Prevalence and risk factors of degenerative disc disease in pilots_West China Medical Journal

Authors：

HENG Wei ¹ , LIAO Bo ¹ , YU Jinwen ² , WEI Feilong ¹ , ZHU Kailong ¹ , YANG Fan ¹ ,  ZHOU Chengpei ¹ ,  QIAN Jixian ¹

1. Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi 710038, P. R. China;
2. Outpatient Department, Unit 95960 of PLA, Xi’an, Shaanxi 710065, P. R. China;

Corresponding?author：

ZHOU Chengpei, Email: zhoucpei@126.com; QIAN Jixian, Email: pasmiss2012@163.com

Keywords：

Pilot; degenerative disc disease; prevalence; risk factor

DOI：

10.7507/1002-0179.202208120

Video：

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Objective To investigate the prevalence and risk factors of degenerative disc disease (DDD) in pilots. Methods From January 2021 to May 2022, pilots were surveyed using a whole group sampling method and relevant imaging data were collected. The contents of the survey included basic information, DDD-related information, flight-related information, and personal habits. The prevalence of DDD was calculated, and univariate χ² test, t-test, and multivariate logistic regression analysis were performed for the diseased and healthy groups to screen the risk factors of DDD. Results A total of 170 copies of questionnaire were sent out and 162 valid copies were returned. The prevalence of DDD was 47.5% (77/162), including 27.8% (45/162) for cervical spondylosis, 29.6% (48/162) for lumbar disc herniation, and 3.1% (5/162) for degenerative lumbar spondylolisthesis. The results of univariate analysis showed that body mass index (t=2.594, P=0.010), driving age (t=2.160, P=0.032), maximum load in flight (t=2.953, P=0.004), mean load in flight (t=2.575, P=0.011), insomnia (χ²=4.756, P=0.029) and smoking (χ²=7.977, P=0.005) were significantly different between the diseased group and the healthy group. Multivariate logistic regression showed that driving age [odds ratio (OR)=1.077, 95% confidence interval (CI) (1.025, 1.132), P=0.004], maximum load in flight [OR=1.279, 95%CI (1.109, 1.475), P=0.001], helmet weight [OR=1.516, 95%CI (1.056, 2.175), P=0.024], insomnia [OR=2.235, 95%CI (1.114, 4.483), P=0.024], and smoking [OR=2.527, 95%CI (1.255, 5.087), P=0.009] were risk factors for DDD. Conclusions The prevalence of DDD is high in pilots. High driving age, high maximum load in flight, high helmet weight, insomnia, and smoking may be independent risk factors for DDD.

Citation： HENG Wei, LIAO Bo, YU Jinwen, WEI Feilong, ZHU Kailong, YANG Fan, ZHOU Chengpei, QIAN Jixian. Prevalence and risk factors of degenerative disc disease in pilots. West China Medical Journal, 2023, 38(4): 543-549. doi: 10.7507/1002-0179.202208120 Copy

