Citation

Schoenfeld AJ, Laughlin MD, McCriskin BJ, Bader JO, Waterman BR, Belmont PJ. Spine 2013; 38(20): 1770-1778.

Affiliation

Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e31829ef226

PMID

23759821

Abstract

Study Design: Retrospective analysis of a prospective dataset.Objective: Determine the incidence and epidemiology of combat-related spinal injuries for the wars in Afghanistan and Iraq.

Summary of Background Data: Recent studies have identified a marked increase in the rate of combat-related spine trauma among casualties in Afghanistan and Iraq. Limitations in these previous works, however, limit their capacity for generalization.

Methods: A manual search of casualty records stored in the Department of Defense Trauma Registry was performed for the years 2005-2009. Demographic information, nature of spinal wounding, injury mechanism, concomitant injuries, year and location of injury were recorded for all soldiers identified as having sustained combat-related spine trauma. Incidence rates were constructed by comparing the frequencies of spine casualties against Defense Manpower deployment data. Multivariate Poisson regression was employed to identify statistically significant factors associated with spinal injury.

Results: In the years 2005-2009, 872 (11.1%) casualties with spine injuries were identified among a total of 7,877 combat wounded. The mean age of spine casualties was 26.6. Spine fractures were the most common injury morphology, comprising 83% of all spinal wounds. The incidence of combat-related spinal trauma was 4.4 per 10,000, while that of spine fractures was 4.0 per 10,000. Spinal cord injuries occurred at a rate of 4.0 per 100,000. Spinal injuries were most likely to occur in Afghanistan [Incident rate ratio (IRR) 1.96, 95% CI 1.68, 2.28], among Army personnel (IRR 16.85, 95% CI 8.39, 33.84), and in the year 2007 (IRR 1.90, 95% CI 1.55, 2.32). Spinal injuries from gunshot were significantly more likely to occur in Iraq (17%) as compared to Afghanistan (10%, p = 0.02).

Conclusion: The incidence of spine trauma in modern warfare exceeds reported rates from earlier conflicts. The study design and population size may enhance the capacity for generalization of our findings.

Language: en