Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts

The combat burst fracture study—results of a cohort analysis of the most prevalent combat specific mechanism of major thoracolumbar spinal injury

“…Despite surgical treatment, only 8 % of patients with a neurological deficit improved following treatment. An overall complication rate of 18 % was also appreciated, although this figure is in keeping with other series reporting combat-related spinal injuries [1,2].…”

“…The work of Ragel et al [3] was limited to a single facility in theater and studies conducted by investigators from Walter Reed focused solely on soldiers treated at their facility with spinal injuries other than TL burst fracture [1,2]. Compared to previous reports, particularly that of Ragel and colleagues [3], the current study revealed higher rates of neurological damage as well as TLICS scores.…”

“…Furthermore, the overall incidence of combat burst fractures significantly increased in 2009-2010 as compared to the previous 2 years, and the primary statistical driver of this phenomenon was the marked increase in such fractures from the Afghanistan theater where these injuries were overwhelmingly precipitated by explosive attacks on up-armored military vehicles [9][10][11][12]. These injuries are known to have a high frequency of associated combat wounds, consume a tremendous amount of medical resources and, even following effective surgical intervention, are associated with high complication rates [2,17] and low return to active duty [18]. Such findings are reflected in the present study, where primary treatment was operative for 68 % of soldiers.…”

“…Despite the fact that the United States has been engaged in armed conflict for the longest continuous period in its history, the literature reporting the clinical characteristics of combat-related injuries to the spine has been limited to small case series [1][2][3] or has relied on registries as the principle data source [4][5][6]. No published study has solely utilized primary source data across the war zones, to fully characterize spinal injury and its process of care.…”

The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures

“…The lumbosacral spine possess a critical role in axial weightbearing of the spine [2]. This segment of the spine has unique anatomic and biomechanical characteristics, including its location below the pelvic brim and the apex of the lumbar lordosis in conjunction with the stabilizing effect of the iliolumbar ligaments that protect this region from traumatic injury [2,[4][5][6][7]. The spinal canal is widest in this region with neurologic damage, ending up with injury to the cauda equina in contrast to the conus medullaris [6].…”