The Overlooked Significance of the Ponticulus Posticus in Whiplash Patients

Because of its anatomical complexity, the cervical spine is highly susceptible to injury, especially the blunt acceleration/deceleration trauma of which the most frequent mechanism, is “whiplash”, commonly referred to as Whiplash Associated Disorder (WAD). Despite this knowledge the significance and complexity of whiplash injuries are widely underestimated. This underestimation of the significance of this injury is the widely held belief that it is a benign self-limiting soft tissue injury that frequently has monetary gain attached. Estimates are that 10% of all spine injuries are related to WAD with 40% of these involving the Atlas (C1) and Axis (C2). This negative framing of the injury which has largely been shaped by the insurance industry rather than by clinicians frequently causes medical providers to view the injury with skepticism, despite estimates showing that approximately 50% of whiplash patients suffer chronic neck-related disability. Adding to the problem faced by clinicians are the more recently imposed guidelines for diagnosing and treating acute whiplash, especially in the area of imaging that has placed both the provider and the patient at increased risk.