Spinal MRI in Fighter Pilots and Controls: A 13-Year Longitudinal Study

Sovelius²,

Biomedical Human Kinetics

et al. 2017

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SummaryStudy aim: The aim of this study was to evaluate the possible association of pre-career magnetic resonance imaging (MRI) findings and physical performance level with possible musculoskeletal disorders during jet flight training. Material and methods:The study group consisted of 73 fighter pilots who had undergone pre-career cervical and lumbar spine MRI. Physical performance of a subgroup of the pilots (n = 67) was measured initially at the same time and followed up to the fast jet training phase (ranging from 3.8 to 7.0 years). Musculoskeletal pain history during pilot training was taken from the medical charts. MRI findings and physical performance were associated with perceived clinical complaints during the follow-up. Results: 82% of the cervical and 92% of the lumbar spines showed abnormalities at at least one disk level. MRI did not reveal significant cervical degeneration. Thirteen disk bulges in the lumbar spine were discovered, while 5 pilots had listhesis and/or osteophyte formation on the spine (lumbar vertebra 4/sacroiliac joint level, L4-SI). 41% of the studied pilots suffered spinal symptoms during the follow-up, but only 16% and 17% of the cervical and lumbar MRI findings, respectively, were associated with subsequent symptoms. Endurance and strength levels were not, but lower body motor skills were, strongly (relative risk, RR 0.46) associated with a decreased number of flight-induced medical appointments in the early flight career. Conclusions: Minor MRI findings have no predictable value in the very early flight career. Nevertheless, versatile, skills/ power-oriented exercises before the flight career seem to be occupationally beneficial in reducing musculoskeletal disorders.

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 51%

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MRI findings and physical performance as predictors of flight-induced musculoskeletal pain incidence among fighter pilots

Sovelius²,

Biomedical Human Kinetics

et al. 2017

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“…From another study by Rios-Tejada et al 32 only one radiological outcome (disc protrusion)—showing a positive association—was included in their meta-analysis and the other two outcomes (osteophytes, disc height change)—showing reverse or no association—were not considered. Furthermore, we included four new studies3 4 26 33 showing no association between G-forces and cervical disc degeneration.…”

Section: Discussionmentioning

confidence: 99%

Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis

et al. 2014

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To assess the associations of acceleration force indicators (aircraft type and flight hours) with cervical and lumbar pain and radiological degeneration among fighter pilots. The PubMed, Embase, Scopus and Web of Science databases were searched until October 2013. Twenty-seven studies were included in the review and 20 in the meta-analysis. There were no differences in the prevalence of neck pain (pooled OR=1.07, 95% CI 0.87 to 1.33), cervical disc degeneration (OR=1.26, CI 0.81 to 1.96), low back pain (OR=0.80, CI 0.47 to 1.38) or lumbar disc degeneration (OR=0.87, CI 0.67 to 1.13) between fighter pilots and helicopter or transport/cargo pilots. Moreover, the prevalence of cervical (OR=1.14, CI 0.61 to 2.16) or lumbar (OR=1.05, CI 0.49 to 2.26) disc degeneration did not differ between fighter pilots and non-flying personnel. Most studies did not control their estimates for age and other potential confounders. Among high-performance aircraft pilots, exposure to the highest G-forces was associated with a higher prevalence of neck pain compared with exposure to lower G-forces (pooled OR=3.12, CI 2.08 to 4.67). The studies on the association between flight hours and neck pain reported inconsistent findings. Moreover, looking back over the shoulder (check six) was the most common posture associated with neck pain. Fighter pilots exposed to high G-forces may be at a greater risk for neck pain than those exposed to low G-forces. This finding should be confirmed with better control for confounding. Awkward neck posture may be an important factor in neck pain among fighter pilots.

“…Alternatively, the IVD injuries could have occurred whilst astronauts were still fighter pilots and that the injuries were only picked up as part of medical management once they entered the astronaut program. However, the longitudinal data available [45] and meta-analysis of cross-sectional data [46] suggest that the majority of degenerative changes in the IVDs of fighter pilots are due to normal ageing and not the fighter pilot occupation per se.…”

Section: Cumulative Injury To the Ivd Prior To Spaceflightmentioning

confidence: 99%

Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?

et al. 2015

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Purpose Recent work showed an increased risk of cervical and lumbar intervertebral disc (IVD) herniations in astronauts. The European Space Agency asked the authors to advise on the underlying pathophysiology of this increased risk, to identify predisposing factors and possible interventions and to suggest research priorities. Methods The authors performed a narrative literature review of the possible mechanisms, and conducted a survey within the team to prioritize research and prevention approaches.Results and conclusions Based on literature review the most likely cause for lumbar IVD herniations was concluded to be swelling of the IVD in the unloaded condition during spaceflight. For the cervical IVDs, the knowledge base is too limited to postulate a likely mechanism or recommend approaches for prevention. Basic research on the impact of (un)loading on the cervical IVD and translational research is needed. The highest priority prevention approach for the lumbar spine was post-flight care avoiding activities involving spinal flexion, followed by passive