Study Design: A prospective 1-year follow-up study of whiplash patients presenting with neurological signs/or
symptoms (WADIII), and whiplash patients with neck pain but no neurologic findings (WADI/II).
Objective: We hypothesize that WADI/II and WADIII are distinct entities, with regards to clinical presentation,
pathoanatomy, and prognosis.
Summary of Background Data: symptoms associated with whiplash injury range from mild neck pain (WADI/II), to
injuries associated with neurologic sequellae (WADIII). To date, literature considers whiplash associated disorders
(WAD) a single clinical and pathologic entity, with different grades of severity (WADI-IV).
Methods: Thirty one subjects were divided into a WADIII study group and a WADI/II comparison group. All subjects
underwent H&P, radiographic evaluations, and clinical outcome measures (collected at 3, 6, and 12 months). Statistical
analysis was performed (Student T-test, Wilcoxon Signed-Rank test) with significance set at p=0.05. A finite element
analysis (FEA) technology (SCOSIA©) was used to predict stresses within the neuraxis.
Results: At day 0: Better neurologic assessments, functional performances, and higher quality-of-life measurements were
noted in WADI/II compared to WADIII. VAS scores were comparable.
At 12 months: Both groups reported improvements in neurologic status and disability symptoms. However functional
recovery and quality-of-life measures significantly improved in WADIII, and conversely deteriorated in WADI/II along
with notable worsening of pain symptoms. Litigation claims were comparable. FEA predicted higher stress within the
neuraxis of WADIII, notably in subjects with preexisting stenosis and odontoid retroflexion.
Conclusion: WADI/II and WADIII are distinct entities. Musculoskeletal injury precipitates WADI/II pain symptoms
while neuronal stretching leads to WADIII neurologic injuries, which are mostly recoverable.
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