• Rigmor Myran, John-Anker Zwart, Kjell Arne Kvistad, Mari Folvik, Stian Lydersen, Magne Ro, Astrid Woodhouse, and Oystein Petter Nygaard.
• Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. rigmor.myran@ntnu.no
• Spine. 2011 Jun 1; 36 (13): E862-7.

Study DesignCross-sectional study.ObjectiveTo evaluate the association between degree of signal changes in the alar ligaments on MRI with respect to pain and disability.Summary Of Background DataConflicting evidence exists whether areas of high-signal intensity in the alar ligaments on MRI are associated with pain and disability.MethodsA cross-sectional designed study of 173 subjects including a group with persistent whiplash associated disorder (WAD) Grade II after a car accident (n = 59), a group with chronic nontraumatic neck pain (n = 57) and a group without neck pain or previous neck trauma (n = 57). To assess pain and disability, all participants filled in the Brief Pain Inventory (BPI-intensity and BPI-interference), the European Quality of Life (EQ-5D and EQ VAS) and the Hospital Anxiety and Depression Rating Scale (HADS). High-resolution proton-weighted MR images in three planes were evaluated by two experienced neuroradiologists who were blinded to patient history and group allocation. The alar ligaments were evaluated according to a 4-point grading scale; 0 = low-signal intensity throughout the entire cross-section area, 1 = high-signal intensity in one third or less, 2 = high-signal intensity in one third to two thirds, and 3 = high-signal intensity in two thirds or more of the cross-section area.ResultsWith respect to BPI and HADS, the scores were highest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and lowest among controls. EuroQol scores were lowest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and highest among controls (P < 0.001). There was, however, no significant correlation between the alar ligament changes and measures for pain and disability.ConclusionThe previously reported assumption that changes in the alar ligaments detected on MRI are associated with pain and disability is not supported by this study. The diagnostic value and the clinical relevance of MR-detectable areas of high intensity in the alar ligaments remain questionable.

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