Overview of axial skeleton injuries: burden of disease

Axial skeletal injury and related illness is a major cause of medical disability and force attrition in deployed service members. Predeployment identification of at-risk personnel is unreliable. Risk of axial skeletal injury or illness during deployment is heterogeneous. Major spinal trauma casualties are uncommon, accounting for 1% of casualties, and are usually related to battle injuries. These major spinal injuries are often associated with multiple system/anatomic injuries. Spinal cord injuries account for 18% of major spinal injuries in persons with battle-related spinal injury. Non-battle spine pain, that is, back or neck area pain not associated with major trauma, is a significant force attrition problem, accounting for 40% of all combat casualty evacuation in some years. Personnel attrition due to neck and back pain not associated with major trauma is highly variable by unit and exposure, including psychological exposure. Return-to-duty rates for both traumatic and atraumatic spine injuries is poor (≤15%); this rate is predicted by psychological comorbidities.