2013 Issues   /   January 2013

Learning More About Spinal Injuries in Wounded Servicemembers

USM By U.S. Medicine
January 11, 2013

FORT SAM HOUSTON, TX –Even though spinal injuries can be extremely disabling for wounded servicemembers, exactly how the injuries occur and what damage they cause has not been fully understood.

A new study recently published in the Journal of Bone and Joint Surgery (JBJS) by a team of orthopaedic surgeons sought to answer those questions.1

Investigators reviewed more than eight years of data on back, spinal-column and spinal-cord injuries sustained by American military personnel while serving in Iraq or Afghanistan. The injuries were then categorized according to anatomic location, neurological involvement, cause of injury and accompanying wounds.

The authors noted that the analysis is important in helping orthopaedic surgeons develop treatment plans for wounded servicemembers and for severely injured civilians who sustain similar disabling injuries.

Researchers found that, of 10,979 evacuated combat casualties, 598 (5.45%) sustained a total of 2,101 spinal injuries, with explosions accounting for 56% of spine injuries, motor vehicle collisions for 29% and gunshots for 15%.

Nearly all of the injuries, 92%, were fractures, with 84% of patients sustaining their wounds during combat. The spinal cord also was damaged in 17% of injuries to the spine, with 53% of gunshot wounds also resulting in spinal-cord injury. The abdomen, chest, head and face often were also involved in a spinal-cord injury.

Most of the injured, 90%, were enlisted personnel, with an average age of 26.5 years.

“In these current military conflicts, the latest technologies in body armor, helmets, and other protective devices have helped save many soldiers’ lives,” said James A. Blair, MD, an orthopaedic surgery chief resident in the Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX. “We also have access to advanced lifesaving techniques in the field and medical evacuation strategies that are keeping many more servicemembers alive.

“But when a person survives an explosion or vehicle collision, there has still been a great deal of force on the body,” Blair added. “Many of those survivors are coming to us with severe injuries to their spine and back. We needed to describe and characterize these injuries so recommendations can be made on how to provide the most effective treatment and rehabilitation for our wounded warriors.”

While the survival rate for such injuries is high, so is the disability rate, the authors noted, calling for more research to improve outcomes for spinal injuries.

1. Blair JA, Patzkowski JC, Schoenfeld AJ, et al. Spinal Column Injuries Among Americans in the Global War on Terrorism. J Bone Joint Surg Am. 2012 Sep 19;94(18):e1351-9. PubMed PMID: 22992883.

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