Chadi Whiplash

8/7/2019 Chadi Whiplash

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Whiplash Injuries: Finite ElementStudy

Orthopeadic Chief Resident at Thomas Jefferson University Hospital and the RothInstitute Administrative and Academic Chief Resi2010-2011

Interest : Spine Surgery Medical Illustrations Medical education Medical Leadership Emergent Leader Physician

Enjoys Arts, Music, Martial Arts, Travel,Social Networking Contact: [email protected]

Chadi Tannoury, MD


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Clinical and Finite Element Analysis of Acute Whiplash

Chadi Tannoury, M.D. Thomas Jefferson University Hospital

& The Rothman InstituteS.P.I.N.E. Meeting Lebanon June 2010


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Acknowledgment

Alexander Vaccaro, MD* Jeffrey Rihn, MDFraser Henderson, MD*

William Wilson, BA*


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Disclosure

*Disclosure of Fina ncia l Interest The authors William A. Wilson, IV., Fraser C.Henderson, Sr., and Alexander R. Vaccaro hold anequity ownership interest in ComputationalBiodynamics, LLC., and are entitled to royalty

payments from the Spinal Cord Stress Injury Analysis(SCOSIA ) upon commercialization. Research relatedto potential Computational Biodynamics, LLC.

products, including early-stage research essential to thedevelopment of these products, has been conducted byindividuals who hold a financial stake in the successfuloutcome of that research .


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Whiplash

Acceleration Deceleration InjuriesMVA, Sports, Falls, etc..Symptoms: Range from mild neck painNeurologic sequelaeClassification:Spitze r Spin e 95


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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 OutcomeSterner J Sp ina l Disd Tech 03, Berglund Pa in


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Conclusion

Whiplash Associated Disorders I/II and WADIII are distinct entities

Patho-anatomy:

MSK injuries WAD I/IICord stretching injuries WAD III

Prognosis WADI/II: Chronic neck pain WADIII: Neurologic Sx are mostly recoverable


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Materials

March 2006 December 200731 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)


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Clinical Outcome Measures

Pain: VASNeurologic Status: ASIA scaleBrainstem Disability: BDI*Function: K.P.S and N.D.IQ.O.L: SF-36 Mental + Physical* All above (Except BDI) are validated & reliabl

*H enderson e t a l , Surgica l Neu rology In tern l In Press 2010


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Finite Element Assessment The analysis is based on different moduli of elasticity to white and gray matterSCOSIA Technology: Virtual Computation

Models the brainstem, C-spine, and upper T spinacord under dynamic loading and strainComputes predicted relative magnitude and locatioof stress within the Neuraxis

Current use of FEA is NON-Validated


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Finite Element Assessment

Performed on 2 representative patientsFEA: Measures Predicted Stress across Neuraxis

WADI/II vs. WADIII in Flexion WADIII: with DDD/Stenosis/Odontoid Retrof

Higher Predicted Stresses in Brainstem MedullaLow C-spine cord


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Pictures Flexion/Stress WAD I/II (5N/Cm2) WAD III ( 58N/Cm2)

C1

Brainstem

Brainstem

C3

C4


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Clivo-axial Angle CC strain Normal 150-165 degree Odontoid Retroflexion


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Results - Discussion

Day 0: WADI/II: Better + Higher (Neuro assessment,Functional Performance, QOL)

VAS scores were comparable12months:

Both Gps Improved: Neuro status + Disability Sx

WADIII: Sig Improvement QOL/Funct Recov WADI/II: Deterioration QOL/Functional status


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FEA

Predicted Higher Stress within Neuraxis:Pre-existing DDDOdontoid Retroflexion

Resulting Neuro-deficits: Mostly recoverable


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ClinicalOutcome

Measures

VAS ASIA BDI NDI KPS SF-36 P SF

Case0/12 mo

5.5/1.6 284/318 85%/36% 43/20 70/88 33/49 40/49

Control0/12 mo

6/4 324/324 15%/8.5% 53/27 86/85 55/45 55/54

P-values0/12 mo .1/. 001 .01/.01 0.001 .01/.01 .001/.01 .001/.05 .00


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Conclusion

Whiplash Associated Disorders I/II and WADIII are distinct entities

Patho-anatomy:

MSK injuries WAD I/IICord stretching injuries WAD III

Prognosis WADI/II: Chronic neck pain

WADIII: Neurologic Sx are mostly recoverable


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Conclusion

Our results are at variance with others whoreport that WADIII is persistent anddebilitating.

The WAD is not a continuum of one entitiy

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Chadi Whiplash