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More powerful roadside bombs lead to increase in spinal injuries among troops

LANDSTUHL, Germany - Stronger armored vehicles are preventing more servicemembers in Afghanistan from being killed by roadside bombs. But the bombs are still powerful enough to cause severe skeletal and spinal injuries, the worst of which are leaving some paralyzed, Army surgeons say.

Mine Resistant Ambush Protected vehicles, or MRAPs, have V-shaped armored hulls, designed to protect riders from a bomb’s shrapnel and firepower. The bomb’s immense energy is also absorbed by the vehicle. But as insurgents try to counter the vehicles’ protections with bigger blasts, much more of this energy is reaching soldiers’ bodies, especially their spines.

This has led to a new type of broken-back injury called a combat burst fracture, said Army Dr. (Maj.) Brett Freedman, director of spine and neurosurgery service at Landstuhl Regional Medical Center in Germany.

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The results can be devastating: limited movement, chronic back pain, even paralysis.

“Dead nerves,” Freedman said, “like dead people, don’t ever regenerate.”

A combat burst fracture occurs when a bomb’s pressure travels through the feet, legs or pelvis of any servicemember harnessed to a truck’s seats. Since the spine is rigid against the seat, the upward pressure pancakes the spine. With enough force, the energy cracks one or more vertebrae, Freedman said.

“This triangular fragment of bone,” he said, “then shoots out backwards, and that’s where the spinal nerves live.”

After examining data from August 2007 through October 2009, Freedman found that 33 servicemembers in Iraq and Afghanistan had suffered burst fractures in combat, and that 13 of those injuries occurred during a two-month period in the summer of 2009.

During those two months, Freedman said, servicemembers were seven times more likely to suffer this injury than in the previous two years. Of those 13 servicemembers who suffered this newly identified injury, five servicemembers were left paralyzed. “This is almost a pure vertical force,” he said. “That does not happen in civilian trauma other than a fall from height.”

Freedman and colleagues are waiting for approval to sift through the last year of data and patient CT scans, looking for more evidence of burst fractures. “We know it’s real and not a statistical anomaly,” he said.

With some combat burst injuries, the damage to the spinal cord causes paralysis. And more than 60 percent of Freedman’s subjects had some form of neurological impairment, including partial loss of movement, as well as loss of bowel and bladder control, and sexual function.

“This is a young healthy kid who is now permanently damaged,” Freedman said.

In addition to spinal injuries, troops can suffer shattered bones in the feet and ankles. And when larger blasts hurl the heavy armored trucks into the air, concussions and other physical damage can occur.

Freedman plans to compare his data with that of the military’s forensic investigators to determine exactly what factors — seating position, vehicle type and force of explosion, among others — are contributing to combat burst injuries.

In an attempt to prevent these broken-back injuries, late last year the military sent 100 MRAPs to Afghanistan with energy-absorbing seats, said retired Col. John Rooney, deputy chief engineer for the Joint Program Office of MRAPs. He was unable to give details about these new seats because that information is classified, he said.

Other prevention options include seats on a rail that can absorb not only the energy from the blast, but can also shield servicemembers from the force of the truck slamming into the ground, Rooney said. The military is also testing energy-absorbing flooring, harnesses and boots.

“It’s all about finding ways to strip away pieces of the energy such that the body doesn’t have to deal with it,” he said.

Rooney said more than 25,000 troops traveling in MRAPs have survived roadside bomb blasts, even as enemy fighters try to find new and devastating ways to blow them up. “We are very familiar with what the threat is,” he said, “what the forces are, and what we have to mitigate.”

robbinss@estripes.osd.mil

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