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US Department of Defense
BLAST INJURY RESEARCH
COORDINATING OFFICE
Advancing Blast Injury Research to Protect and Heal Those Who Serve

The Impact of Modern Warfare on the Nature of Spinal Injuries in Combat Trauma: A Retrospective Cohort Study


Access the full list of previous Research Highlights to learn about the latest accomplishments in blast-injury research.

Blasts and the Backbone: The Reality of Spinal Injuries in Modern Warfare

Study Design: Nationwide retrospective cohort study.

Objective: The study aimed to determine the incidence and characteristics of spinal injuries sustained by soldiers during the Israel-Hamas conflict.

Summary of Background Data:
In recent wars, advances in body armor and battlefield care have greatly improved survival rates. As more soldiers survive injuries that might once have been fatal, the types and patterns of spinal injuries seen in combat have also changed. These shifts highlight the evolving nature of combat trauma and the need to adapt medical care accordingly.

Methods:
A comprehensive review was conducted of medical records (Israel National Trauma Registry) for all soldiers hospitalized due to war injuries between October 9, 2023, and October 31, 2024. Researchers focused only on those with spinal injuries. They collected details such as age, type of injury (explosion, gunshot, etc.), severity, what treatments were needed, and what happened to the patients afterward.

Results:
Out of 2,182 hospitalized soldiers, 93 (about 4%) had spinal injuries, most often broken bones in the lower back (lumbosacral spine). Explosions were the main cause, followed by blunt force injuries and gunshot wounds. About half of these soldiers also had other serious injuries, and many of them were very severe or even critical. Nearly half required treatment in the intensive care unit, and about two-thirds went to rehabilitation centers after discharge. Sadly, approximately 5% died while in the hospital. Overall, soldiers with spinal injuries stayed in the hospital longer, required more intensive care, and were more likely to be hurt by blunt force and sustain multiple injuries at the same time.

Conclusion:
Spinal injuries are a significant challenge in modern combat, most often caused by high-energy blasts and commonly affecting the lower back. While most soldiers survive, these injuries can lead to long-term disabilities that place a heavy burden on the wounded, their families, and the healthcare system. In cases of severe injury or blunt trauma, clinicians should remain vigilant for spinal damage. However, as neurogenic shock is uncommon early on, alternative causes of hypotension should be prioritized in the initial assessment. Only a small number of patients ultimately require neurosurgical intervention. Advances in protective gear and battlefield care have improved outcomes, but further solutions are needed to lessen the lasting impact of these injuries.

References:

The Impact of Modern Warfare on the Nature of Spinal Injuries in Combat Trauma: A Retrospective Cohort Study. Shachar Shapira, Adi Givon, Roy Nadler, Alon Friedlander, Danny Epstein. Spine 2025 Aug 15;50(16) E324-E329 DOI: 10.1097/BRS.0000000000005397


Funding:

Information not available.

Last modified: 08-Sep-2025