title: Spinal column injuries among Americans in the global war on terrorism.
abstract: BACKGROUND
  While combat spinal injuries have been documented since the fourth century BC, a comprehensive analysis of such injuries has not been performed for any American military conflict. Recent literature has suggested that spinal injuries account for substantial disability in wounded service members.
  
  
  METHODS
  The Joint Theater Trauma Registry was queried to identify all American military personnel who sustained injuries to the back, spinal column, and/or spinal cord in Iraq or Afghanistan from October 2001 to December 2009. Spinal injuries were categorized according to anatomic location, neurological involvement, mechanism of injury, and concomitant wounds.
  
  
  RESULTS
  Of 10,979 evacuated combat casualties, 598 (5.45%) sustained 2101 spinal injuries. Explosions accounted for 56% of spinal injuries, motor vehicle collisions for 29%, and gunshots for 15%. Ninety-two percent of all injuries were fractures, with transverse process, compression, and burst fractures the most common. Spinal cord injuries were present in 17% (104) of the 598 patients. Concomitant injuries frequently occurred in the abdomen, chest, head, and face.
  
  
  CONCLUSIONS
  The incidence of spine trauma sustained by military personnel in Iraq and Afghanistan is higher than that reported for previous conflicts, and the nature of these injuries may be similar to those in severely injured civilians. Further research into optimal management and rehabilitation is critical for military service members and severely injured civilians with spine trauma.
authors.affiliation: Skeletal Trauma Research Consortium (STReC), Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, United States Army Institute of Surgical Research, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Blair: james.blair@amedd.army.mil
authors.forename: James A
authors.initials: JA
authors.lastname: Blair
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Patzkowski
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Cross Rivera
authors.forename: Eric S
authors.initials: ES
authors.lastname: Grenier
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D017677:Age Distribution; D001753:Blast Injuries / Q000150:complications / Q000453:epidemiology; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004185:Disability Evaluation; D005107:Explosions; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D023481:Terrorism; D014481:United States; D014857:Warfare; D014948:Wounds, Gunshot / Q000150:complications / Q000453:epidemiology; D055815:Young Adult