Combat-Related Spine Trauma in the War on Terror

Most Americans are aware that the war on terror continues on the battlefields in Afghanistan and Iraq. Blast munitions meant to rip through armored vehicles during Operations Enduring Freedom and Iraqi Freedom continue to cause serious injuries among our military warriors. Military physicians are studying the types and effects of these injuries in order to help prevent them.

In this study, surgeons from the United States Army review the medical records of soldiers who were treated for spine injuries. They were specifically trying to determine the number and type of complications that developed around or during surgery. Spine injuries included different types of fractures based on location in the vertebrae (e.g., pedicle, spinous process, facet, transverse process) as well as ligament injuries and dislocations.

Soldiers are evacuated in helicopters and planes referred to as flying intensive care units (ICUs). Surgeons and nurses treat the soldiers while in the air evacuating from the field of battle to military hospitals. But there are many challenges as you can imagine. They have limited equipment to make a complete diagnosis. The evacuation process is complex and can delay treatment. And there’s really only so much that can be done to treat serious injuries even in a flying ICU.

Focusing on ways to minimize complications that occur before, during, and after surgery is one alternate way to aid our wounded warriors. As this studied showed, major and minor complications are fairly common. And multiple complications in many soldiers were typical.

Major complications occurred in nine per cent of the military spine injuries. Minor complications were reported in six per cent of the total. But the most significant finding was the high number (more than 30 per cent) of complications among the dismounted soldiers who had surgery. And 80 per cent of all complications occurred among the dismounted service members. Military personnel in vehicles when injured made up only 20 per cent of those who had complications with treatment.

Understanding the mechanism of injuries is also important when planning wartime strategies. For example, the data from this study showed that soldiers in armored vehicles suffered fewer and less serious injuries compared with those individuals who were unprotected walking on the ground. The idea behind dismounted troops in today’s war theatre is to “win hearts and minds” of the nationals (people living in those countries) whom we are protecting. But this strategy does expose our soldiers to the risk of blasts from exploding bombs.

The specific types of complications experienced weren’t that different from what happens among civilian patients with similar injuries. Infections, blood clots, urinary tract infections, cerebrospinal leak after surgery, and pneumonia were typical minor complications. Likewise, more serious problems such as failure of the wound to heal, injury to blood vessels or nerves during surgery, spinal cord injury, injury to the gastrointestinal tract, and even death were the same as reported in civilian studies following surgery for spine injuries.

In summary, findings can be summarized by three points. 1) Risk of complications is greater when surgery is required — no matter what type of injury has occurred. 2) Dismounted soldiers are at greater risk of injury and 3) complications of treatment are greater among troops on foot compared to those who are in armored vehicles. This last point was true for all types of injuries regardless of treatment provided (surgical or nonsurgical).

How will the military use this information? Protection of our troops is an important goal — whether on the ground, in armored vehicles, during transport following injury, or during and after surgery. Examining the type and number of complications associated with military spine injuries will help with decision-making in the Theater of Battle. Given these findings, the placement of troops on the ground in an unprotected fashion will require some additional thought and consideration by military strategists.