This is the first report published comparing penetrating with blunt spine injuries in U.S. servicemembers in Afghanistan and Iraq. High-velocity gunshot or shrapnel injuries to the spine entered into the Joint Theater Trauma Registry (JTTR) were included. Records were reviewed to find out more information such as demographics on the soldiers, mechanism of injury, location of injury, type of surgery done, and long-term injuries sustained.
This information is important to gather and analyze strictly from an historical perspective tracing trends and changes in wartime over the years. But more importantly, this type of analysis may help improve treatment for our injured soldiers who experience high-energy, penetrating injuries to the spine. Many of these wounds are extensive and cause multiple injuries that cannot be treated on the field of battle.
Although some servicemembers had both a penetrating and a blunt injury from improvised explosive devices (IEDs), only those individuals with one or the other were included in this study. Excluding patients with both types of spinal injuries allowed for a more direct comparison of one mechanism (blunt) to the other (penetrating). Injuries from C1 (top of cervical spine) down to the sacrum were included. Injuries to the coccyx (tail bone) were not included.
As the names suggest, a blunt injury occurs when the soldier is exposed to a blast from a bomb explosion. 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 to the spine injuring the spinal cord.
These are not typical injuries seen in the civilian sector but rather, specific to military war-time efforts in Iraq and Afghanistan. Men are affected more often than women because fewer women are in direct combat roles compared with men.
Surgery to decompress the spine is more common in penetrating injuries of 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. Current recommendations are to perform surgical decompression only when the servicemember is medically stable and does not have a complete spinal cord injury.
Neurologic recovery is less likely with penetrating spinal cord injuries. Both blunt and penetrating injuries often cause additional injuries to the head, face, chest, and abdomen. Of course, severing the spinal cord results in long-term paralysis. Death is a possibility but this database did not have information on the number of spinal cord injured-related deaths have occurred among US servicemen and women in the War on Terror.
Complications (mostly from surgery) affect up to 10 per cent of all servicemembers with spinal cord injuries. These include pneumonia, skin and wound infections, blood clots, and urinary tract infections.
The authors summarize by saying this study helped surgeons identify the two main mechanisms that contribute to spinal cord injuries in US servicemembers involved in Operation Iraqi Freedom and Operation Enduring Freedom. Understanding the need for surgery required by spinal cord injuries will help military medical personnel better plan for on-site triage, treatment, and transportation at the time of the injuries. Efforts to prevent long-term neurologic problems are another important outcome of this study.
They also saw from reviewing the records that surgeons involved in immediate care for these surgeons understandably do not chart details about the mechanism of injury and severity of bodily harm at the time of injury. Likewise, spinal cord injuries in servicemembers who die on the battle field go unreported. This means there is a loss of information that would otherwise be helpful in a retrospective (looking back) type of study like this one.