Spinal fractures in current military deployments.

Objective: To describe spinal fracture patterns presenting to deployed medical facilities during recent military operations.
Methods: Retrospective analysis of the United Kingdom Centre for Defence Imaging Computed Tomography database, 2005-2009. Fractures are classified, mechanism noted and associated injuries recorded. Statistical analysis is by Fisher's Exact test.
Results: 128 fractures in 57 casualties are analysed. Ballistic (79%) and non-ballistic mechanisms contribute to vertebral fracture at all regions of the spinal column in patients treated at deployed medical facilities. There is a high incidence of lumbar spine fractures, which are more likely to be due to explosion than gunshot wounding (p < 0.05). Two thirds of thoracolumbar spine fractures caused by explosive devices are unstable and are mainly burst-fractures in configuration. 60% of spinal fracture patients had concomitant injuries. There is a strong relationship between spinal fractures caused by explosions and lower limb fractures.
Conclusion: Injuries to the spine caused by explosive devices account for greater numbers, greater associated morbidity and increasing complexity than other means of spinal injury managed in contemporary warfare. With the predominance of explosive injury in current conflict, this work provides the first detail of an evolving injury mechanism with implications for injury mitigation research.