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Thoracic and Lumbar Spine Injuries

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Musculoskeletal Injuries in the Military

Abstract

The thoracic and lumbar spine is among the most common sites of injury in the military population. These injuries result in a significant burden to the military healthcare system and carry significant implications for military readiness. The causes of these injuries are numerous with complex interactions between external and intrinsic factors. Military-specific activities and training are commonly implicated in the development of back pain including fitness training, marching, and combat training. Within the military, specific occupations have also been shown to be associated with higher rates of injury and back pain. Such occupations include aviators, drivers, and those involved in military parachuting. Military deployments also represent high-risk periods for development of back pain, which results in a significant amount of lost duty days and evacuations from theater. Such injuries range from minor back injuries to serious combat-related spine trauma. Combat-related spine trauma is an increasingly common injury in modern combat environments due to an increase in survival from other injuries as well as a shift in tactics from previous combat engagements. These injuries carry some important differences from civilian spine trauma with important implications in evaluation and management.

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References

  1. Feuerstein M, Berkowitz SM, Peck CA Jr. Musculoskeletal-related disability in US Army personnel: prevalence, gender, and military occupational specialties. J Occup Environ Med (American college of occupational and environmental medicine). 1997;39(1):68–78.

    Article  CAS  PubMed  Google Scholar 

  2. Lincoln AE, Smith GS, Amoroso PJ, Bell NS. The natural history and risk factors of musculoskeletal conditions resulting in disability among US Army personnel. Work. 2002;18(2):99–113.

    PubMed Central  PubMed  Google Scholar 

  3. Ambulatory visits among members of the active component, U.S. Armed Forces. MSMR. 2012 (Apr 2013);20(4):18–23; disussion 23.

    Google Scholar 

  4. Mydlarz D. Degenerative disc disease, active component, U.S. armed forces, 2001–2011. MSMR. 2012;19(5):6–9.

    PubMed  Google Scholar 

  5. Hauret KG, Jones BH, Bullock SH, Canham-Chervak M, Canada S. Musculoskeletal injuries description of an under-recognized injury problem among military personnel. Am J Prev Med. 2010;38(1 Suppl):S61–S70.

    Article  PubMed  Google Scholar 

  6. Knox J, Orchowski J, Scher DL, Owens BD, Burks R, Belmont PJ. The incidence of low back pain in active duty United States military service members. Spine (Phila Pa 1976). 2011;36(18):1492–1500.

    Article  Google Scholar 

  7. Childs JD, Wu SS, Teyhen DS, Robinson ME, George SZ. Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs. Spine J. 2013;14:571–83.

    Article  PubMed  Google Scholar 

  8. Strowbridge N. Gender differences in the cause of low back pain in British soldiers. J R Army Med Corps. 2005;151(2):69–72.

    Article  CAS  PubMed  Google Scholar 

  9. Morken T, Mageroy N, Moen BE. Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study. BMC Musculoskelet Disord. 2007;8:56.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hamalainen O. Thoracolumbar pain among fighter pilots. Mil Med. 1999;164(8):595–6.

    CAS  PubMed  Google Scholar 

  11. Gruhn J, Leggat P, Muller R. Injuries presenting to Army physiotherapy in North Queensland, Australia. Mil Med. 1999;164(2):145–52.

    CAS  PubMed  Google Scholar 

  12. Carragee EJ, Cohen SP. Lifetime asymptomatic for back pain: the validity of self-report measures in soldiers. Spine (Phila Pa 1976). 2009;34(9):978–83.

    Article  Google Scholar 

  13. Hou ZH, Shi JG, Ye H, et al. Prevalence of low back pain among soldiers at an Army base. Chin Med J. 2013;126(4):679–82.

    PubMed  Google Scholar 

  14. Kemp PA, Burnham BR, Copley GB, Shim MJ. Injuries to air force personnel associated with lifting, handling, and carrying objects. Am J Prev Med. 2010;38(1 Suppl):S148–55.

