Incidence and Risk Factors for Lumbar Degenerative Disc Disease in the United States Military 1999–2008

Department of Orthopedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920, USA.
Military medicine (Impact Factor: 0.77). 11/2011; 176(11):1320-4. DOI: 10.7205/MILMED-D-11-00061
Source: PubMed


The epidemiology of lumbar degenerative disc disease (DDD) is poorly understood, and the incidence of this disorder has not previously been characterized for a young, physically active population. This study sought to evaluate the incidence of lumbar DDD, and identify risk factors for its development, among individuals serving in the U.S. military over a 10-year period. The Defense Medical Epidemiology Database was queried for the years 1999-2008 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for lumbar disc degeneration (722.52). Overall incidence was determined and multivariate Poisson regression analysis was performed to identify risk factors among demographic characteristics such as age, sex, race, military rank, and branch of service. White race, female sex, Army, Air Force, or Marine service, enlisted positions within the ranks, and age were found to be significant risk factors for the development of lumbar disc degeneration. Increased age appeared to be one of the most important risk factors, with adjusted incidence rates successively increasing for each age group under study. The incidence of lumbar DDD in this young, racially diverse, and physically active population is higher than most other degenerative conditions.

Full-text preview

Available from:
  • Source
    • "The epidemiological focus on spine injuries sustained during the current conflicts has steadily increased over the past decade, largely due to the rising incidence of high-energy axial load injuries resulting from a mounted blast mechanism [13] [14] [15]. When also considering non-combat etiologies, the prevalence of overuse spine injuries has also increased due to the heavy occupational demands of military service [16] [17]. In the current study, spine complaints accounted for 7.9% of all consultations and 7.1% of all medical evacuations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Since its advent, telemedicine has facilitated access to subspecialty medical care for the treatment of patients in remote and austere settings. The United States military introduced a formal orthopaedic teleconsultation system in 2007, but few reports have explored its scope of practice and efficacy, particularly in a deployed environment during a time of conflict. All teleconsultations placed to the orthopaedic service between April 2009 and December 2012 were obtained and retrospectively reviewed. Case files were abstracted and anatomical location of injury, type of injury, origin of consult (country or Navy Afloat), branch of service, and treatment recommendations, were recorded for descriptive analysis. The final result of the consult was also determined, with service members transported from the combat theatre or deployment location defined as medically evacuated. Instances where teleconsultations averted a medical evacuation were also documented as a separate outcome. Over a 32-month period, 597 orthopaedic teleconsultations were placed, with the majority derived from Army (46%) and Navy (32%) personnel deployed in Afghanistan, Iraq, or with Navy Afloat. Approximately 51% of consults involved the upper extremity, including 197 hand injuries, followed by lower extremity (37%) and spine (7.8%) complaints. Fractures comprised over half of all injuries, with the hand and foot most commonly affected. The average response time for teleconsultations was 7.54h. A total of 56 service members required immediate evacuation for further orthopaedic management, while at least 26 medical evacuations were prevented due to the teleconsultation system. The teleconsultation system promotes early access to orthopaedic subspecialty care in a resource-limited, deployed military setting. The telemedicine network also appears to mitigate unnecessary aeromedical evacuations, reducing healthcare costs, lost duty time, and treatment delays. These findings have important meaning for the future of telemedicine in both the military and civilian setting. LEVEL OF EVIDENCE: IV.
    Full-text · Article · Mar 2014 · Injury
  • Source
    • "IDD is perhaps best defined as a cascade that begins with changes to the cellular microenvironment and progresses to the structural breakdown and functional impairment of the intervertebral disc [6]. Aging, living conditions, biomechanical loading and genetic factors are often related to disc degeneration [7,8]. Prominent changes occurring during IDD are characterized by a decrease of active cell numbers, depletion of extracellular matrix, altered phenotype of normal disc cells, and the presence of pro-inflammatory cytokines and mediators [9,10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intervertebral disc degeneration (IDD) is a common orthopedic disease associated with mechanical changes that may result in significant pain. Current treatments for IDD mainly depend on conservative therapies and spinal surgeries that are only able to relieve the symptoms but do not address the cause of the degeneration and even accelerate the degeneration of adjacent segments. This has prompted research to improve our understanding of the biology of intervertebral disc healing and into methods to enhance the regenerative process. Recently, biological therapies, including active substances, gene therapy and tissue engineering based on certain cells, have been attracting more attention in the field of intervertebral disc repair and regeneration. Early selection of suitable biological treatment is an ideal way to prevent or even reverse the progressive trend of IDD. Growth factors have been enjoying more popularity in the field of regeneration of IDD and many have been proved to be effective in reversing the degenerative trend of the intervertebral disc. Identification of these growth factors has led to strategies to deliver platelet-derived factors to the intervertebral disc for regeneration. Platelet-rich plasma (PRP) is the latest technique to be evaluated for promoting intervertebral disc healing. Activation of the PRP leads to the release of growth factors from the α-granules in the platelet cytoplasm. These growth factors have been associated with the initiation of a healing cascade that leads to cellular chemotaxis, angiogenesis, synthesis of collagen matrix, and cell proliferation. This review describes the current understanding of IDD and related biological therapeutic strategies, especially the promising prospects of PRP treatment. Future limitations and perspectives of PRP therapy for IDD are also discussed.
    Full-text · Article · Oct 2013 · Arthritis research & therapy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gunshot wounds are an important cause of both morbidity and mortality within the military. With the deployment of the United States military into a two theater campaign over the past decade, the role of gunshot wounds in military personnel has come to the forefront. Gunshot wounds are often used and glamourized in popular culture. They are also fascinating to clinicians due to the difficulty in assessing such patients for injuries and treatment options.(1) Gunshot wounds also provide an opportunity to develop certain aspects of trauma management.(2) Walker et al. provide a coherent analysis of gunshot wounds to US military personnel during this period.(3).
    Preview · Article · Apr 2012 · International Journal of Surgery (London, England)
Show more