Spinal cord injury in the United States Army Special Forces

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

View More View Less
  • 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York;
  • 2 Johns Hopkins University, Baltimore, Maryland; and
  • 3 Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Spinal cord injury (SCI) is an area of key interest in military medicine but has not been studied among the US Army Special Forces (SF), the most elite group of US soldiers. SF soldiers make up a disproportionate 60% of all Special Operations casualties. The objective of this study was to better understand SCI incidence in the SF, its mechanisms of acquisition, and potential areas for intervention by addressing key issues pertaining to protective equipment and body armor use.

METHODS

An electronic survey questionnaire was formulated with the close collaboration of US board-certified neurosurgeons from the Mount Sinai Hospital and Cleveland Clinic Departments of Neurosurgery, retired military personnel of the SF, and operational staff of the Green Beret Foundation. The survey was sent to approximately 6000 SF soldiers to understand SCI diagnosis and its associations with various health and military variables.

RESULTS

The response rate was 8.2%. Among the 492 respondents, 94 (19.1%) self-reported an SCI diagnosis. An airborne operation was the most commonly attributed cause (54.8%). Moreover, 87.1% of SF soldiers reported wearing headgear at the time of injury, but only 36.6% reported wearing body armor, even though body armor use has significantly increased in post-9/11 SF soldiers compared with that in their pre-9/11 counterparts. SCI was significantly associated with traumatic brain injury, arthritis, low sperm count, low testosterone, erectile dysfunction, tinnitus, hyperacusis, sleep apnea, posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Only 16.5% of SF soldiers diagnosed with SCI had been rescued via medical evacuation (medevac) for treatment.

CONCLUSIONS

A high number of SF soldiers self-reported an SCI diagnosis. Airborne operations landings were the leading cause of SCI, which coincided with warfare tactics employed during the Persian Gulf War, Operation Iraqi Freedom, and other conflicts. A majority of SCIs occurred while wearing headgear and no body armor, suggesting the need for improvements in protective equipment use and design. The low rate of medevac rescue for these injuries may suggest that medical rescue was not attainable at the time or that certain SCIs were deemed minor at the time of injury.

ABBREVIATIONS GBF = Green Beret Foundation; IED = improvised explosive device; medevac = medical evacuation; MFF = Military Free Fall; SCI = spinal cord injury; SF = Special Forces; TBI = traumatic brain injury; VA = Department of Veterans Affairs.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Remi A. Kessler: Icahn School of Medicine at Mount Sinai, New York, NY. remi.kessler@icahn.mssm.edu.

INCLUDE WHEN CITING Published online September 25, 2020; DOI: 10.3171/2020.7.SPINE20804.

Disclosures Dr. Benzil is a founding partner of Benzil Zusman, LLC (not related to the content of this study). Dr. Hadjipanayis is a medical advisor to NX Development Corp., is entitled to royalties from NX Development Corp., and is a consultant to Synaptive Medical (not related to the content of this study).

  • 1

    Grimm PD, Mauntel TC, Potter BK. Combat and noncombat musculoskeletal injuries in the US military. Sports Med Arthrosc Rev. 2019;27(3):8491.

    • Search Google Scholar
    • Export Citation
  • 2

    Fitzgerald GJ. Chemical warfare and medical response during World War I. Am J Public Health. 2008;98(4):611625.

  • 3

    Atiyeh BS, Gunn SW, Hayek SN. Military and civilian burn injuries during armed conflicts. Ann Burns Fire Disasters. 2007;20(4):203215.

    • Search Google Scholar
    • Export Citation
  • 4

    Mccafferty RR, Neal CJ, Marshall SA, Neurosurgery and medical management of severe head injury. Mil Med. 2018;183(suppl_2):6772.

  • 5

    Ursano RJ, Kessler RC, Naifeh JA, Frequency of improvised explosive devices and suicide attempts in the U.S. Army. Mil Med. 2017;182(3):e1697e1703.

