This study examines spinal cord injury in the United States Army Special Forces. This investigation was conducted by the Departments of Neurosurgery at the Mount Sinai Hospital and Cleveland Clinic. This research was conducted in collaboration with the U.S. Green Beret Foundation. The authors have no conflicts of interest to disclose. Combat-related spinal injuries are a large issue, comprising greater than 11 percent of U.S. casualties from the Iraq and Afghanistan wars. Spine trauma is present in greater than 38 percent full combat-related casualties. Importantly, military SCI differs from civilian SCI in that it often exists with polytrauma, has complex injury patterns, and soldiers or environments with limited access to surgical intervention. The long-term effects of SCI include reproductive and sexual impairment, cardiac disease, infections, and mental illness, which can be devastating. In 2013, the VA annual cost per patient with spinal cord injury was $44,000. That results in over $1.2 billion in direct costs for treating SCI in veterans annually. U.S. Army SF soldiers represent a disproportionate 60 percent of all special operations casualties. This is related to the extraordinary challenges of their missions in high-risk enemy environments and use of unconventional guerrilla warfare tactics. Yet, the incidence and etiologies of SCI in U.S. Army SF has not been previously studied. Hence, the objectives of the current study are to establish the current profile of war-related SCI in special forces, to identify incidents and mechanisms of injury to allow focused prevention efforts, and to address potential issues pertaining to personal protective equipment and use. Current inclusion criteria included being U.S. Army SF qualified and completing the neurological portion of the questionnaire. Data was collected through an online survey developed in collaboration with the Green Beret Foundation and the Departments of Neurosurgery at Mount Sinai and Cleveland Clinic. The data points collected included military background, demographics, medical and family history, and injuries. Inclusive statistics, chi-squares tests of independence, and two-tailed independent samples t-tests were employed for statistical analysis. Statistical significance was set at 0.05. 492 SF soldiers met inclusion criteria, giving a response rate of 8.2 percent. All SF soldiers are male, with a mean age of 51 years in this study, and there was a U.S. Army service range of 1945 to 2019. Overall, SCI diagnosis was reported by 19 percent of SF soldiers. There was a significant association found between being a pre-911 SF soldier and having an SCI diagnosis. Our results highlight that the leading cause of SCI was due to airborne operations. A majority of Green Berets were wearing headgear at the time of injury, while only a fraction, less than 40 percent, were wearing body armor at the time of spinal cord injury. Headgear use has remained consistent in both pre- and post-911 service members, though body armor use has increased in post-911 service members, as there is a significant association between being a post-911 service member and wearing body armor at the time of spinal cord injury. There were a number of comorbid conditions and mental illnesses associated with spinal cord injury, including traumatic brain injury, arthritis, low sperm count, low testosterone, erectile dysfunction, tinnitus, hyperacusis, and sleep apnea. Mental illnesses associated with SCI include post-traumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Being diagnosed with spinal cord injury was also associated with receiving disability compensation for brain injury and spine injury, though there was no significant association between being diagnosed with a spinal cord injury and receiving mental illness compensation. Only 16.5 percent of SF soldiers were medevaced at the time of SCI. Past research shows that spine-related injuries were a major cause of medical discharge from the military, and so our work explores spinal cord injury in an unexamined front-line cohort of combat military personnel, specifically the U.S. Army Special Forces. Airborne operations are reported to be the leading etiology of spinal cord injury in this study in both pre- and post-9-11 service members. The low rate of medevac rescue suggests that the medical rescue was either not attainable at the time or that certain spinal cord injuries were deemed minor at the time of injury. This diagram highlights the maneuver that SF soldiers employ upon parachute landing. As demonstrated, this can cause significant strain on the body and the spinal cord. So while parachute design and mechanics have remained relatively static for greater than 70 years, there's been other aspects of military equipment and experience that have changed. Despite this, our study indicates that there's a high SCI instance that's been sustained over time by U.S. Army SF. Though body armor use has significantly increased in post-9-11 service members, there is seemingly still a need for better-optimized technologies for the prevention of spinal cord injury. So future efforts are needed in prevention through engineering PPE or implementing new field protocols for suspected spinal cord injury. Lastly, there are, of course, a number of lessons that can be learned from military to civilian SCI and in civilian trauma care. We'd like to thank the staff at the U.S. Green Beret Foundation for their extensive assistance in the participant recruitment and for guiding us on designing survey questions related to the military background and the exposures. We'd also like to thank our military advisors, all of whom are from the U.S. Army Special Forces, for their invaluable counsel and their knowledge related to the global U.S. military operations and associated injuries. Thanks for listening. Feel free to check us out at sfneurosurgery.org to learn more about our work.

spinal cord injuries

United States Army Special Forces

study

war-related SCI

prevention efforts