Selection of individualized surgery for pilot lumbar degenerative diseases and analysis of flight qualification after operation

LV Ao; HUANG Xiaogang; WANG Jie; DU Junjie; WU ji; ZHENG Chao; SHANG Yong

Abstract：Objective To analyze the clinical effect of different surgical approaches to lumbar degenerative disease among pilots and to explore flight qualification standards after different operations according to the follow-up results. Methods A retrospective analysis was conducted among fourteen cases of Air Force active pilots admitted to Air Force General Hospital between March 2010 and March 2016. The approach to surgery was determined according to the type of degenerative lumbar spinal disorders. Oswerstry disability index (ODI) and lumbar JOA score, low back pain visual analog score (VAS) before surgery and 12 months after surgery and the identification results were collected. Results These fourteen pilots were followed-up for 12-36 months, an average of 27 months. Ground observation time was 4-12 months, an average of 8 months. ODI index, lumbar JOA score and low back pain VAS score of nine pilots with degenerative lumbar disc herniation 12 months after surgery were not significantly different between minimally invasive surgery and open surgery, but the change of these indexes was statistically significant after surgery. Eight cases were determined to be qualified for flying after 6 months of rehabilitation, but one case was unqualified. Five cases of degenerative lumbar spinal stenosis complicated with lumbar spondylolisthesis were permitted to fly after 12 months of rehabilitation training. Thirteen of these pilots remained in good health after operation, whose average flight time was 431 h. According to the follow-up result, there was not any new symptom, such as lower back pain, and both lumbar spine radiographs and CT examinations found no signs of secondary lumbar spine instability. Conclusion For pilots with lumbar degenerative disease on whom conservative treatment had poor therapeutic effect, individualized surgery can have satisfactory effects and help qualify the pilots for flying within 12 months after appropriate rehabilitation training. The identification standards in force should be combined with clinical practice, flight requirements and other factors to maximize pilots' power to fight.