Evaluation and Management of Combat-Related Spinal injuries: A Review Based on Recent Experiences
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND CONTEXT The current approach to the evaluation and treatment of military casualties in the Global War on Terror is informed by medical experience from prior conflicts and combat encounters from the last 10 years. In an effort to standardize the care provided to military casualties in the ongoing conflicts, the Department of Defense DoD has published Clinical Practice Guidelines CPGs that deal specifically with the combat casualty sustaining a spinal in jury. However, the combat experience with spine injuries in the present conflicts remains incompletely described. PURPOSE To describe the CPGs for the care of the combat casualty with suspected spine injuries and discuss them in light of the published military experience with combat related spinal trauma. STUDY DESIGN Literature review. METHODS A literature review was conducted regarding published works that discussed the incidence, epidemiology, and management of combat related spinal trauma. The CPGs, established by the DoD, are discussed in light of actual military experiences with spine trauma, the present situation in the forward surgical teams and combat support hospitals treating casualties in theater, and recent publications in the field of spine surgery. RESULTS In the conventional wars fought by the United States between 1950 and 1991 Korea, Vietnam, Gulf War I, the incidence of spine injuries remained close to 1 of all combat casual ties. However, in the Global War on Terror, the enemy has relied on implements of asymmetric warfare, including sniper attacks, ambush, roadside bombs, and improvised explosive devices. The increase in explosive mechanisms of injury has elevated the number of soldiers exposed to blunt force trauma and, consequently, recent publications reported the highest incidence of combat related spinal injuries in American military history.
- Anatomy and Physiology
- Medicine and Medical Research
- Weapons Effects (Biological)
- Military Forces and Organizations