Management Of Unstable Cervical Spine Injuries In Southern Iraq During OP TELIC

Abstract

IntroductionCervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3. MethodologyThe MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries. ResultsForty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier.Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7,one unifacetal dislocation and one bifacetal dislocation. ConclusionsFive casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK.

Spinal Fractures in Current Military Deployments

“…Cervical spine injuries have been the subject of considerable interest in the military medical literature in terms of injury distribution and subsequent pre-hospital stabilisation [11][12][13]. Bird et al [11] report a case series of five cervical spine fractures caused by non-ballistic mechanisms from the Iraq conflict.…”

“…Bird et al [11] report a case series of five cervical spine fractures caused by non-ballistic mechanisms from the Iraq conflict. This characterises the injury pattern seen in periods of peace support missions where the majority of spinal injuries are due to Road Traffic Accidents (RTAs) or falls from height.…”

“…Traditionally associated with military aviators [7,8] and parachutists [9,10], the distribution of injury to the spine in those injured in ground operations, particularly those resulting from explosive devices is less well understood. Recent publications have either concentrated on pre-hospital stabilisation of the cervical spine [11][12][13], detailed combat experiences from distant conflicts [14][15][16][17][18][19][20] or have been confined to gunshot wounding (GSW), predominately in civilian populations [21][22][23][24][25].…”

Chinese expert consensus on the treatment of modern combat-related spinal injuries

“…If surgery is not planned for patients with unstable spine fractures, the patients can be evacuated after spine immobilization with cervical collars, Halo braces, and head, cervical, thoracic and lumbar braces [49]. Among these fixations, the Halo brace is commonly used by the following method.…”

Specialisation of spinal services: consequences for cervical trauma management in the district hospital

“…Methods of immobilisation of the injured cervical spine include cervical orthotics (hard cervical collar), head cervical orthotics (Philadelphia collar and Miami-J collar), cervical traction, and halo-vest immobilisation. The halo vest is the most rigid of all cervical orthoses [ 1 ], and represents the immobilisation method of choice when preparing patients for transfer between hospitals [ 2 ].…”