title: Evaluation of immediate postoperative complications and outcomes among military personnel treated for spinal trauma in Afghanistan: a cohort-control study of 50 cases.
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  The objective of the study was to compare neurological outcomes and complication rates between a series of combat-injured patients treated in Afghanistan (AFG) and those treated at Landstuhl Regional Medical Center (LRMC).
  
  
  BACKGROUND
  At present, no studies have addressed the ideal timing and setting for surgical stabilization in combat-injured soldiers who sustain spinal trauma.
  
  
  METHODS
  Soldiers who sustained spine injuries while deployed to Afghanistan and who underwent surgery in theater or at LRMC between 2010 and 2011 were identified. Demographic information, injury-specific data, neurological status, type of surgical intervention, postoperative complications, and need for additional surgery were abstracted for all patients. Neurological improvement was the primary dependent variable. Secondary variables included the risk of developing complications and the need for additional surgery. Statistical analysis was performed using t tests, and the Fisher exact test was used for categorical variables.
  
  
  RESULTS
  Between 2010 and 2011, 30 individuals were treated in AFG, and 20 received surgery at LRMC. Neurological improvement occurred in 10% of AFG patients and 5% of those treated at LRMC. Complications occurred in 40% of AFG patients and in 20% of the LRMC group. Twenty-three percent of AFG patients required additional spine surgery after leaving Afghanistan. There was no statistical difference in neurological improvement between the AFG and LRMC groups (P=0.64). Soldiers who received surgery in AFG were at significantly increased risk of requiring additional procedures (P=0.03).
  
  
  CONCLUSIONS
  Soldiers treated in theater did not have statistically higher rates of neurological improvement as compared with those treated at LRMC. Patients treated in-theater were at elevated risk for the need for additional surgery. This study is among the first to evaluate clinical outcomes after surgical intervention for war-related spinal trauma.
  
  
  METHODS
  Level III (case-control).
authors.affiliation: *Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX †Orthopaedic Surgery Service, Madigan Army Medical Center, Tacoma, WA ‡Department of Neurosurgery, Harold F. Young Neurosurgery Center, Virginia Commonwealth University Medical Center, Richmond, VA §Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, GA ∥Spine and Neurosurgery Service, Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: James M
authors.initials: JM
authors.lastname: Mok
authors.forename: Brian
authors.initials: B
authors.lastname: Cameron
authors.forename: Keith L
authors.initials: KL
authors.lastname: Jackson
authors.forename: Jose A
authors.initials: JA
authors.lastname: Serrano
authors.forename: Brett A
authors.initials: BA
authors.lastname: Freedman
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D016022:Case-Control Studies; D005858:Germany; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008887:Military Medicine; D008889:Military Personnel / Q000706:statistics & numerical data*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D020127:Recovery of Function; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000453:epidemiology* / Q000601:surgery; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult