Return-to-active-duty rates after anterior cervical spine surgery in military pilots

Miller, Charles A.; Boulter, Jason H; Coughlin, Daniel J.; Rosner, Michael; Neal, Chris J.; Dirks, Michael

doi:10.3171/2018.9.focus18380

Cited by 13 publications

(12 citation statements)

References 8 publications

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“…Success of an orthopaedic procedure is often dictated by the rate by which patients return to full function (such as preinjury levels of physical activity, or in the case of athletes, the rate of return to sport). In the military, return to duty is commonly reported as a way of describing a patient’s return to full function, or even equated to return to sport [2-4, 7, 11, 15, 19-24, 26, 29-32, 34-36, 38]. Because military studies often are used as a part of systematic reviews or meta-analyses that encompass both military and civilian patients, return to duty is a relevant outcome measure for civilian and military readers alike as they attempt to interpret these studies.…”

Section: Discussionmentioning

confidence: 99%

“…In athletes, this may be further specified in terms of the likelihood and timing of return to sport. In the military, a commonly used metric of functional outcome after orthopaedic surgery is return to duty [2-4, 7, 11, 15, 19-24, 26, 29-32, 34-36, 38]. Return to duty is an easily collectable data point for military patients, as soldiers who are unable to return to their physical duties are placed on a trackable mandated activity restriction, called a physical profile, which prevents them from participating fully in fitness requirements (such as group physical training, group sports, and the twice-yearly graded physical fitness test).…”

Section: Introductionmentioning

confidence: 99%

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Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Zalneraitis

Drayer

Nowak

et al. 2021

Clin Orthop Relat Res

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Background In the military, return-to-duty status has commonly been used as a functional outcome measure after orthopaedic surgery. This is sometimes regarded similarly to return to sports or as an indicator of return to full function. However, there is variability in how return-to-duty data are reported in clinical research studies, and it is unclear whether return-to-duty status alone can be used as a surrogate for return to sport or whether it is a useful marker for return to full function. Questions/purposes (1) What proportion of military patients who reported return to duty also returned to athletic participation as defined by self-reported level of physical activity? (2) What proportion of military patients who reported return to duty reported other indicators of decreased function (such as nondeployability, change in work type or level, or medical evaluation board)? Methods Preoperative and postoperative self-reported physical profile status (mandated physical limitation), physical activity status, work status, deployment status, military occupation specialty changes, and medical evaluation board status were retrospectively reviewed for all active-duty soldiers who underwent orthopaedic surgery at Madigan Army Medical Center, Joint Base Lewis-McChord from February 2017 to October 2018. Survey data were collected on patients preoperatively and 6, 12, and 24 months postoperatively in all subspecialty and general orthopaedic clinics. Patients were considered potentially eligible if they were on active-duty status at the time of their surgery and consented to the survey (1319 patients). A total of 89% (1175) were excluded since they did not have survey data at the 1 year mark. Of the remaining 144 patients, 9% (13) were excluded due to the same patient having undergone multiple procedures, and 2% (3) were excluded for incomplete data. This left 10% (128) of the original group available for analysis. Ninety-eight patients reported not having a physical profile at their latest postoperative visit; however, 14 of these patients also stated they were retired from the military, leaving 84 patients in the return-to-duty group. Self-reported “full-time duty with no restrictions” was originally used as the indicator for return to duty; however, the authors felt this to be too vague and instead used soldiers’ self-reported profile status as a more specific indicator of return to duty. Mean length of follow-up was 13 ± 3 months. Eighty-three percent (70 of 84) of patients were men. Mean age at the preoperative visit was 35 ± 8 years. The most common surgery types were sports shoulder (n = 22) and sports knee (n = 14). The subgroups were too small to analyze by orthopaedic procedure. Based on active-duty status and requirements of the military profession, all patients were considered physically active before their injury or surgery. Return to sport was determined by asking patients how their level of physical activity compared with their level before their injury (higher, same, or lower). We identified the number of other indicators that may suggest decreased function by investigating change in work type/level, self-reported nondeployability, or medical evaluation board. This was performed with a simple survey. Results Of the 84 patients reporting return to duty at the final follow-up, 67% (56) reported an overall lower level of physical activity. Twenty-seven percent (23) reported not returning to the same work level, 32% (27) reported being nondeployable, 23% (19) reported undergoing a medical evaluation board (evaluation for medical separation from the military), and 11% (9) reported a change in military occupation specialty (change of job description). Conclusion Return to duty is commonly reported in military orthopaedics to describe postoperative functional outcome. Although self-reported return to duty may have value for military study populations, based on the findings of this investigation, surgeons should not consider return to duty a marker of return to sport or return to full function. However, further investigation is required to see to what degree this general conclusion applies to the various orthopaedic subspecialties and to ascertain how self-reported return to duty compares with specific outcome measures used for particular procedures and subspecialties. Level of Evidence Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Zalneraitis

Drayer

Nowak

et al. 2021

Clin Orthop Relat Res

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“…The normal acceleration magnitude during ejection from the seat is 12 to 14 + Gz, and parachute opening shock can range from 10 to 20 + Gz [7]. Vertebral fractures occur frequently with forces greater than 20 + Gz, but with poor positioning, forces as low as 10 + Gz have caused fractures [7]. Sommer et al [14] found that military aircrew had a high risk of spinal injuries (56.3%) after emergency evacuation using an ejection seat, including spinal fracture, soft tissue injury, and disc herniation.…”

