Whiplash Injuries: Finite Element

Study
• Orthopeadic Chief Resident at Thomas
Jefferson University Hospital and the Rothman
Institute
• Administrative and Academic Chief Resident
2010-2011
• Interest:
• Spine Surgery
• Medical Illustrations
• Medical education
• Medical Leadership – Emergent Leader Physician

Chadi Tannoury, MD • Enjoys Arts, Music, Martial Arts, Travel,

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• Contact: chadi.tannoury@gmail.com
Clinical and Finite Element
Analysis of Acute Whiplash

Chadi Tannoury, M.D.

Thomas Jefferson University Hospital
& The Rothman Institute
S.P.I.N.E. Meeting – Lebanon June 2010
 Acknowledgment
 Alexander Vaccaro, MD*
 Jeffrey Rihn, MD
 Fraser Henderson, MD*
 William Wilson, BA*
 Disclosure
* Disclosure of Financial Interest
The authors William A. Wilson, IV., Fraser C.
Henderson, Sr., and Alexander R. Vaccaro hold an
equity ownership interest in Computational
Biodynamics, LLC., and are entitled to royalty
payments from the Spinal Cord Stress Injury Analysis
(SCOSIA © ) upon commercialization. Research related
to potential Computational Biodynamics, LLC.
products, including early-stage research essential to the
development of these products, has been conducted by
individuals who hold a financial stake in the successful
outcome of that research .
 Whiplash
 Acceleration – Deceleration Injuries
 MVA, Sports, Falls, etc..
 Symptoms: Range from mild neck pain 
Neurologic sequelae
 Classification: Spitzer Spine’ 95
 Whiplash – Classification:
 WAD I: Neck Pain – No Physical findings
 WADII: Neck Pain + TTP on P/E
 WADIII: Presence of Neurologic Signs & Sx
 WADIV: Injuries a/w Frx-Dislocations
Spitzer Spine’ 95

More severe injuries  Worse Outcome

Sterner J Spinal Disd Tech’ 03, Berglund Pain’ 06
 Conclusion
 Whiplash Associated Disorders I/II and WAD
III are distinct entities
 Patho-anatomy:
 MSK injuries  WAD I/II
 Cord stretching injuries  WAD III

 Prognosis
 WADI/II: Chronic neck pain
 WADIII: Neurologic Sx are mostly recoverable
 Materials
 March 2006 – December 2007
 31 Pts w Neck Pain s/p MVA-Falls-Sports inj..
 21 Pts WADI/II vs 10 Pts WADIII
 All Subjects:
 H&P (T0, T3, T6, T12 mo)
 Xrays, CT , MRI C-spine (T0, T12mo)

 Clinical Outcome Measures (T0, T3, T6, T12 mo)

 Litigaiton Claims (T12 mo)

 Clinical Outcome Measures
 Pain: VAS
 Neurologic Status: ASIA scale
 Brainstem Disability: BDI*
 Function: K.P.S and N.D.I
 Q.O.L: SF-36 Mental + Physical
* All above (Except BDI) are validated & reliable
*Henderson et al, Surgical Neurology Intern’l – In Press 2010
 Finite Element Assessment
 The analysis is based on different moduli of
elasticity to white and gray matter
 SCOSIA © Technology: Virtual Computation
 Models the brainstem, C-spine, and upper T spinal
cord under dynamic loading and strain
 Computes predicted relative magnitude and location
of stress within the Neuraxis
 Current use of FEA is NON-Validated
 Finite Element Assessment
 Performed on 2 representative patients
 FEA: Measures Predicted Stress across Neuraxis
 WADI/II vs. WADIII in Flexion
 WADIII: with DDD/Stenosis/Odontoid Retrof
 Higher Predicted Stresses in Brainstem – Medulla –
Low C-spine cord
 Pictures – Flexion/Stress
WAD I/II (5N/Cm2) WAD III ( 58N/Cm2)
Brainstem

C1
C3

Brainstem
C4
 Clivo-axial Angle – CC strain ε
Normal 150-165 degree Odontoid Retroflexion
 Results - Discussion
 Day 0:
 WADI/II: Better + Higher (Neuro assessment,
Functional Performance, QOL)
 VAS scores were comparable

 12months:
 Both Gps Improved: Neuro status + Disability Sx
 WADIII: Sig Improvement QOL/Funct’ Recov

 WADI/II: Deterioration QOL/Functional status

 FEA
 Predicted Higher Stress within Neuraxis:
 Pre-existing DDD
 Odontoid Retroflexion

 Resulting Neuro-deficits: Mostly recoverable

Clinical VAS ASIA BDI NDI KPS SF-36 P SF-36 M
Outcome
Measures
Case 5.5/1.6 284/318 85%/36% 43/20 70/88 33/49 40/49
0/12 mo
Control 6/4 324/324 15%/8.5% 53/27 86/85 55/45 55/54
0/12 mo
P-values .1/.001 .01/.01 0.001 .01/.01 .001/.01 .001/.05 .001/.001
0/12 mo
 Conclusion
 Whiplash Associated Disorders I/II and WAD
III are distinct entities
 Patho-anatomy:
 MSK injuries  WAD I/II
 Cord stretching injuries  WAD III

 Prognosis
 WADI/II: Chronic neck pain
 WADIII: Neurologic Sx are mostly recoverable
 Conclusion
 Our results are at variance with others who
report that WADIII is persistent and
debilitating.
 The WAD is not a continuum of one entitiy