PHILADELPHIA, PA – September 2005 - Neurologic deterioration during evacuation to the United States is rare among victims of severe spinal injuries on the battlefields of Iraq. Medical teams on the battlefield and during evacuation are generally able to prevent worsening of muscle, sensory, and other neurological functions after soldiers suffer spinal cord and spinal column injuries.
The war in Iraq has taken an incalculable toll on the lives of American soldiers. In addition to some 1900 fatalities, there have been some 19,000 casualties.
Since American troops landed in the spring of 2003, medical teams have evacuated more than 5,500 soldiers from the country’s battlegrounds to Walter Reed Army Medical Center in Washington DC. Among them are scores of men and women with severe spinal cord and spinal column injuries.
The goal of the evacuation team is to stabilize the soldiers with spinal injuries so that they do not worsen during their transit to the U.S.. For the majority whose destination is Walter Reed, the new study suggests, the efforts of the military medical teams appear to be successful. Neurological deterioration during evacuation occurred in just one spinal-cord injured soldier. In this soldier, a partial spinal cord injury progressed to a complete injury.
“The present evacuation system satisfactorily cares for spinal cord and column injuries, as noted by the low incidence of neurologic deterioration during evacuation,” said Army Colonel Timothy Kuklo, MD. Kuklo reported the findings on Friday, September 30, at the 20th annual meeting of the North American Spine Society in Philadelphia.
Kuklo and his colleagues studied the first 84 patients with spinal injuries to arrive at Walter Reed from Iraq. The soldiers typically reached their destination within 8 or 9 days of their injury, though ranged from just a few day to a couple of weeks. The most common cause of their wounds was penetrating trauma, often from explosives.
Most soldiers suffered injury to the spinal column. Spinal column injury is damage to the vertebral column, but not necessarily a devastating injury to the spinal cord.
In addition, 22 soldiers had complete or partial spinal cord injuries. Eleven with incomplete spinal cord injuries showed some improvement.
The clinical significance of spinal cord and spinal column injuries can vary. In a complete spinal cord injury, the patient loses all motor and sensory function below the level of the injury.
Complete spinal cord injury in the thoracic or lumbar spine (from the chest to low back), for example, will result in complete loss of the use of the legs as well as bowel, bladder, and sexual function. Soldiers also lose sensation below the level of injury.
Complete spinal cord injury in the cervical spine, or neck, causes patients to lose the use of their arms; soldiers might be able only to shrug or move their elbows. In more severe cases, patients might lose the ability to breathe on their own and become dependent on a respirator.
In an “incomplete” injury, there is some sparing of motor and/or sensory function below the level of injury. For example, said Kuklo, a soldier with an incomplete spinal cord injury in the back might retain partial use of a leg, but without complete strength. Or a soldier might have complete return of muscle function but lose control of the bladder or bowels.
“There are unfortunate cases of all of these in this group of soldiers,” said Kuklo.
In all, 63 of the 84 soldiers underwent surgery. Of these, 10 showed improvements in neurological status. Only four soldiers in the cohort had infections.
“Surgical management appears to be best performed at the highest echelons of care—a tertiary care center—with a low rate of infection,” said Kuklo.
Overall, said Kuklo, the evacuation teams “are doing a good job.” The prognosis for the soldiers, he said, “is good.”
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NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research, and advocacy. Since its start in 1985, NASS has grown to nearly 4,000 members in 22 spine-related specialties. NASS members are MDs, DOs, and PhDs, including orthopedics, neurosurgery, physiatry, pain management, and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators, and other allied health care professionals involved in spine care are also represented as affiliate members.
For further information, contact:
North American Spine Society
Toll-free: (866) 960-6277 Direct: (630) 230-3600
or
Kathleen Hansen
(630) 933-9477