Skip to main content

Cervical Spine and Neck Injuries

  • Chapter
  • First Online:
Musculoskeletal Injuries in the Military

Abstract

Cervical spine and neck injuries are becoming increasingly recognized as significant contributors to morbidity and mortality in the USA and Coalition Armed Forces. Throughout history, combat-related spinal injury has been recognized as rare but severe, often associated with other devastating injuries and a high mortality rate. In today’s military, both atraumatic “spine pain” and combat injury have had deleterious effects on force readiness, while recent literature has suggested that the rate of cervical injury in the current conflicts in Iraq and Afghanistan may be the highest ever recorded. These injury patterns continue to be associated with significant mortality. Evolving literature is beginning to shed light on this previously under-recorded but substantial aspect of combat-related injury as well as the limits of intervention in hostile environments. It is therefore highly important to understand the history, epidemiology, characterization, and treatment protocols for these injuries to maximize military capabilities in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Colton CL. The history of fracture treatment. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma. 3rd ed. Philadelphia: Saunders; 2003. p. 3e28.

    Google Scholar 

  2. Filler AG. A historical hypothesis of the first recorded neurosurgical operation: Isis, Osiris, Thoth, and the origin of the djed cross. Neurosurg Focus. 2007;23:E6.

    PubMed  Google Scholar 

  3. Gabriel RA, Metz KS. Contributions in military studies: a history of military medicine. New York: Greenwood Press; 1992.

    Google Scholar 

  4. Goodrich JT. History of spine surgery in the ancient and medieval worlds. Neurosurg Focus. 2004;16:E2.

    Article  PubMed  Google Scholar 

  5. Kumar K. Spinal deformity and axial traction. Historical perspective. Spine. 1996;21:653e5.

    Google Scholar 

  6. Schoenfeld AJ, Belmont PJ, Weiner BK. A history of military spine surgery. Spine J. 2012;
12:729–36.

    Article  PubMed  Google Scholar 

  7. Breasted JH. The Edwin Smith surgical papyrus. Chicago: University of Chicago Press; 1930.

    Google Scholar 

  8. Hanigan WC, Sloffer C. Nelson’s wound: treatment of spinal cord injury in 19th and early 20th century military conflicts. Neurosurg Focus. 2004;16:E4.

    Article  PubMed  Google Scholar 

  9. Hays I, ed. The American journal of the medical sciences. Philadelphia: Henry C. Lea; 1867.

    Google Scholar 

  10. Otis GA, ed. The medical and surgical history of theWar of the Rebellion (1861–1865). Surgical 
history. Volume II. Washington, DC: GPO; 1870.

    Google Scholar 

  11. Otis G. Surgical cases treated in the Army of the United States from 1865–1871. Washington, DC: Government Printing Office; 1871.

    Google Scholar 

  12. Belmont PJ Jr., Schoenfeld AJ, Goodman GP. Epidemiology of combat wounds in operation Iraqi freedom and Operation Enduring Freedom: orthopaedic burden of disease. J Orthop Surg Adv. 2010;19:2e7.

    Google Scholar 

  13. Schoenfeld AJ, et al. Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during operation Iraqi freedom. Spine J. 2012;12:771–6.

    Article  PubMed  Google Scholar 

  14. Bohlman HH. Acute fractures and dislocations of the cervical spine. J Bone Joint Surg Am. 1979;61:1119–42.

    CAS  PubMed  Google Scholar 

  15. Demetriades D, Charalambides K, Chahwan S, et al. Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls. J Trauma. 2000;48:724–7.

    Article  CAS  PubMed  Google Scholar 

  16. Ryan MD, Henderson JJ. The epidemiology of fractures and fracture dislocations of the cervical spine. Injury 1992;23:38–40.

    Article  CAS  PubMed  Google Scholar 

  17. Burney RE, Maio RF, Maynard F, Karunas R. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America. Arch Surg. 1993;128:596–9.

    Article  CAS  PubMed  Google Scholar 

  18. Dryden DM, Saunders LD, Rowe BH, et al. The epidemiology of traumatic spinal cord injury in Alberta, Canada. Can J Neurol Sci. 2003;30:113–21.

    PubMed  Google Scholar 

  19. Hu R, Mustard CA, Burns C. Epidemiology of incident spinal fracture in a complete population. Spine. 1996;21:492–9.

    Article  CAS  PubMed  Google Scholar 

  20. Jackson AB, Dijkers M, Devivo M, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil. 2004;85:1740–8.

    Article  PubMed  Google Scholar 

  21. Lowery DW, Wald MM, Browne BJ, et al. NEXUS Group. Epidemiology of cervical spine injury victims. Ann Emerg Med. 2001;38:12–6.

    Article  CAS  PubMed  Google Scholar 

  22. Schoenfeld AJ, Sielski B, Rivera KP, Bader JO, Harris MB. Epidemiology of cervical spine fractures in the US military. Spine J. 2012;12(9):777–83.

    Article  PubMed  Google Scholar 

  23. Kahraman S, Gonul E, Kayali H, et al. Retrospective analysis of spinal missile injuries. Neurosurg Rev. 2004;27:42–5.

    Article  PubMed  Google Scholar 

  24. Schoenfeld AJ, 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):1112–8.25

    Article  PubMed  Google Scholar 

  25. Blair JA, et al. Are spine injuries sustained in battle truly different? Spaine J. 2012;12:824–9.

    Article  Google Scholar 

  26. Department of Defense. “Operation Enduring Freedom (OEF) U.S. Casualty Status” and “Operation Iraqi Freedom (OEF) U.S. Casualty Status” Fatalities as of February 5, 2013, 10 a.m. EDT. 2013. http://www.defense.gov/news/casualty.pdf. Accessed 6 Jan 2013.

  27. Carragee, EJ. Marching home again (Editorial): spine casualties, combat exposure, and the long wars. Spine J. 2012;12:723–6.

    Article  PubMed  Google Scholar 

  28. Hoeffler DF, Melton LJ. Changes in the distribution of Navy and Marine Corps casualties from World War I through the Vietnam conflict. Mil Med. 1981;146:776–9.

    CAS  PubMed  Google Scholar 

  29. Cohen SP, Brown C, Kurihara C, et al. 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. Lancet. 2010;375:301–9.

    Article  PubMed  Google Scholar 

  30. Cohen SP, Gallagher RM, Davis SA, Griffith SR, Carragee EJ. Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment. Spine J. 2012;
12:833–42.

    Article  PubMed  Google Scholar 

  31. Cohen SP, Kapoor SG, Nguyen C, et al. Neck pain during combat operations: an epidemiological study analyzing clinical and prognostic factors. Spine. 2010;35:758–63.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi freedom and Operation Enduring Freedom. J Trauma. 2008;64(2):295–9.

    Article  PubMed  Google Scholar 

  34. Champion HR, Holcomb JB, Young LA. Injuries from explosions: physics, biophysics, pathology, and required research focus. J Trauma. 2009;66:1468–77. (discussion 1477)

    Article  PubMed  Google Scholar 

  35. DePalma RG, Burris DG, Champion HR, Hodgson MJ. Blast injuries. N Engl J Med. 2005;352:1335–42.

    Article  CAS  PubMed  Google Scholar 

  36. Hayda R, Harris RM, Bass CD. Blast injury research: modeling injury effects of landmines, bullets, and bombs. Clin Orthop Relat Res. 2004;422:97–108.

    Google Scholar 

  37. Ramasamy A, Hill AM, Clasper JC. Improvised explosive devices: pathophysiology, injury profiles and current medical management. J R Army Med Corps. 2009;155:265–72.

    Article  CAS  PubMed  Google Scholar 

  38. Kang DG, et al. Wartime spine injuries: understanding the improvised explosive device and biophysics of blast trauma. Spine J. 2012;12:849–57.

    Article  PubMed  Google Scholar 

  39. Belmont PJ, et al. 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):204–10.

    Article  PubMed  Google Scholar 

  40. Jankovic S, Busic Z, Primorac D. Spine and spinal cord war injuries during the war in Croatia. 
Mil Med. 1998;163:847–9.

    CAS  PubMed  Google Scholar 

  41. Klimo P Jr, Ragel BT, Rosner M, et al. Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus. 2010;28:E4.

    Article  PubMed  Google Scholar 

  42. Blair JA, et al. Military penetrating spine injuries compared with blunt. Spaine J. 2012;
12:762–8.

    Article  Google Scholar 

  43. Patzkowski JC, et al. Multiple associated injuries are common with spine fractures during war. Spine J. 2012;12:791–7

    Article  PubMed  Google Scholar 

  44. Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. J Neurosurg Spine. 2010;12:131–40.

    Article  PubMed  Google Scholar 

  45. Holcomb JB, Stansbury LG, Champion HR, et al. Understanding combat casualty care statistics. J Trauma. 2006;60:397–401.

    Article  PubMed  Google Scholar 

  46. Reister FA. Battle casualties and medical statistics: U.S. Army experience in the Korean war. Washington, DC: Surgeon General, Department of the Army; 1973.

    Google Scholar 

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

    Google Scholar 

  48. Breeze J, et al. Mortality and morbidity from combat neck injury. J Trauma. 2012;72(4):969–74.

    Google Scholar 

  49. Joint Theater Trauma System Clinical Practice Guideline: Cervical and Thoracolumbar spine injury: Surgical Management and Transport. 2012. http://www.usaisr.amedd.army.mil/assets/cpgs/Cervical_and_Thoracolumbar_Spine_Injury_9_Mar_12.pdf. Accessed 6 Jan 2013.

  50. Burris DG, Dougherty PJ, Elliot DC, et al. eds. Emergency war surgery. Washington, DC: Borden Institute, Walter Reed Army Medical Center; 2004.

    Google Scholar 

  51. Joint Theater Trauma System Clinical Practice Guideline: Cervical spine evaluation and non-surgical management. 2012. http://www.usaisr.amedd.army.mil/assets/cpgs/Cervical_Spine_Evaluation_19_Mar_12.pdf. Accessed 6 Jan 2013.

  52. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Scott C. Wagner MD, MC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this chapter

Cite this chapter

Wagner, S., Lehman, R. (2016). Cervical Spine and Neck 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_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2984-9_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2983-2

  • Online ISBN: 978-1-4939-2984-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics