Combat related spine and spinal cord injuries: a systematic literature review and meta-analysis

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Objective. To study the epidemiology and clinical features of spinal injuries and wounds in combat situations. Material and Methods. A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Cochrane Library databases. Statistical analysis of the data was performed using the R statistical programming language in the RStudio integrated development environment. The meta and metafor libraries were used for meta-analysis. The Knapp-Hartung correction was used to calculate the confidence intervals of the pooled effects. Results. Of the 30 full-text articles, 11 met the required criteria and were included in this review with STROBE assessment. The mean age of the injured was 26.58 years (95 % CI: 25.8–27.4 years; I 2 = 0 %; p = 0.65), males accounted for 98 % (95 % CI: 98–99; I 2 = 37 %; p = 0.1), closed spinal cord injury was diagnosed in 47.11 % of cases (95 % CI: 28.83–66.19 %; I 2 = 99 %; p < 0,01), and gunshot wounds – in 43.64 % (95 % CI: 23.94–65.59 %; I 2 = 99 %; p < 0.01). Cervical injures were recorded in 32.13 % of cases (95 % CI: 17.75–50.94 %; I 2 = 95.1 %; p < 0.01), thoracic injuries – in 34.28 % (95 % CI: 22.58–48.27 %; I 2 = 88 %; p < 0.01), lumbar injuries – in 57.16 % (95 % CI: 44.52–68.92 %; I 2 = 97.5 %; p < 0.01), and sacral – in 21.23 % of cases (95 % CI: 16.99–26.21 %; I 2 = 76 %; p < 0.01). Conclusion. The results emphasize the peculiarities of the modern epidemiology of combat related spine and spinal cord injuries and wounds. Conflicts of the 21st century are characterized by the predominance of mine and explosive action; as a rule, young people suffer, the overwhelming majority of them are men; at least 30 % of wounded with gunshot injuries to the spine require surgical treatment. The vast majority of authors choose isolated posterior fixation. The most common complications include thromboembolic complications, urinary tract infections, pneumonia and bedsores.

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