Spinal Stabilization Using Orthopedic Extremity Instrumentation Sets during Operation Enduring Freedom-Afghanistan

Background The Role III, Multinational Medical Unit at Kandahar Air Field, Afghanistan, was established to provide combat casualty care in theater for International Security Assistance Forces, Afghanistan National Security Forces, and local nationals during Operation Enduring Freedom-Afghanistan. The authors describe their experience of treating unstable lumbar spine fractures with orthopedic extremity instrumentation sets from January 2007 to January 2008 and November 2010 to May 2011. Methods During the study periods, 15 patients comprising Afghanistan National Security Forces and local nationals presented to the medical facility for treatment of unstable lumbar spine fractures. The patients underwent surgery for either anterior corpectomy and instrumented fusion (n = 5) or posterior instrumented fusion (n = 10). Because of periodic scarcity of spinal instrumentation sets, orthopedic extremity instrumentation sets were used (Synthes Large Fragment LCP Instrument and Implant Set) for spinal stabilization. Results Immediate postoperative standing and sitting plain radiographs demonstrated no evidence of fracture progression or immediate hardware failure. One patient was seen in follow-up at 4 weeks and demonstrated construct stability on follow-up radiographs. Conclusions In the combat environment with sparse resources, unstable spine fractures may potentially be treated using instrumentation not specifically designed for spinal implantation. This is an off-label use, and the authors do not recommend the use of these techniques as standard treatment in most medical environments.