed, often explained by synovitis of the facet joints. This delayed manifestation leads to neck pain and limited range of motion several hours or days after the accident.

Prognosis and Long-Term Effects:

While many patients recover within weeks or months, a significant percentage may experience prolonged symptoms, with 20-40% reporting ongoing neck pain and headaches for several years. Long-term effects may include abnormally prolonged arthritis, cervical nerve root irritation, vestibular reflex abnormalities, and other complications.

Symptoms and Their Variability:

Symptoms such as dizziness, tinnitus, headache, memory loss, swallowing difficulties, and temporomandibular joint pain can appear across different grades of WAD, highlighting the variability of manifestations.


In conclusion, the landscape of Whiplash Associated Disorders is intricate, encompassing a diverse array of symptoms that extend beyond the traditional understanding of neck trauma. The evolving comprehension of WAD, its classifications, and the myriad neurological symptoms underscore the need for a nuanced and comprehensive approach to diagnosis and treatment. As research continues to uncover the underlying mechanisms and variability in symptom presentation, healthcare professionals are better equipped to address the complexities of traumatic cervical syndrome and provide tailored interventions for those affected.