    • Search Google Scholar
    • Export Citation
  • 6

    Schoenfeld AJ, Laughlin MD, McCriskin BJ, Spinal injuries in United States military personnel deployed to Iraq and Afghanistan: an epidemiological investigation involving 7877 combat casualties from 2005 to 2009. Spine (Phila Pa 1976). 2013;38(20):17701778.

    • Search Google Scholar
    • Export Citation
  • 7

    Bernstock JD, Caples CM, Wagner SC, Characteristics of combat-related spine injuries: a review of recent literature. Mil Med. 2015;180(5):503512.

    • Search Google Scholar
    • Export Citation
  • 8

    Abrams GM, Wakasa M. Chronic complications of spinal cord injury and disease. UpToDate. August 19, 2019. Accessed August 11, 2020. https://www.uptodate.com/contents/chronic-complications-of-spinal-cord-injury-and-disease

    • Search Google Scholar
    • Export Citation
  • 9

    Spotlight: Improving care for veterans with spinal cord injury and disorders. Health Services Research & Development. Veterans Administration. April 2013. Accessed August 11, 2020. https://www.hsrd.research.va.gov/news/feature/sci.cfm

    • Export Citation
  • 10

    The US Green Beret Foundation. Accessed August 11, 2020. https://greenberetfoundation.org

    • Export Citation
  • 11

    Clancy T, Gresham J. Special Forces: A Guided Tour of U.S. Army Special Forces. Sidgwick & Jackson; 2001.

  • 12

    Berwick D, Downey A, Cornett E, eds. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. National Academies Press; 2016.

    • Search Google Scholar
    • Export Citation
  • 13

    Rivera JC, Anderson ER, Jenne JW, Topp RF. Spine-related disability following combat injury. J Surg Orthop Adv. 2014;23(3):136139.

  • 14

    Furlan JC, Kurban D, Craven BC. Traumatic spinal cord injury in military personnel versus civilians: a propensity score-matched cohort study. J R Army Med Corps. Published online May 31, 2019. doi: 10.1136/jramc-2019-001197

    • Search Google Scholar
    • Export Citation
  • 15

    Furlan JC, Gulasingam S, Craven BC. Epidemiology of war-related spinal cord injury among combatants: a systematic review. Global Spine J. 2019;9(5):545558.

    • Search Google Scholar
    • Export Citation
  • 16

    Chapter 1. Introduction. In: Airborne Operations Field Manual. No. 90-26. Headquarters, Department of the Army; 1990. https://usacac.army.mil/sites/default/files/misc/doctrine/CDG/cdg_resources/manuals/fm/fm90_26.pdf

    • Search Google Scholar
    • Export Citation
  • 17

    Kotwal RS, Meyer DE, O’Connor KC, Army Ranger casualty, attrition, and surgery rates for airborne operations in Afghanistan and Iraq. Aviat Space Environ Med. 2004;75(10):833840.

    • Search Google Scholar
    • Export Citation
  • 18

    Johnson ES, Gaydos SJ, Pavelites JJ, U.S. Army parachute mishap fatalities: 2010–2015. Aerosp Med Hum Perform. 2019;90(7):637642.

  • 19

    Bricknell MC, Craig SC. Military parachuting injuries: a literature review. Occup Med (Lond). 1999;49(1):1726.

  • 20

    Steele JR, Mickle KJ, Whitting WJ. Preventing injuries associated with military static-line parachuting landings. In: Gefen A, Epstein Y, eds. The Mechanobiology and Mechanophysiology of Military-Related Injuries. Springer; 2016:5055.

    • Search Google Scholar
    • Export Citation
  • 21

    Knapik J, Steelman R. Risk factors for injuries during military static-line airborne operations: a systematic review and meta-analysis. J Athl Train. 2016;51(11):962980.

    • Search Google Scholar
    • Export Citation
  • 22

    Ball VL, Sutton JA, Hull A, Sinnott BA. Traumatic injury patterns associated with static line parachuting. Wilderness Environ Med. 2014;25(1):8993.

    • Search Google Scholar
    • Export Citation
  • 23

    Ciccone R, Richman RM. The mechanism of injury and the distribution of 3000 fractures and dislocations caused by parachute jumping. J Bone Joint Surg Am. 1948;30A(1):7797.

    • Search Google Scholar
    • Export Citation
  • 24

    Ivins BJ, Crowley JS, Johnson J, Traumatic brain injury risk while parachuting: comparison of the personnel armor system for ground troops helmet and the advanced combat helmet. Mil Med. 2008;173(12):11681172.

    • Search Google Scholar
    • Export Citation
  • 25

    Pirson J, Verbiest E. A study of some factors influencing military parachute landing injuries. Aviat Space Environ Med. 1985;56(6):564567.

    • Search Google Scholar
    • Export Citation
  • 26

    Lillywhite LP. Analysis of extrinsic factor associated with 379 injuries occurring during 34,236 military parachute descents. J R Army Med Corps. 1991;137(3):115121.

    • Search Google Scholar
    • Export Citation
  • 27

    Injury Prevention: Just the Facts. Parachuting Injuries. Army Public Health Center. Accessed August 11, 2020. https://phc.amedd.army.mil/PHC%20Resource%20Library/ParachutingInjuries_FS_12-006-1115.pdf

    • Export Citation
  • 28

    Schoenfeld AJ, Lehman RA Jr, Hsu JR. Evaluation and management of combat-related spinal injuries: a review based on recent experiences. Spine J. 2012;12(9):817823.

    • Search Google Scholar
    • Export Citation
  • 29

    Belmont PJ Jr, Goodman GP, Zacchilli M, Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a U.S. Army brigade combat team. J Trauma. 2010;68(1):204210.

    • Search Google Scholar
    • Export Citation
  • 30

    Farr WD. The Death of the Golden Hour and the Return of the Future Guerrilla Hospital. Joint Special Operations University; 2017.

  • 31

    Furlan JC, Tator CH. Global epidemiology of traumatic spinal cord injury. In: Morganti-Kossman C, Raghupathi R, Maas A, eds. Traumatic Brain and Spinal Cord Injury: Challenges and Developments. 1st ed. Cambridge University Press; 2012:216228.

    • Search Google Scholar
    • Export Citation
  • 32

    Blair JA, Patzkowski JC, Schoenfeld AJ, Are spine injuries sustained in battle truly different? Spine J. 2012;12(9):824829.

  • 33

    Lehman RA Jr, Paik H, Eckel TT, Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts. Spine J. 2012;12(9):784790.

    • Search Google Scholar
    • Export Citation
  • 34

    Kellerman A, Elster E, Rasmussen T. How the US military reinvented trauma care and what this means for US medicine. Health Affairs. July 3, 2018. Accessed August 11, 2020. https://www.healthaffairs.org/do/10.1377/hblog20180628.431867/full/

    • Search Google Scholar
    • Export Citation
  • 35

    Furlan JC, Gulasingam S, Craven BC. The health economics of the spinal cord injury or disease among veterans of war: a systematic review. J Spinal Cord Med. 2017;40(6):649664.

    • Search Google Scholar
    • Export Citation
  • 36

    Bauman WA, La Fountaine MF, Spungen AM. Age-related prevalence of low testosterone in men with spinal cord injury. J Spinal Cord Med. 2014;37(1):3239.

    • Search Google Scholar
    • Export Citation
  • 37

    Patki P, Woodhouse J, Hamid R, Effects of spinal cord injury on semen parameters. J Spinal Cord Med. 2008;31(1):2732.

  • 38

    Sommer JL, Witkiewicz PM. The therapeutic challenges of dual diagnosis: TBI/SCI. Brain Inj.2004;18(12):12971308.

Metrics

All Time Past Year Past 30 Days
Abstract Views 847 847 847
Full Text Views 63 63 63
PDF Downloads 33 33 33
EPUB Downloads 0 0 0