The spine journal : official journal of the North American Spine Society
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To evaluate the effect of critical time periods in vehicle protection on spine injuries in the Global War on Terror. ⋯ The incidence of spine fractures and SCI is significantly higher in dismounted operations. The data suggest that current uparmored vehicles convey greater protection against spinal fracture compared with dismounted operations in which servicemembers are engaged on foot, outside their vehicles. The TL junction is at greatest risk for spine fractures sustained in mounted and dismounted combat operations. Recently, the incidence of TL fractures, especially severe fractures, has significantly increased in mounted operations. Although there has been an increased incidence of TL spine fractures, in context of the number of servicemembers deployed in support of Operation Enduring Freedom/Operation Iraqi Freedom, these severe fractures still represent a relatively rare event.
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The severity and prognosis of combat-related injuries to the spine and spine injuries sustained unrelated to direct combat have not been previously compared. Differences may have implications on tactics, treatment strategies, and directions for future research. ⋯ Battle spine injury and NBSI are separate entities that may ultimately have disparate long-term prognoses. Nonbattle spine injury patients, although having similar MOIs compared with civilian spinal trauma, maintain a different patient demographic. Further research must be directed at accurately quantifying the long-term disabilities of all spine injuries sustained in a combat theater, whether they are the result of battle or not.
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To assess the presence of complications associated with spine injuries in the Global War on Terror. ⋯ Patients treated with surgery appear to be at increased complication risk regardless of the mechanism of injury. Uparmored vehicles may safeguard servicemembers from spine injuries and complications associated with their treatment. This may be reflective of the fact that less severe spinal and concomitant injuries are sustained in the precipitating trauma because of the protection afforded by the vehicle. Dismounted soldiers had more complications in all groups regardless of type of management or injury mechanism.
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Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts.
The most common location for burst fractures occurs at the thoracolumbar junction, where the stiff thoracic spine meets the more flexible lumbar spine. With our current military conflicts in Iraq and Afghanistan, we have seen a disproportionate number of low lumbar burst fractures. ⋯ Low lumbar burst fractures are the predominant combat-related spine injury in our current military conflicts. The rigidity offered by current body armor may effectively lower the transition zone that normally occurs at the thoracolumbar junction, thereby, transferring forces into the lower lumbar spine. Increased awareness of this fracture pattern is warranted by all surgeons because of unique clinical challenges associated with its treatment. Although the incidence is increased in the military population, other surgeons may be involved with long-term care of these patients on completion of their military service.
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Musculoskeletal disorders of the spine in the US military account for the single largest proportion of the absence of sickness causes leading to early termination. We explored if selected psychological and physical factors were associated with poor outcome after episodes of low back pain (LBP). ⋯ The findings that fear-avoidance beliefs were predictive of subsequent work status among active duty service personnel in this study population (after adjusting for clinical, demographic, and psychological covariates) suggest the clinical utility of addressing these factors during treatment of back pain episodes in the military. These findings reflect the important role that psychological factors may play in the return to work process in an active duty military population.