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Text
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<a href="http://doi.org/10.1016/j.spinee.2011.04.028" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.spinee.2011.04.028</a>
Pages
817–823
Issue
9
Volume
12
Dublin Core
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Title
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Evaluation and management of combat-related spinal injuries: a review based on recent experiences.
Publisher
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The spine journal : official journal of the North American Spine Society
Date
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2012
2012-09
Subject
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*Practice Guidelines as Topic; 2003-2011; Afghan Campaign 2001-; Humans; Iraq War; Military Medicine/*methods; Spinal Injuries/*diagnosis/*therapy
Creator
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Schoenfeld Andrew J; Lehman Ronald A Jr; Hsu Joseph R
Description
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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 injury. 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 casualties. 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. Wounded soldiers are expeditiously evacuated through the echelons of care but typically do not receive surgical management in theater. The current CPGs for the care of soldiers with combat-related spinal injuries should be re-examined in light of data regarding the increasing number of spine injuries, new injury patterns, such as lumbosacral dissociation and low lumbar burst fractures, and recent reports within the field of spine surgery as a whole. CONCLUSIONS: American and coalition forces are sustaining the highest spine combat casualty rates in recorded history and previously unseen injuries are being encountered with increased frequency. While the CPGs provide useful direction in terms of the evaluation and management of combat casualties with spine injuries, such recommendations may warrant periodic re-evaluation in light of recent combat experiences and evolving scientific evidence within the spine literature.
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<a href="http://doi.org/10.1016/j.spinee.2011.04.028" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2011.04.028</a>
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*Practice Guidelines as Topic
2003-2011
2012
Afghan Campaign 2001-
Hsu Joseph R
Humans
Iraq War
Lehman Ronald A Jr
Military Medicine/*methods
Schoenfeld Andrew J
Spinal Injuries/*diagnosis/*therapy
The spine journal : official journal of the North American Spine Society