Spine Injuries Sustained by U.S. Military Personnel in Combat are Different From Non-Combat Spine Injuries

Abstract

Spine injuries are more prevalent among Iraq and Afghanistan veterans than among veterans of previous conflicts. The purpose of this investigation was to characterize the context, mode, and clinical outcomes of spine injuries sustained by U.S. military personnel in theater. Injury and clinical data from patients who sustained a spine injury in Iraq or Afghanistan between 2003 and 2008 were extracted from the Joint Theater Trauma Registry. Fischer's exact test was used to compare demographic variables between battle and nonbattle spine injuries. Two-sided t tests and univariate analyses were performed to analyze the association between injury context, mechanism, and severity with clinical outcome. A total of 307 patients sustained spine injuries in theater during the study period, and 296 had adequate data for analysis. Most injuries occurred in battle (69.6%), and these injuries were more likely to have an Injury Severity Score considered severe (44.7% vs. 20.0%; p < 0.001) or critical (13.6% vs. 5.6%; p = 0.0458). Blast was the most common mechanism of injury (42.2%) and was more likely to be blunt (81.6%) than penetrating (18.4%; p < 0.0001). Battle-associated spine injuries were most commonly caused by blasts, were more severe, and more likely to involve multiple spinal levels.