1
|
Yang F, Xie B, Zhang H, Li T, Mao J, Chen Z, Peng Y, Li T, Sun S, Chen J, Chen Y, Du J. Return to flight duty (RTFD) after posterior lumbar spine surgery for symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) in Chinese military pilots. BMC Musculoskelet Disord 2024; 25:81. [PMID: 38245679 PMCID: PMC10799416 DOI: 10.1186/s12891-024-07175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) present significant challenges for military pilots, which may result in grounding if not effectively managed. Surgical treatment for LDH and LIS may offer a pathway to return to flight duty (RTFD), but recent data on this crucial topic is lacking. This study seeks to address this gap by investigating the RTFD outcomes among Chinese military pilots who have undergone lumbar spine surgery for symptomatic LDH and LIS. METHODS A retrospective review was conducted on active-duty military pilots who underwent isolated decompressive or fusion procedures at an authorized military medical center from March 1, 2007, to March 1, 2023. The analysis utilized descriptive statistics to examine demographic, occupational, surgical, and outcome data, with a particular focus on preoperative flight status, recommended clearance by spine surgeons, and actual RTFD outcomes and time. RESULTS Among the identified cases of active-duty military pilots with LDH or LIS treated by lumbar surgery (n = 24), 70.8% (17 of 24) consistently maintained RTFD status without encountering surgical complications or medical issues during the follow-up period. Of the seven pilots who did not RTFD, one retired within a year of surgery, two had anterior cruciate ligament injuries, three had residual radicular symptoms, and one had chronic low back pain. Excluding pilots who retired and did not RTFD for reasons unrelated to their lumbar conditions, the RTFD rate stood at 81.0% (17 of 21). The median time for recommended clearance by spine surgeons was 143.0 days (inter-quartile range, 116.5-196.0), while the median duration for actual RTFD attainment was 221.0 days (inter-quartile range, 182.0-300.0). The median follow-up post-lumbar surgery was 1.7 years (inter-quartile range, 0.4-2.9). CONCLUSION Most military pilots diagnosed with symptomatic LDH and LIS can continue their careers and regain active-duty flight status following lumbar spine surgery, as reflected by the high RTFD rate. Lumbar spine surgery can successfully alleviate the physical constraints associated with spinal conditions, facilitating the return of military pilots to their demanding profession.
Collapse
Affiliation(s)
- Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- The Fifth School of Clinical Medicine, Air Force Clinical College, Anhui Medical University, Anhui, 230032, China
| | - Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Jian Mao
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Ye Peng
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Tengfei Li
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Siguo Sun
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Jingyang Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China.
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China.
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China.
- The Fifth School of Clinical Medicine, Air Force Clinical College, Anhui Medical University, Anhui, 230032, China.
| |
Collapse
|
2
|
Dewar C, Ravindra VM, Woodle S, Scanlon M, Shields M, Yokoi H, Meister M, Porensky P, Bossert S, Ikeda DS. Effect of Fusion and Arthroplasty for Cervical Degenerative Disc Disease in Active Duty Service Members Performed at an Overseas Military Treatment Facility: A 2-Year Retrospective Analysis. Mil Med 2023; 188:e3454-e3462. [PMID: 37489817 DOI: 10.1093/milmed/usad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/13/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Among U.S. military active duty service members, cervicalgia, cervical radiculopathy, and myelopathy are common causes of disability, effecting job performance and readiness, often leading to medical separation from the military. Among surgical therapies, anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are options in select cases; however, elective surgeries performed while serving overseas (OCONUS) have not been studied. MATERIALS AND METHODS A retrospective analysis of a prospectively collected surgical database from an OCONUS military treatment facility over a 2-year period (2019-2021) was queried. Patient and procedural data were collected to include ACDF or CDA surgery, military rank, age, tobacco use, pre- and post-operative visual analogue scales for pain, and presence of radiographic fusion after surgery for ACDF patients or heterotopic ossification for CDA patients. Chi-square and Student t-test analyses were performed to identify variables associated with return to full duty. RESULTS A total of 47 patients (25 ACDF and 22 CDA) underwent surgery with an average follow-up of 192.1 days (range 7-819 days). Forty-one (87.2%) patients were able to return to duty without restrictions; 10.6% of patients remained on partial or limited duty at latest follow-up and one patient was medically separated from the surgical cohort. There was one complication and one patient required tour curtailment from overseas duty for ongoing symptoms. CONCLUSIONS Both ACDF and CDA are effective and safe surgical procedures for active duty patients with cervicalgia, cervical radiculopathy, and cervical myelopathy. They can be performed OCONUS with minimal interruption to the patient, their family, and the military unit, while helping to maintain surgical readiness for the surgeon and the military treatment facility.
Collapse
Affiliation(s)
- Callum Dewar
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Samuel Woodle
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Michaela Scanlon
- Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Margaret Shields
- Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Hana Yokoi
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Melissa Meister
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Paul Porensky
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Sharon Bossert
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| |
Collapse
|
3
|
Woodle S, Ravindra VM, Dewar C, Yokoi H, Meister M, Curry B, Miller C, Ikeda DS. Craniotomies at an overseas military treatment facility: Maintaining readiness for the unit and the surgeon. Clin Neurol Neurosurg 2023; 230:107742. [PMID: 37178524 DOI: 10.1016/j.clineuro.2023.107742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Craniotomy and craniectomy are common neurosurgical procedures with wide applications in both civilian and military practice. Skill maintenance for these procedures is required for military providers in the event they are called to support forward deployed service members suffering from combat and non-combat injuries. The presents investigation details the performance of such procedures at a small, overseas military treatment facility (MTF). MATERIALS AND METHODS A retrospective review of craniotomy procedures performed at an overseas military treatment facility (MTF) over a 2-year period (2019-2021) was performed. Patient and procedural data were collected for all elective and emergent craniotomies including surgical indications, outcomes, complications, military rank, and impact on duty status and tour curtailment. RESULTS A total of 11 patients underwent a craniotomy or craniectomy procedure with an average follow-up of 496.8 days (range 103-797). Seven of the 11 patients were able to undergo surgery, recovery, and convalesce without transfer to a larger hospital network or MTF. Of the 6 patients that were active duty (AD), one returned to full duty while three separated and two remain in partial duty status at latest follow-up. There were four complications in four patients with one death. CONCLUSIONS In this series, we demonstrate that cranial neurosurgical procedures can be performed safely and effectively while at an overseas MTF. There are potential benefits to the AD service members, their unit, and family as well as to the hospital treatment team and surgeon as this represents a clinical capability requisite to maintain trauma readiness for future conflicts.
Collapse
Affiliation(s)
- Samuel Woodle
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Callum Dewar
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Hana Yokoi
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Melissa Meister
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Brian Curry
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Charles Miller
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
| |
Collapse
|