title: Spinal injuries in United States military personnel deployed to Iraq and Afghanistan: an epidemiological investigation involving 7877 combat casualties from 2005 to 2009.
abstract: METHODS
  Retrospective analysis of a prospective data set.
  
  
  OBJECTIVE
  Determine the incidence and epidemiology of combat-related spinal injuries for the wars in Afghanistan and Iraq.
  
  
  BACKGROUND
  Recent studies have identified a marked increase in the rate of combat-related spine trauma among casualties in Afghanistan and Iraq. Limitations in these previous works, however, limit their capacity for generalization.
  
  
  METHODS
  A manual search of casualty records stored in the Department of Defense Trauma Registry was performed for the years 2005 to 2009. Demographic information, nature of spinal wounding, injury mechanism, concomitant injuries, year, and location of injury were recorded for all soldiers identified as having sustained combat-related spine trauma. Incidence rates were constructed by comparing the frequencies of spine casualties against defense manpower deployment data. Multivariate Poisson regression was used to identify statistically significant factors associated with spinal injury.
  
  
  RESULTS
  In the years 2005 to 2009, 872 (11.1%) casualties with spine injuries were identified among a total of 7877 combat wounded. The mean age of spine casualties was 26.6 years. Spine fractures were the most common injury morphology, comprising 83% of all spinal wounds. The incidence of combat-related spinal trauma was 4.4 per 10,000, whereas that of spine fractures was 4.0 per 10,000. Spinal cord injuries occurred at a rate of 4.0 per 100,000. Spinal cord injuries were most likely to occur in Afghanistan (incident rate ratio: 1.96; 95% confidence interval: 1.68-2.28), among Army personnel (incident rate ratio: 16.85; 95% confidence interval: 8.39-33.84), and in the year 2007 (incident rate ratio: 1.90; 95% confidence interval: 1.55-2.32). Spinal injuries from gunshot were significantly more likely to occur in Iraq (17%) than in Afghanistan (10%, P = 0.02).
  
  
  CONCLUSIONS
  The incidence of spine trauma in modern warfare exceeds reported rates from earlier conflicts. The study design and population size may enhance the capacity for generalization of our findings.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX; and †Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Laughlin
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: McCriskin
authors.forename: Julia O
authors.initials: JO
authors.lastname: Bader
authors.forename: Brian R
authors.initials: BR
authors.lastname: Waterman
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine / Q000706:statistics & numerical data; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012042:Registries / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D013124:Spinal Injuries / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications*