Research Letter: Prevalence of Spine Injuries Among US Military Personnel With Combat-Related Concussion

Abstract

Objective: To describe the prevalence of spine injuries among US service members with combat-related concussion. Design and Participants: A retrospective review of medical records for US service members injured during combat operations in Iraq and Afghanistan between 2002 and 2020. The study sample included 27 897 service members categorized into 3 groups: concussion with loss of consciousness (LOC, n = 4631), concussion non-LOC (n = 5533), and non-concussion (n = 17 333). Main Measures: Spine injuries were identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and classified by body region and nature of injury using the Barell injury diagnosis matrix. Differences in prevalence of spine injuries by concussion group were evaluated using χ2 tests. Results: Spine injuries were most prevalent among service members with concussion LOC (31.1%), followed by concussion non-LOC (18.3%), and non-concussion (10.0%, P < .001). Sprains and strains were the most prevalent spine injury category, with injuries to the cervical, thoracic, and lumbar regions significantly more prevalent in the concussion groups (P values < .001), particularly individuals with LOC compared with non-concussion. Conclusion: The US military personnel with combat-related concussion, especially individuals with LOC, may also have spine injuries. Routine assessment for spine injury is recommended during concussion screening because this may impact clinical management and rehabilitation.