    Article  PubMed  Google Scholar 

  15. MacGregor AJ, Dougherty AL, Mayo JA, Rauh MJ, Galarneau MR. Occupational correlates of low back pain among U.S. Marines following combat deployment. Mil Med. 2012;177(7):845–9.

    Article  PubMed  Google Scholar 

  16. Reynolds K, Cosio-Lima L, Creedon J, Gregg R, Zigmont T. Injury occurrence and risk factors in construction engineers and combat artillery soldiers. Mil Med. 2002;167(12):971–7.

    PubMed  Google Scholar 

  17. Pelham TW, White H, Holt LE, Lee SW. The etiology of low back pain in military helicopter aviators: prevention and treatment. Work. 2005;24(2):101–10.

    PubMed  Google Scholar 

  18. Lings S, Leboeuf-Yde C. Whole-body vibration and low back pain: a systematic, critical review of the epidemiological literature 1992–1999. Int Arch Occup Environ Health. 2000;73(5):290–7.

    Article  CAS  PubMed  Google Scholar 

  19. Pope MH, Wilder DG, Magnusson ML. A review of studies on seated whole body vibration and low back pain. Proc Inst Mech Eng [H]. 1999;213(6):435–46.

    Article  CAS  Google Scholar 

  20. Kasin JI, Mansfield N, Wagstaff A. Whole body vibration in helicopters: risk assessment in relation to low back pain. Aviat Space Environ Med. 2011;82(8):790–6.

    Article  PubMed  Google Scholar 

  21. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283–98.

    Article  PubMed Central  PubMed  Google Scholar 

  22. de Oliveira CG, Nadal J. Back muscle EMG of helicopter pilots in flight: effects of fatigue, vibration, and posture. Aviat Space Environ Med. 2004;75(4):317–22.

    PubMed  Google Scholar 

  23. Gaydos SJ. Low back pain: considerations for rotary-wing aircrew. Aviat Space Environ Med. 2012;83(9):879–89.

    Article  PubMed  Google Scholar 

  24. Shanahan DF, Reading TE. Helicopter pilot back pain: a preliminary study. Aviat Space Environ Med. 1984;55(2):117–21.

    CAS  PubMed  Google Scholar 

  25. Cunningham LK, Docherty S, Tyler AW. Prevalence of low back pain (LBP) in rotary wing aviation pilots. Aviat Space Environ Med. 2010;81(8):774–8.

    Article  PubMed  Google Scholar 

  26. Thomae MK, Porteous JE, Brock JR, Allen GD, Heller RF. Back pain in Australian military helicopter pilots: a preliminary study. Aviat Space Environ Med. 1998;69(5):468–73.

    CAS  PubMed  Google Scholar 

  27. Hansen OB, Wagstaff AS. Low back pain in Norwegian helicopter aircrew. Aviat Space Environ Med. 2001;72(3):161–4.

    CAS  PubMed  Google Scholar 

  28. Orsello CA, Phillips AS, Rice GM. Height and in-flight low back pain association among military helicopter pilots. Aviat Space Environ Med. 2013;84(1):32–7.

    Article  PubMed  Google Scholar 

  29. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Rotondo G. Spinal injury after ejection in jet pilots: mechanism, diagnosis, followup, and prevention. Aviat Space Environ Med. 1975;46(6):842–8.

    CAS  PubMed  Google Scholar 

  31. Taneja N. Spinal disabilities in military and civil aviators. Spine (Phila Pa 1976). 2008;33(25):2749–53.

    Article  Google Scholar 

  32. Lewis ME. Spinal injuries caused by the acceleration of ejection. J R Army Med Corps. 2002;148(1):22–6.

    Article  CAS  PubMed  Google Scholar 

  33. Hamalainen O, Visuri T, Kuronen P, Vanharanta H. Cervical disk bulges in fighter pilots. Aviat Space Environ Med. 1994;65(2):144–6.

    CAS  PubMed  Google Scholar 

  34. Grant KA. Ergonomic assessment of a helicopter crew seat: the HH-60G flight engineer position. Aviat Space Environ Med. 2002;73(9):913–8.

    PubMed  Google Scholar 

  35. Simon-Arndt CM, Yuan H, Hourani LL. Aircraft type and diagnosed back disorders in U.S. Navy pilots and aircrew. Aviat Space Environ Med. 1997;68(11):1012–8.

    CAS  PubMed  Google Scholar 

  36. Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are occupational drivers at an increased risk for developing musculoskeletal disorders? Spine (Phila Pa 1976). 1996;21(6):710–7.

    Article  CAS  Google Scholar 

  37. Waters T, Genaidy A, Barriera Viruet H, Makola M. The impact of operating heavy equipment vehicles on lower back disorders. Ergonomics. 2008;51(5):602–36.

    Article  PubMed  Google Scholar 

  38. Liira JP, Shannon HS, Chambers LW, Haines TA. Long-term back problems and physical work exposures in the 1990 Ontario health survey. Am J Public Health. 1996;86(3):382–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Rozali A, Rampal KG, Shamsul Bahri MT, et al. Low back pain and association with whole body vibration among military armoured vehicle drivers in Malaysia. Med J Malaysia. 2009;64(3):197–204.

    CAS  PubMed  Google Scholar 

  40. Knox JBOJ, Scher DL, Owens BD, Burks R, Belmont PJ. Occupational driving as a risk factor for low back pain in active duty military service members. Spine J. Publication Pending.

    Google Scholar 

  41. Bricknell MC, Craig SC. Military parachuting injuries: a literature review. Occup Med (Lond). 1999;49(1):17–26.

    Article  CAS  Google Scholar 

  42. Murray-Leslie CF, Lintott DJ, Wright V. The spine in sport and veteran military parachutists. Ann Rheum Dis. 1977;36(4):332–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Deyo RAMS, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys. Spine. 2006;31(23):2724–7.

    Article  PubMed  Google Scholar 

  44. Heir T, Glomsaker P. Epidemiology of musculoskeletal injuries among Norwegian conscripts undergoing basic military training. Scand J Med Sci Sports. 1996;6(3):186–191.

    Article  CAS  PubMed  Google Scholar 

  45. Jones BH, Cowan DN, Tomlinson JP, Robinson JR, Polly DW, Frykman PN. Epidemiology of injuries associated with physical training among young men in the Army. Med Sci Sports Exerc. 1993;25(2):197–203.

    Article  CAS  PubMed  Google Scholar 

  46. Taanila HP, Suni JH, Pihlajamaki HK, et al. Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness. Spine J. 2012;12(9):737–48.

    Article  PubMed  Google Scholar 

  47. Milgrom C, Finestone A, Lev B, Wiener M, Floman Y. Over exertional lumbar and thoracic back pain among recruits: a prospective study of risk factors and treatment regimens. J Spinal Disord. 1993;6(3):187–93.

    Article  CAS  PubMed  Google Scholar 

  48. O’Connor FG, Marlowe SS. Low back pain in military basic trainees. A pilot study. Spine (Phila Pa 1976). 1993;18(10):1351–4.

    Article  Google Scholar 

  49. Linenger JM, West LA. Epidemiology of soft-tissue/musculoskeletal injury among U.S. Marine recruits undergoing basic training. Mil Med. 1992;157(9):491–3.

    CAS  PubMed  Google Scholar 

  50. Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A. A controlled randomized study of the effect of training with orthoses on the incidence of weight bearing induced back pain among infantry recruits. Spine (Phila Pa 1976). 2005;30(3):272–5.

    Article  Google Scholar 

  51. George SZ, Childs JD, Teyhen DS, et al. Predictors of occurrence and severity of first time low back pain episodes: findings from a military inception cohort. PloS One. 2012;7(2):e30597.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Roy TC, Knapik JJ, Ritland BM, Murphy N, Sharp MA. Risk factors for musculoskeletal injuries for soldiers deployed to Afghanistan. Aviat Space Environ Med. 2012;83(11):1060–6.

    Article  PubMed  Google Scholar 

  53. Roy TC, Lopez HP, Piva SR. Loads worn by soldiers predict episodes of low back pain during deployment to Afghanistan. Spine (Phila Pa 1976). 2013;38:1310–7.

    Article  Google Scholar 

  54. Cohen SP, Nguyen C, Kapoor SG, et al. Back pain during war: an analysis of factors affecting outcome. Arch Intern Med. 2009;169(20):1916–23.

    Article  PubMed  Google Scholar 

  55. Rodriguez-Soto AE, Jaworski R, Jensen A, et al. Effect of load carriage on lumbar spine kinematics. Spine (Phila Pa 1976). 2013;38(13):E783–91.

    Article  Google Scholar 

  56. Konitzer LN, Fargo MV, Brininger TL, Lim Reed M. Association between back, neck, and upper extremity musculoskeletal pain and the individual body armor. J Hand Ther Off J Am Soc Hand Ther. 2008;21(2):143–8; quiz 149.

    Article  Google Scholar 

  57. Carragee EJ. Overview of axial skeleton injuries: burden of disease. J Am Acad Orthop Surg. 2012;20(Suppl 1):S18–S22.

    Article  PubMed  Google Scholar 

  58. Warr BJ, Heumann KJ, Dodd DJ, Swan PD, Alvar BA. Injuries, changes in fitness, and medical demands in deployed National Guard soldiers. Mil Med. 2012;177(10):1136–42.

    Article  PubMed  Google Scholar 

  59. Clays EDBD, Leynen F, Kornitzer M, Kittel F, De Backer G. The impact of psychosocial factors on low back pain: longitudinal results from the Belstress study. Spine. 2007;32(2):262–8.

    Article  PubMed  Google Scholar 

  60. Gilgil EKC, Bütün B, Tuncer T, Urhan S, Yildirim C, Sünbüloglu G, Arikan V, Tekeoglu I, Oksüz MC, Dündar U. Prevalence of low back pain in a developing urban setting. Spine. 2005;30(9):1093–8.

    Article  PubMed  Google Scholar 

  61. Bejia IYM, Jamila HB, Khalfallah T, Ben Salem K, Touzi M, Akrout M, Bergaoui N. Prevalence and factors associated to low back pain among hospital staff. Jt Bone Spine. 2005;72(3):254–9.

    Article  Google Scholar 

  62. Gourmelen JCJ, Ozguler A, Lanoe JL, Ravaud JF, Leclerc A. Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys. Ann Readapt Med Phys. 2007;50(8):640–4.

    Article  CAS  PubMed  Google Scholar 

  63. Strine TWHJUS. National prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57(4):656–65.

    Article  PubMed  Google Scholar 

  64. Leboeuf-Yde CNJ, Kyvik K O, Fejer R, Hartvigsen J. Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskelet Disord. 2009;10:39.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Strowbridge NF. Musculoskeletal injuries in female soldiers: analysis of cause and type of injury. J R Army Med Corps. 2002;148(3):256–8.

    Article  CAS  PubMed  Google Scholar 

  66. Feuerstein M, Berkowitz SM, Haufler AJ, Lopez MS, Huang GD. Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. Am J Ind Med. 2001;40(6):627–38.

    Article  CAS  PubMed  Google Scholar 

  67. Gemmell IM. Injuries among female Army recruits: a conflict of legislation. J R Soc Med. 2002;95(1):23–7.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Hart LGDR, Charkin DC. Physician office visits of low back pain: frequency, clinical evaluation, and treatment patterns from a US national survey. Spine. 1995;20:11–9.

    Article  CAS  PubMed  Google Scholar 

  69. Knox JB, Orchowski JR, Owens B. Racial differences in the incidence of acute low back pain in United States military service members. Spine (Phila Pa 1976). 2012;37(19):1688–92.

