What Is a Non-Disc Spinal Ligament Injury?
A non-disc spinal ligament injury is damage to any of the ligaments between two vertebrae other than the disc itself. After a car accident it is the injury most likely to go unrecorded, because the test most patients receive, an MRI, is usually read and reported as a disc study. I see this pattern in records from across Charlotte, and it is the injury Dr. Jeffrey Cronk and I spend the most time explaining to patients and attorneys.
The Ligaments of a Spinal Motion Segment
Two vertebrae and the tissue between them form a motion segment. Counting paired structures separately, ten ligamentous structures hold a segment together: the disc annulus, the anterior longitudinal ligament, the posterior longitudinal ligament, the ligamentum flavum, the interspinous ligament, the supraspinous ligament, two intertransverse ligaments, and two facet joint capsules. Panjabi groups the spinal ligaments, the disc annulus, and the facet capsules together as the tissues that sustain subfailure injury (Panjabi, Eur Spine J 2006).
The disc is one of the ten. That count is the basis of Dr. Cronk's point that an MRI report limited to the disc addresses about a tenth of the segment's ligamentous structures. The arithmetic is anatomy. It is not a measured miss rate, and I do not present it as one.
The top of the neck is built differently. The craniocervical junction has its own specialized ligaments, including the alar and transverse ligaments, and a neurosurgical review notes that injury to these structures usually results in death or serious morbidity (Tubbs, J Neurosurg Spine 2011). The injuries in this post are the lower-energy, survivable ones in the rest of the spine.
What a Subfailure Injury Is
A ligament can tear completely, or it can be stretched past its elastic limit without rupturing. The second kind, a subfailure injury, is the one most relevant to a typical collision. Manohar Panjabi of the Yale Biomechanics Research Laboratory proposed a sequence linking it to chronic pain: the injury damages the ligament and the mechanoreceptors embedded in it, the damaged receptors send corrupted signals, muscle activation patterns change, and the abnormal loading on ligaments and facet joints persists and can become chronic pain. He also cited the poor healing capacity of spinal ligaments.
That paper is a hypothesis and was published as one. It organizes a large set of clinical observations into a plausible chain, but no study has confirmed each link in living patients. I use it to explain why a ligament injury could produce symptoms out of proportion to what a still image shows. I do not use it to tell a patient that their pain is proven to come from a ligament.
How These Injuries Are Found
A complete ligament disruption in severe trauma is often visible on MRI. In surgical cervical trauma cases, MRI sensitivity against what surgeons found ranged from 67% for the ligamentum flavum to 100% for the interspinous soft tissues (Goradia, AJNR 2007). MRI can also overcall these injuries. In 89 patients with spinal fractures, the specificity of MRI for posterior ligament injury ranged from 51.5% to 80.5% (Rihn, J Neurosurg Spine 2010).
Subfailure injuries are a different problem. The ligament can look intact on a still image yet allow too much motion when the segment moves. That is why the AMA Guides measure motion segment integrity only on lateral flexion and extension X-rays, and why my workup for a suspected ligament injury includes motion films once fracture has been ruled out.
What the Injury Means for Recovery
Whiplash recovery is often slow. The Bone and Joint Decade Task Force estimated that about 50% of people with whiplash-associated disorders still report neck pain a year after injury. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery, as did psychological factors after the injury, while few features of the collision itself were prognostic (Carroll, Spine 2008).
The task force did not sort patients by ligament status, so that 50% cannot be attributed to ligament injury. What it supports is narrower: persistent symptoms after whiplash are common enough that an incomplete workup has a real cost to the patient.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What is a non-disc spinal ligament injury?
A non-disc spinal ligament injury is damage to any ligament between two vertebrae other than the disc, such as the anterior or posterior longitudinal ligament, ligamentum flavum, interspinous or supraspinous ligament, intertransverse ligaments, or facet joint capsules. Dr. Justin Dick evaluates these injuries in car accident patients in Charlotte, NC.
How many ligaments hold two vertebrae together?
Counting paired structures separately, ten ligamentous structures hold a spinal motion segment together, and the disc annulus is one of them. A report that describes only the disc addresses one of the ten.
Can MRI show spinal ligament injuries?
MRI often shows complete ligament disruption in severe trauma, with sensitivity from 67% to 100% depending on the ligament in surgical cervical cases (Goradia, AJNR 2007). It is less suited to subfailure injuries, where the ligament may look intact on a still image but allow excessive motion.
What is a subfailure ligament injury?
A subfailure ligament injury is a stretch past the ligament's elastic limit without complete rupture. Panjabi proposed that these injuries damage embedded mechanoreceptors and alter muscle control, which may lead to chronic pain. That mechanism is a published hypothesis and has not been confirmed step by step in patients.
How long does neck pain last after whiplash?
About 50% of people with whiplash-associated disorders still report neck pain one year after injury, according to the Bone and Joint Decade Task Force (Carroll, Spine 2008). Higher initial pain and disability predict slower recovery.
Where can I get evaluated for a spinal ligament injury in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), evaluates spinal ligament injuries at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278. Call 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15(5):668-676. PMID 16047209. LinkEvidence tier: Hypothesis paper (mechanistic reasoning)
- Tubbs RS, Hallock JD, Radcliff V, et al. Ligaments of the craniocervical junction. J Neurosurg Spine. 2011;14(6):697-709. PMID 21395398. LinkEvidence tier: Narrative anatomical review
- Goradia D, Linnau KF, Cohen WA, Mirza S, Hallam DK, Blackmore CC. Correlation of MR imaging findings with intraoperative findings after cervical spine trauma. AJNR Am J Neuroradiol. 2007;28(2):209-215. PMID 17296981. LinkEvidence tier: Diagnostic accuracy cohort (31 surgical patients)
- Rihn JA, Yang N, Fisher C, et al. Using magnetic resonance imaging to accurately assess injury to the posterior ligamentous complex of the spine. J Neurosurg Spine. 2010;12(4):391-396. PMID 20367374. LinkEvidence tier: Prospective diagnostic accuracy cohort
- American Medical Association. Guides to the Evaluation of Permanent Impairment, Fourth, Fifth, and Sixth Editions.Evidence tier: Expert consensus (impairment rating guideline)
- Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force. Spine. 2008;33(4 Suppl):S83-S92. PMID 18204405. LinkEvidence tier: Best evidence synthesis (systematic review)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
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Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
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- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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