1. Page 1 Recording of this session via any media type is strictly prohibited. Page 1 Sore Back Boot Camp: Understand Evaluate and Defend Lee Wertz, Partner Harrison Bettis McFarland LLP Wednesday April 30

2. Page 2 Recording of this session via any media type is strictly prohibited. B. Lee Wertz, Jr. Partner, Harrison Bettis McFarland LLP His experience in civil litigation includes complex, multi-party commercial and residential construction disputes concerning construction and design defects, product failure and warranty claims, commercial litigation, products liability, personal injury defense and insurance coverage. Lee received his B.A. from Southwestern University in 1990, his J.D. from Baylor University in 1996 and was admitted to the State Bar of Texas in 1996. Lee is a frequent speaker on litigation and insurance issues

3. Page 3 Recording of this session via any media type is strictly prohibited. Minor Impact, Low Speed 1.Reinforce jury’s natural skepticism. 2.Not every accident can cause a herniated disc.

4. Page 4 Recording of this session via any media type is strictly prohibited. Natural Skepticism 1.It is not an injury. It is a condition. 2.Use the picture early and often.

5. Page 5 Recording of this session via any media type is strictly prohibited.

6. Page 6 Recording of this session via any media type is strictly prohibited.

7. Page 7 Recording of this session via any media type is strictly prohibited.

8. Page 8 Recording of this session via any media type is strictly prohibited.

9. Page 9 Recording of this session via any media type is strictly prohibited. Causes of Back Pain 1.Other Causes: Degenerative Changes 2.What CAN cause a herniated disc?

10. Page 10 Recording of this session via any media type is strictly prohibited.

11. Page 11 Recording of this session via any media type is strictly prohibited. Things To Look For On MRI Reports: Degenerative Changes

12. Page 12 Recording of this session via any media type is strictly prohibited. Degenerative Changes Hypertrophy of the right facet joints (black arrows). Osteophytes Dessication

13. Page 13 Recording of this session via any media type is strictly prohibited. Experts Radiologists Orthopedic Surgeons Biomechanical Engineers

14. Page 14 Recording of this session via any media type is strictly prohibited. Science

15. Page 15 Recording of this session via any media type is strictly prohibited. Hyperflexion + Axial Compression M.A. Adams & W.C. Hutton, Prolapsed Intervertebral Discs: A Hyperflexion Injury, 7 Spine 3, 184 (1982)

16. Page 16 Recording of this session via any media type is strictly prohibited.

17. Page 17 Recording of this session via any media type is strictly prohibited. Page 17 Textbooks

18. Page 18 Recording of this session via any media type is strictly prohibited. “… [I]t can be safely said that disc ruptures do not occur as the result of a single loading event, unless there are associated massive bony injuries to the spine. Alan Nahum, Accidental Injury: Biomechanics and Prevention (2001)

19. Page 19 Recording of this session via any media type is strictly prohibited. “… a causal relationship between an impact and rupture does usually not exist. Disc ruptures are generally the result of a slow degenerative process.” K. U. Schmitt, Trauma Biomechanics, (2004)

20. Page 20 Recording of this session via any media type is strictly prohibited. Page 20 Human Testing

21. Page 21 Recording of this session via any media type is strictly prohibited. “The subjects were exposed in 50 different experiments at average impact G of 3.25 to 9.02 for durations of.3 to.1 seconds. No permanent physiological changes were noted.” Albert Zaborowski, Human Tolerance to Lateral Impact With Lap Belt Only, (1964)

22. Page 22 Recording of this session via any media type is strictly prohibited. Eight volunteers were used in a series of twenty-five staged side impact collisions with impact speeds ranging from approximately 2 km/h to 10 km/h and impact configurations to the front, middle and rear side portions of the vehicle. Fugger, T., Randles, B., Wobrock, J., Welcher, J. et al., Human Occupant Kinematics in Low Speed Side Impacts, SAE Technical Paper 2002-01-0020, 2002

23. Page 23 Recording of this session via any media type is strictly prohibited. 3 subjects experienced minor soreness in the neck or back, not more than 24 hours in duration. One subject had complaints two days after tests, lasting only one day. Fugger, T., Randles, B., Wobrock, J., Welcher, J. et al., Human Occupant Kinematics in Low Speed Side Impacts, SAE Technical Paper 2002-01-0020, 2002

24. Page 24 Recording of this session via any media type is strictly prohibited. Page 24 Lumbar Discs

25. Page 25 Recording of this session via any media type is strictly prohibited. “…rear impact automobile collisions with delta V’s up to 9.3 m/s (20.7mph) do not produce much, if any, lumbar axial compression.” D. Gates, A. Bridges, et al, Lumbar Loads in Low to Moderate Speed Rear Impacts, SAE Technical papers 2010-01-0141, 2010.

26. Page 26 Recording of this session via any media type is strictly prohibited. Because the lumbar axial compression was small and significant axial compression is required to create damage to the intervertebral disc, it is unlikely that low to moderate speed impacts could cause significant damage to the lumbar discs.” D. Gates, A. Bridges, et al, Lumbar Loads in Low to Moderate Speed Rear Impacts, SAE Technical papers 2010-01-0141, 2010.

27. Page 27 Recording of this session via any media type is strictly prohibited. Page 27 Damaged Discs

28. Page 28 Recording of this session via any media type is strictly prohibited. “Severely weakened lumbar disc, with the posterior elements removed, could not be ruptured... Additional loads causing fracture of the vertebral body did not result in herniation or excessive bulging.” Paul Brinckmann, Injury of the Annulus Fibrosis and Disc Protrusions, 11 Spine 2, 149 (1986)

29. Page 29 Recording of this session via any media type is strictly prohibited. Analogy

30. Page 30 Recording of this session via any media type is strictly prohibited. Daily Living

31. Page 31 Recording of this session via any media type is strictly prohibited. Questions, Final Comments and Contact Information B. Lee Wertz, Jr. Harrison Bettis McFarland LLP 1415 Louisiana 37th Floor Houston, Texas 77002 713-843-7889 Direct lee.wertz@harrisonbettis.com @leewertzlaw