Axial spine injuries in the current conflicts in Iraq and Afghanistan.

The burden of injury to the axial skeleton has been substantial relative to the conflicts in Iraq and Afghanistan.A coordinated treatment algorithm is required that begins with the first encounter on the battlefield and continues through treatment at a facility in the continental United States. Translation of these spinal trauma classification systems to the battlefield requires that issues of expediency,operational limitations and restrictions, and personnel be addressed.Current staffing of far-forward echelons in theater may not include a spine-trained orthopaedic surgeon, neurosurgeon, or musculoskeletal specialist.The classification systems and treatment algorithms being used today were formed in the context of a civilian trauma setting. The ready availability of advanced medical imaging, sterile operating room theaters, and specialty-specific intensive care units in these civilian hospitals may make modern spinal trauma classification systems less applicable to a far-forward battlefield setting. However, efforts must be made to adapt current knowledge in the pursuit of a theater-specific, relevant pathway or philosophy of care for the spine-injured warrior, with implementation as far forward as feasible to ensure the best possible clinical outcome.