Section: Aeromedical Considerations About Ldh and Lismentioning

confidence: 99%

Return to flight duty rates after posterior lumbar spine surgery for symptomatic lumbar disc herniation and lumbar isthmic spondylolisthesis in Chinese military pilots

Yang,

Xie,

Zhang

et al. 2023

Preprint

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Background Symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) can ground active-duty military pilots if not properly managed. Surgically treated LDH and LIS may be waivable conditions and allow return to full flight status, but waivers are based on expert opinion rather than recent published data. The purpose of this study was to determine the rates of return to flight status among Chinese military pilots who had undergone lumbar spine surgery for symptomatic LDH and LIS. Methods A single-center retrospective review was conducted by the authors for all active-duty pilots who underwent either isolated decompressive or fusion procedures at an authorized military medical center between March 1, 2007 and March 1, 2023. Descriptive statistics were obtained for patients to evaluate demographic, occupational, surgical, and outcome data with particular attention to preoperative flight status, days to recommended clearance by spine surgeons, and days to return to active flight duty. Results Between March 1, 2007, and March 1, 2023, a total of 24 cases of active-duty pilots with LDH or LIS treated by lumbar surgery were identified. Of these, 16 underwent isolated decompressive procedures and 8 underwent fusion procedures. Seventeen (70.8%) of the 24 pilots treated with lumbar spine surgeries were able to return to flight duty (RTFD). Excluding the 1 pilot who retired within 1 year of surgery and the 2 pilots who did not return to active flight duty for reasons other than lumbar conditions, the RTFD rate is actually 81.0% (17 of 21). The average time to clearance by the spine surgeons was 256 days and average time to return to full flight was 339 days. The average follow-up time was 2.6 years. Conclusion Lumbar surgery appears to be safe for military aviators with symptomatic LDH or LIS, and return to flight status is the most likely outcome for the majority of postoperative pilots.

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“…Studies have reported that the onset age of cervical spondylosis in military pilots is earlier than that of ordinary people, and the incidence of cervical spondylosis increases significantly after the age of 30.In this study, the onset of cervical spondylosis was earlier in military pilots, and the cervical cervical "premature senescence" was most obvious in the early stage of military pilots's career [12] .In the study of the risk factors of cervical vertebra disease among military pilotsof different aircraft classes, there was no difference in the age of onset of cervical vertebra disease among different aircraft classes, and age may not be a risk cervical fusion, but no other details were provided [13] . Miller [14] conducted a single-center retrospective study on active pilots in the US military who received ACDF or CTDR from January 2010 to June 2017. The proportion of military pilots returning to active flight status after anterior cervical surgery was 84.6%.…”

Section: Discussmentioning

confidence: 99%

Investigation on Hospitalization of Cervical Spondylosis among Military Pilots, 2010 - 2019

Zhang

Chen

et al. 2021

Preprint

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ObjectiveTo investigate and analyze the situation of hospitalization and medical appraisal of cervical spondylosis in military pilots. MethodsA single-center retrospective study was conducted on the active military pilots hospitalized for cervical spondylosis in our center from January 2010 to December 2019.After inclusion and exclusion criteria, descriptive statistics and analysis were made on age, sex, flight type, flight time, disease type, diagnosis and treatment and medical identification results of the included subjects.ResultsDuring January 2010 to December 2019, 166 military pilots with cervical spondylosis were admitted to our center, accounting for 17.61% of the total orthopaedic diseases, ranking the second place.The hospitalization rate of military pilots with cervical spondylosis in orthopedics department decreased from 2015 to 2019, but the hospitalization rate (193 person-times) was in an increasing trend compared with that in 2010-2014 (148 person-times) (P < 0.05).The average age of the pilots with cervical spondylosis was 37.37±7.37 years old, and there was no significant difference in the age of the pilots of different aircraft types. Compared with the age of other active servicemen in the same period (39.72±8.98 years), the incidence of the pilots tended to be younger (P < 0.05).The average incidence of cervical spondylosis in flight crew was 2597.09±1954.50h, and fighter pilots were more likely to have cervical spondylosis in early flight than those who flew helicopter, transport aircraft and trainer aircraft (P < 0.05).4 cases (2.41%) received surgical treatment, which was significantly lower than that of non-aircrew members (12.09%) (P < 0.05).Among the 166 cases, 87 cases (52.41%) were qualified and returned to work,53 cases of military pilots temporary unqualified flight, 26 cases of military pilots unqualified flight, unable to continue to fly.ConclusionCervical spondylosis of pilots account for the forefront of orthopedic disease spectrum, and the onset age is younger, the treatment is relatively simple, and the qualified rate of flight after treatment is low.

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Return-to-active-duty rates after anterior cervical spine surgery in military pilots

Cited by 13 publications

References 8 publications

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Return to flight duty rates after posterior lumbar spine surgery for symptomatic lumbar disc herniation and lumbar isthmic spondylolisthesis in Chinese military pilots

Investigation on Hospitalization of Cervical Spondylosis among Military Pilots, 2010 - 2019

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