    Article  Google Scholar 

  70. Cohen SP, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels SA. Diagnoses and factors associated with medical evacuation and return to duty for service members participating in operation Iraqi freedom or Operation Enduring Freedom: a prospective cohort study. The Lancet. 2010;375(9711):301–9.

    Article  Google Scholar 

  71. Barrett DH, Doebbeling CC, Schwartz DA, et al. Posttraumatic stress disorder and self-reported physical health status among U.S. military personnel serving during the Gulf War period: a population-based study. Psychosomatics. 2002;43(3):195–205.

    Article  PubMed  Google Scholar 

  72. Shaw WS, Means-Christensen AJ, Slater MA, et al. Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain. Pain Med. 2010;11(9):1391–400.

    Article  PubMed  Google Scholar 

  73. Feuerstein M, Berkowitz SM, Huang GD. Predictors of occupational low back disability: implications for secondary prevention. J Occup Environ Med (American college of occupational and environmental medicine). 1999;41(12):1024–31.

    Article  CAS  PubMed  Google Scholar 

  74. Schoenfeld AJCPA. American combat spine surgery in the modern period (2001-present): a history and review of current literature. J Spinal Res Found. 2012;7(1):33–9.

    Google Scholar 

  75. Hardaway RM 3rd. Viet Nam wound analysis. J Trauma. 1978;18(9):635–43.

    Article  PubMed  Google Scholar 

  76. Parsons TW 3rd, Lauerman WC, Ethier DB, et al. Spine injuries in combat troops–Panama, 1989. Mil Med. 1993;158(7):501–2.

    PubMed  Google Scholar 

  77. Blair JA, Patzkowski JC, Schoenfeld AJ, et al. Spinal column injuries among Americans in the global war on terrorism. J Bone Joint Surg. Am Vol. 2012;94(18):e135(131–9).

    Article  Google Scholar 

  78. Comstock S, Pannell D, Talbot M, Compton L, Withers N, Tien HC. Spinal injuries after improvised explosive device incidents: implications for tactical combat casualty care. J Trauma. 2011;71(5 Suppl 1):S413–7.

    Article  PubMed  Google Scholar 

  79. Schoenfeld AJ, Newcomb RL, Pallis MP, et al. Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan: a study of 2089 instances of spine trauma. J Trauma Acute Care Surg. 2013;74(4):1112–8.

    Article  PubMed  Google Scholar 

  80. Possley DR, Blair JA, Freedman BA, Schoenfeld AJ, Lehman RA, Hsu JR. The effect of vehicle protection on spine injuries in military conflict. Spine J. 2012;12(9):843–8.

    Article  PubMed  Google Scholar 

  81. Schoenfeld AJ, Goodman GP, Belmont PJ Jr. Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during operation Iraqi freedom. Spine J. 2012;12(9):771–6.

    Article  PubMed  Google Scholar 

  82. Possley DR, Blair JA, Schoenfeld AJ, Lehman RA, Hsu JR. Complications associated with military spine injuries. Spine J. 2012;12(9):756–61.

    Article  PubMed  Google Scholar 

  83. Helgeson MD, Lehman RA Jr, Cooper P, Frisch M, Andersen RC, Bellabarba C. Retrospective review of lumbosacral dissociations in blast injuries. Spine (Phila Pa 1976). 2011;36(7):E469–75.

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Surgery Service, Tripler Army Medical Center, 96859, Honolulu, HI, USA

    MAJ Jeffrey B. Knox MD & COL Joseph Orchowski MD

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  1. MAJ Jeffrey B. Knox MD
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Correspondence to Jeffrey B. Knox MD .

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Editors and Affiliations

  1. Keller Army Hospital, West Point, New York, USA

    Kenneth L. Cameron

  2. Keller Army Hospital, West Point, New York, USA

    Brett D. Owens

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Knox, J., Orchowski, J. (2016). Thoracic and Lumbar Spine Injuries. In: Cameron, K., Owens, B. (eds) Musculoskeletal Injuries in the Military. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2984-9_12

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