1.	Dowdell J, Erwin M, Choma T, et al. Intervertebral disk degeneration and repair. Neurosurgery, 2017, 80(3S): S46-S54.
2.	Kim HS, Wu PH, Jang IT. Lumbar degenerative disease part 1: anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature. Int J Mol Sci, 2020, 21(4): 1483.
3.	沈江潔, 吳卉慧, 石樺. 高性能戰斗機飛行員運動系統疾病譜分析. 空軍醫學雜志, 2020, 36(3): 188-190.
4.	衡偉, 杜明瑞, 魏飛龍, 等. 高性能戰斗機飛行員椎間盤退變危險因素研究進展. 軍事醫學, 2021, 45(11): 878-881.
5.	劉侃. 陸航直升機飛行員頸腰痛及肩、膝關節損傷的流行病學調查. 北京: 中國人民解放軍醫學院, 2014.
6.	吳葉琪. 肌骨超聲技術輔助評估解肌調頸法治療頸型頸椎病療效的臨床研究. 杭州: 浙江中醫藥大學, 2022.
7.	程繼偉, 王振林, 劉偉, 等. Oswestry 功能障礙指數的改良及信度和效度檢驗. 中國脊柱脊髓雜志, 2017, 27(3): 235-241.
8.	中華外科雜志編輯部. 頸椎病的分型、診斷及非手術治療專家共識(2018). 中華外科雜志, 2018, 56(6): 401-402.
9.	中華醫學會骨科學分會脊柱外科學組, 中華醫學會骨科學分會骨科康復學組. 腰椎間盤突出癥診療指南. 中華骨科雜志, 2020, 40(8): 477-487.
10.	Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013, 13(7): 734-743.
11.	Matz PG, Meagher RJ, Lamer TJ, et al. Diagnosis and treatment of degenerative lumbar spondylolisthesis. 2nd ed. Burr Ridge: North American Spine Society, 2014.
12.	何劼, 季軍, 田建全, 等. 軍隊飛行人員頸腰疾病流行病學調查分析. 華南國防醫學雜志, 2019, 33(6): 407-410.
13.	陳立君, 衛杰, 龔成, 等. 軍事飛行人員勞損退變性頸椎疾病薈萃分析. 空軍醫學雜志, 2013(4): 195-200.
14.	朱克順, 徐先榮, 潘慶聯, 等. 殲擊機飛行員改裝體檢脊柱病癥的醫學鑒定. 中華航空航天醫學雜志, 2006(1): 42-45, 82.
15.	Schoenfeld AJ, Nelson JH, Burks R, et al. Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008. Mil Med, 2011, 176(11): 1320-1324.
16.	Keskimölö T, Pernu J, Karppinen J, et al. Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up. BMJ Mil Health, 2021: e001848.
17.	H?m?l?inen O, Vanharanta H, Kuusela T. Degeneration of cervical intervertebral disks in fighter pilots frequently exposed to high +Gz forces. Aviat Space Environ Med, 1993, 64(8): 692-696.
18.	馮天有, 趙平, 張挽時, 等. 殲擊機飛行員無癥狀腰椎間盤突出的 CT、X 線檢查分析. 中華航空醫學雜志, 1997(2): 44-48.
19.	楊崇格, 馮麗娟, 郭想民. 軍事飛行人員頸椎病流行病學調查研究. 中國療養醫學, 2012, 21(6): 491-492.
20.	何劼, 孫景泰, 宋明芳, 等. 高性能戰斗機飛行員腰椎退行性變調查與致病因素分析. 中國骨與關節損傷雜志, 2013, 28(11): 1013-1015.
21.	李中正, 邱聯波. 軍隊飛行員腰椎間盤突出癥病因分析及預防保健. 中國療養醫學, 2018, 27(1): 103-104.
22.	朱俐俐, 裴楠, 張婷勇, 等. 不同機型飛行員疾病流行病學調查和分析. 解放軍預防醫學雜志, 2016, 34(3): 424-425.
23.	何東東, 孟威宏, 劉德寶. 2000~2006 年東北地區軍事飛行人員停飛疾病分布與特點. 中華航空航天醫學雜志, 2008, 19(2): 81-85.
24.	朱克順, 潘慶聯, 徐先榮, 等. 303 例殲擊機飛行員骨科病癥譜分析. 中華航空航天醫學雜志, 2008, 19(1): 13-16, 73.
25.	Hendriksen IJ, Holewijn M. Degenerative changes of the spine of fighter pilots of the Royal Netherlands Air Force (RNLAF). Aviat Space Environ Med, 1999, 70(11): 1057-1063.
26.	Lawson BK, Scott O, Egbulefu FJ, et al. Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison. Aviat Space Environ Med, 2014, 85(12): 1185-1189.
27.	陳鵬, 高秋平, 張莎莎. 256 例高性能戰斗機飛行員頸椎 X 線表現分析. 中國療養醫學, 2017, 26(4): 410-411.
28.	Hermes ED, Webb TS, Wells TS. Aircraft type and other risk factors for spinal disorders: data from 19, 673 military cockpit aircrew. Aviat Space Environ Med, 2010, 81(9): 850-856.
29.	張曄, 張雷, 孫明舉, 等. 高性能殲擊機飛行員頸椎病原因調查分析. 海軍醫學雜志, 2015(4): 298-299.
30.	王超, 冀建軍, 邱小洪, 等. 高性能戰斗機飛行員腰椎生理曲度檢測意義. 中國療養醫學, 2016, 25(8): 819-820.
31.	Petrén-Mallmin M, Linder J. Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study. Aviat Space Environ Med, 2001, 72(5): 443-446.
32.	朱克順, 伍驥, 潘慶聯, 等. 殲擊機飛行員腰椎退行性病變隨訪觀察. 中華航空航天醫學雜志, 2005(1): 42-44, 81.
33.	Yang Y, Liu S, Ling M, et al. Prevalence and potential risk factors for occupational low back pain among male military pilots: a study based on questionnaire and physical function assessment. Front Public Health, 2021, 9: 744601.
34.	孫景泰, 何劼, 宋明芳, 等. 戰斗機飛行員頸椎退行性變調查與致病因素分析. 中國骨與關節損傷雜志, 2013, 28(3): 238-239.
35.	Thoolen SJ, van den Oord MH. Modern air combat developments and their influence on neck and back pain in f-16 pilots. Aerosp Med Hum Perform, 2015, 86(11): 936-941.
36.	Lange B, Torp-Svendsen J, Toft P. Neck pain among fighter pilots after the introduction of the JHMCS helmet and NVG in their environment. Aviat Space Environ Med, 2011, 82(5): 559-563.
37.	陳宏, 劉永平, 馬建芳, 等. 殲擊機飛行員腰腿痛的調查分析. 東南國防醫藥, 2009, 11(6): 508-509, 517.
38.	Shiri R, Falah-Hassani K, Heli?vaara M, et al. Risk factors for low back pain: a population-based longitudinal study. Arthritis Care Res (Hoboken), 2019, 71(2): 290-299.
39.	Elmasry S, Asfour S, de Rivero Vaccari JP, et al. Effects of tobacco smoking on the degeneration of the intervertebral disc: a finite element study. PLoS One, 2015, 10(8): e0136137.
40.	de Loose V, van den Oord M, Burnotte F, et al. Individual, work-, and flight-related issues in F-16 pilots reporting neck pain. Aviat Space Environ Med, 2008, 79(8): 779-783.
41.	Omholt ML, Tveito TH, Ihleb?k C. Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew. Occup Med (Lond), 2017, 67(2): 135-142.
42.	張燚德, 劉賢買. 頸椎病飛行人員睡眠及心理健康水平調查與分析. 人民軍醫, 2014, 57(5): 471-472.
43.	董燕, 方玉婷, 陳虹汝, 等. 殲擊機飛行員睡眠質量危險因素分析. 中華航空航天醫學雜志, 2016, 27(3): 174-179.

