My brother came back from Iraq in a wheelchair no longer able to use the lower half of his body. They say he had a “penetrating spinal cord injury.” What is that exactly? Will he ever get the use of his legs back?

There are two basic types of spinal cord injuries most common among U.S. ground troops involved in the War on Terror: blunt and penetrating. As the names suggest, a blunt injury occurs when the soldier is exposed to a blast from a bomb explosion. In Iraq, most bomb explosions come from improvised explosive devices (IEDs) that are hidden along the roadside. For those soldiers inside an armored vehicle, the force of the blast throwing them against the inside of the vehicle can cause a concussive (blunt) spinal injury.

Penetrating injuries are more likely from gunshot wounds or schrapnel to the spine injuring the spinal cord. With penetrating injuries from gunshot, there is a greater chance for significant damage to the spinal cord as the bullet tumbles and spins, picking up speed and force before impact.

These are not typical injuries seen in the civilian sector but rather, specific to military war-time efforts in Iraq and Afghanistan. So information about treatment, effects of treatment, and prognosis are not exactly the same as for civilian spinal cord injuries. A recent study by the military is helping shed some light on what to expect for your brother.

High-energy, penetrating injuries to the spine from gunshot or blunt concussive force result in extensive wounds and multiple injuries. Soldiers are treated quickly on the field of battle but conditions are sparse with few supplies and limited medical personnel. Most seriously injured servicemembers must be evacuated to the nearest medical base that can provide needed services, including surgery.

Surgery to decompress the spine is more common in penetrating injuries of the spinal cord. Current recommendations are to perform surgical decompression only when the servicemember is medically stable and does not have a complete spinal cord injury.

Both blunt and penetrating injuries often cause additional injuries to the head, face, chest, and abdomen. Neurologic recovery is less likely with penetrating spinal cord injuries. Severing of the spinal cord usually results in long-term paralysis.

Rehab programs today combined with inflammation-fighting medications give our spinal cord injured patients a much better chance of some recovery from partial spinal cord injuries. Your brother’s prognosis will depend on the level and severity of injury as well as his attitude and efforts during the recovery process. Your interest, love, and support as a family member will continue to be a valuable tool for him during this time.