Spinal Injuries: Preservation of Combat Mobility

Spinal trauma represents one of the most complex and high-consequence injuries encountered in combat environments. From blunt trauma sustained in vehicle rollovers and falls to penetrating and blast-related vertebral injuries, spinal insults can lead to catastrophic neurological outcomes and permanent disability. In the absence of advanced diagnostics and surgical support, frontline providers must rapidly identify signs of spinal injury, initiate motion restriction, manage associated neurogenic shock, and coordinate safe evacuation. This chapter offers a comprehensive, field-adapted framework for managing spinal injuries in austere, high-threat environments, grounded in the MARCH protocol and the FORCE doctrine. It outlines mechanisms of injury, classification of spinal cord syndromes, and the approach to diagnosis and stabilization under tactical constraints. Special emphasis is placed on improvisation techniques using battlefield materials for spinal motion restriction, manual handling strategies, field analgesia, and evacuation logistics. The chapter also explores key elements of definitive care, including surgical decompression, neurocritical monitoring, and rehabilitative planning, with a case-based approach that highlights real-world application and outcome optimization. Through this structured yet adaptable model of care, the chapter reinforces the principle that spinal injury management begins at the point of injury—and that combat providers, through vigilance, innovation, and protocol adherence, play a critical role in preserving combat mobility and life.