Pain Management Division, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
Spine J. 2012 Sep;12(9):833-42. doi: 10.1016/j.spinee.2011.10.010. Epub 2011 Nov 18.
Nonbattle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.
To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.
Literature review.
Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.
Spine-area pain is the most common injury or complaint "in garrison" and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.
Spine-area pain syndromes comprise a major source of unit attrition and are often the result of duty-related burdens incurred during combat operations. Current strategies in theaters of operation that may improve the low RTD rates include individual and unit level psychological support, early resumption of at least some forward-area duties, multimodal treatments, and ergonomic modifications.
非战斗伤病是现代战争中部队减员的主要原因。脊柱区疼痛是与极低归队率（RTD）相关的现役军人常见致残性损伤。
概述现役军人脊柱区疼痛综合征的流行病学、可能原因和相对预后，包括讨论战区内各种治疗选择。
文献回顾。
使用电子数据库、教科书、文献参考和个人资料，聚焦于流行病学、病因和相关因素以及脊柱疼痛的治疗进行搜索。
脊柱区疼痛是“驻地”最常见的损伤或抱怨，且似乎在训练和战斗部署期间增加。大约四分之三涉及下腰痛，其次是颈痛和中背痛综合征。与脊柱区疼痛相关的一些预测因素与在平民队列中观察到的因素相似，例如心理困扰、体力活动繁重和更久坐的生活方式。与军人相关的特定风险因素包括同时发生的心理创伤、飞行员和空勤人员的 g 力暴露、极端冲击和振动暴露、繁重的战斗负荷要求以及在空降、空中突击和城市徒步地面作战中跌倒。在前沿地区实施有效的治疗一直很困难，但新策略可能会提高 RTD 率。
脊柱区疼痛综合征是部队减员的主要原因，通常是战斗行动中因职责相关负担造成的。战区内可能提高低 RTD 率的当前策略包括个人和单位层面的心理支持、至少部分提前恢复前沿地区的工作、多模式治疗和人体工程学改造。
