Whiplash Injury: Classification

Classification and severity of disorders in whiplash injury based on the Quebec Task Force, modified from Spitzer.

Severity Symptomatology
0
  • No cervical spine complaints*
  • No objectifiable failures
I
  • Cervical spine complaints: Pain, feeling of stiffness, hypersensitivity.
  • No objectifiable failures
II
  • Cervical spine complaints: Pain, feeling of stiffness, hypersensitivity, and.
  • Musculoskeletal findings: limitation of movement, palpatory (palpable) hypersensitivity.
III
  • Cervical spine complaints: Pain, feeling of stiffness, hypersensitivity, and.
  • Neurological findings: weakened or abolished muscle reflexes, paresis (paralysis), sensory deficits.
IV
  • Cervical spine complaints: Pain, feeling of stiffness, hypersensitivity, and.
  • Cervical spine fracture or cervical spine dislocation.

In addition, a distinction is made according to the duration of the complaint:

  • <4 days
  • 4 to 21 days
  • 22 to 45 days
  • 46 to 180 days
  • > 6 months (chronic)

* Cervical spine complaints refer to the cervical musculature (anterior cervical or posterior neck muscles) or the passive musculoskeletal system. Another classification used in Germany is the modified classification according to Erdmann (table below). Internationally, the classification and severity determination is increasingly based on the Quebec Task Force, modified according to Spitzer (see above). Classification and severity of disorders in whiplash injury, modified after Erdmann.

Criteria Grade 0(no trauma) Grade I(light) Grade II(medium) Grade III(severe) Grade IV(fatal)
Symptomatology
  • None
  • Pain in the muscles of the neck or cervical spine.
  • Possibly movement restriction of the cervical spine, usually after interval (“stiff neck“).
  • Pain in the muscles of the neck or cervical spine.
  • Possibly restricted movement of the cervical spine, usually without interval.
  • are possible:
    • Secondary insufficiency (weakness) of the neck muscles.
    • Pain in the floor of the mouth / interscapular area (scapular = shoulder blade).
    • Paresthesias (insensations) of the arms
  • Pain in the muscles of the neck or cervical spine.
  • Possibly restricted movement of the cervical spine, usually without interval.
  • are possible:
    • Primary insufficiency (weakness) of the neck muscles.
    • Pain in the floor of the mouth / interscapular area (scapular = shoulder blade).
    • Paresthesias (insensations) of the arms
    • Brachialgia (pain in the arm)
    • Brief initial unconsciousness
  • High paraplegia
  • Death in central regulatory failure
  • Usually at the scene of the accident
  • Bulbar brain syndrome (acute reversible loss of brainstem function).
Symptom-free interval – –
  • Frequent
  • Mostly > 1 hour
  • Max. 48 hours
  • Typical are 12 to 16 hours
  • Rarely
  • Mostly < 1 hour
  • Up to 8 hours possible
  • Is usually missing
  • Not present
Complaint duration – –
  • Mostly days to weeks
  • <1 month
  • Weeks to months
  • Often months
  • Rarely > 1 year
  • Mostly death at the scene
Bedridden – –
  • Usually not
  • Frequent
  • Very often
  • Permanently possible
Neurological status
  • Normal/unchanged
  • No failures
  • Possibly movement restriction of the cervical spine.
  • No failures
  • painful movement restriction of the cervical spine
  • Sensory and/or motor deficits
  • Tetrasymptomatic (paralysis of all four extremities).
  • Damage to vital medulla oblongata centers possible.
Morphology
  • No lesion
  • Distortion (sprain), stretching, straining of the cervical soft tissue mantle.
  • Distortion, stretching, straining of the cervical soft tissue mantle.
  • Possible joint capsule tears, vascular injuries (retropharyngeal hematoma/hematoma located behind the pharynx, muscle strains).
  • Distortion, stretching, straining of the cervical soft tissue mantle.
  • Over more than one segment
  • Possible are joint capsule tears, vascular injuries (retropharyngeal hematoma/hemorrhage located behind the pharynx, muscle strains)
  • Disc hemorrhage or rupture
  • Ligament rupture (torn ligament)
  • Vertebral body fracture
  • Luxation (dislocation)
  • Nerve, root, spinal cord lesion
  • Mark contusion
  • Possibly medullary transection
  • Damage to the medulla oblangata or the lowest brain stem.
  • Base of the skull and upper cervical fractures possible.
Cervical spine x-ray
  • Unchanged
  • Unchanged
  • Possibly newly appeared stiffness.
  • Possibly newly appeared stiffness.
  • Kyphotic (kyphosis = hump) kink
  • Slight instability
  • Fracture
  • Malposition
  • Unfoldability for functional images
  • Fractures with dislocations