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MINERVA ORTOPEDICA E TRAUMATOLOGICA

A Journal on Orthopedics and Traumatology


Official Journal of the Piedmontese-Ligurian-Lombard Society of Orthopedics and Traumatology
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Minerva Ortopedica e Traumatologica 2011 October;62(5):397-412

language: English

Thoracolumbar spine trauma in military environments

Stemper B. D. 1, Yoganandan N. 1, Paskoff G. R. 2, Fijalkowski R. J. 1, Storvik S. G. 1, Baisden J. L. 1, Pintar F. A. 1, Shender B. S. 2

1 Neuroscience Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA;
2 Aircraft Division, Naval Air Warfare Center, Patuxent River, MD, USA


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With increasing reports of traumas in ongoing wars around the world, it is important to delineate the spectrum and associated clinical biomechanics of spinal injuries in military environments. Ejections, helicopter crashes, and underbody blast loadings constitute the most common modes of injuries to this region of the human body. The purpose of this paper is to analyze clinical, descriptive, and biomechanical studies in these areas. While ejection-related injuries occur to the entire vertebral column, helicopter crash and underbody blast-related injuries are biased towards the dorsal region. Injuries are focused in the mid-thoracic areas for ejection and in the middle regions of the lumbar spine for the higher-rate loading scenarios. These patterns indicate that the primary mode of external load transmission, as well as rate at which the loading is applied, affect injury distributions within the anatomical structure. These distributions contrast civilian populations wherein the thoracolumbar junction is the most vulnerable region for acute trauma. Important biomechanical factors affecting trauma included loading rate, dynamic load level, occupant anthropometry, and posture/alignment with respect to the loading vector at the time of the transmission of the external load. The changing injury patterns resulting in caudal migration for underbody blast and rostral migration for ejection loadings may have implications in the treatment regimen.

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