Purpose: The multitude of symptoms after a whiplash injury have caused a lot of discussion because of the lack of objective radiologic findings. However, in such a trauma the ligaments that stabilize the cervical spine and the skull to the spine can be injured. These injuries can seldom be seen on static radiographs but pathological motion patterns caused by the injury of these ligaments can be detected on functional kine MRI.

Methods and results: Thirty consecutive patients who had had a whiplash trauma and were clinically supposed to have a problem at the level of C0–C2 were included in the study. The control group consisted of age and sex matched healthy persons. Images of four patients were missing.

The imaging was performed with Philips Gyroscan Intera 1.5 T magnet. A manual therapist performed the bending and rotation of the upper cervical spine to the patients and controls to ensure that the movements were limited to the C0–C2 levels.

The analysis was made blinded and was done by one radiologist. The movement of the dens and the signal of the alaria ligaments were analysed.

Of the 26 patients, 11presented with a normal movement of the dens, whereas 15 presented with a pathological movement. Among controls we could see a normal movement in 24 individuals and pathological in 6 individuals.

Only one patient presented with a normal signal and a normal movement, whereas 20 controls presented with a normal signal as well as normal movement.

Conclusion: Functional kine MRI is a reliable method to find ligament injuries and movement disturbances between C0 and C2.

Introduction: Infliximab, a monoclonal antibody against tumour necrosis factor alfa (TNFα) has been used succesfully in the treatment of rheumatoid arthritis and Crohn’s disease. Recent animal studies suggest that TNFα also has an important role in the pathogenesis of sciatica. The purpose of this study was to evaluate the efficacy and safety of infliximab in the treatment of sciatic patients.

Methods: 10 patients with acute or subacute severe sciatica (duration of symptoms from 2 to 12 weeks) were included. A disc herniation corresponding to symptoms was confirmed by MRI in each case. Patients with previous back operation or with contraindications for infliximab were excluded. A dose of 3 mg/kg body weight of infliximab in saline was infused intravenously over 2 hours. Leg pain (100-mm Visual Analog Scale) was recorded before and one hour after the infusion, and later at 1 week, 2 weeks, 1 month, 3 months and 6 months. Changes in leg pain were compared statistically with 62 historical controls (saline group in a study of periradicular infiltration) using repeated measures analysis of variance. Changes in back pain, back-related disability on Oswestry Index and clinical status were also assessed.

Results: Mean (SD) leg pain before the infusion was 80 (18) mm in the infliximab group. One hour after the infusion, there was a decrease of 49% in leg pain. At 1 week mean leg pain was 26 (21), at 2 weeks 19 (20), at 1 month 18 (19), at 3 months 10 (16) and at 6 months 13 (8). When compared with the historical controls, the difference was in favour of infliximab for leg pain (19 mm; 95% CI, 6 to 32, P=0.005) and for back-related disability on Oswestry (12%; 95%CI, 4 to 20, P=0.003) over the 6 month follow-up period. At the one-month follow-up every patient in the infliximab group had returned to work compared to 38% of control patients (P=0.02). None of the patients treated with infliximab underwent surgery during the follow-up compared to 14 (23%) in the control group (P=0.09). No immediate or delayed adverse drug reactions were observed.

Conclusions: According to this study, a single infusion of infliximab seems to provide immediate, highly effective and safe treatment of sciatica through 6 months. Rapid return to work appears to be fascilitated, and surgery may possibly be avoided in some patients. There is an urgent need for a randomized trial to verify these results.