1. Dowdell J, Erwin M, Choma T, et al. Intervertebral disk degeneration and repair. Neurosurgery, 2017, 80(3S): S46-S54.
2. Kim HS, Wu PH, Jang IT. Lumbar degenerative disease part 1: anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature. Int J Mol Sci, 2020, 21(4): 1483.
3. 沈江潔, 吳卉慧, 石樺. 高性能戰斗機飛行員運動系統疾病譜分析. 空軍醫學雜志, 2020, 36(3): 188-190.
4. 衡偉, 杜明瑞, 魏飛龍, 等. 高性能戰斗機飛行員椎間盤退變危險因素研究進展. 軍事醫學, 2021, 45(11): 878-881.
5. 劉侃. 陸航直升機飛行員頸腰痛及肩、膝關節損傷的流行病學調查. 北京: 中國人民解放軍醫學院, 2014.
6. 吳葉琪. 肌骨超聲技術輔助評估解肌調頸法治療頸型頸椎病療效的臨床研究. 杭州: 浙江中醫藥大學, 2022.
7. 程繼偉, 王振林, 劉偉, 等. Oswestry 功能障礙指數的改良及信度和效度檢驗. 中國脊柱脊髓雜志, 2017, 27(3): 235-241.
8. 中華外科雜志編輯部. 頸椎病的分型、診斷及非手術治療專家共識(2018). 中華外科雜志, 2018, 56(6): 401-402.
9. 中華醫學會骨科學分會脊柱外科學組, 中華醫學會骨科學分會骨科康復學組. 腰椎間盤突出癥診療指南. 中華骨科雜志, 2020, 40(8): 477-487.
10. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013, 13(7): 734-743.
11. Matz PG, Meagher RJ, Lamer TJ, et al. Diagnosis and treatment of degenerative lumbar spondylolisthesis. 2nd ed. Burr Ridge: North American Spine Society, 2014.
12. 何劼, 季軍, 田建全, 等. 軍隊飛行人員頸腰疾病流行病學調查分析. 華南國防醫學雜志, 2019, 33(6): 407-410.
13. 陳立君, 衛杰, 龔成, 等. 軍事飛行人員勞損退變性頸椎疾病薈萃分析. 空軍醫學雜志, 2013(4): 195-200.
14. 朱克順, 徐先榮, 潘慶聯, 等. 殲擊機飛行員改裝體檢脊柱病癥的醫學鑒定. 中華航空航天醫學雜志, 2006(1): 42-45, 82.
15. Schoenfeld AJ, Nelson JH, Burks R, et al. Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008. Mil Med, 2011, 176(11): 1320-1324.
16. Keskimölö T, Pernu J, Karppinen J, et al. Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up. BMJ Mil Health, 2021: e001848.
17. H?m?l?inen O, Vanharanta H, Kuusela T. Degeneration of cervical intervertebral disks in fighter pilots frequently exposed to high +Gz forces. Aviat Space Environ Med, 1993, 64(8): 692-696.
18. 馮天有, 趙平, 張挽時, 等. 殲擊機飛行員無癥狀腰椎間盤突出的 CT、X 線檢查分析. 中華航空醫學雜志, 1997(2): 44-48.
19. 楊崇格, 馮麗娟, 郭想民. 軍事飛行人員頸椎病流行病學調查研究. 中國療養醫學, 2012, 21(6): 491-492.
20. 何劼, 孫景泰, 宋明芳, 等. 高性能戰斗機飛行員腰椎退行性變調查與致病因素分析. 中國骨與關節損傷雜志, 2013, 28(11): 1013-1015.
21. 李中正, 邱聯波. 軍隊飛行員腰椎間盤突出癥病因分析及預防保健. 中國療養醫學, 2018, 27(1): 103-104.
22. 朱俐俐, 裴楠, 張婷勇, 等. 不同機型飛行員疾病流行病學調查和分析. 解放軍預防醫學雜志, 2016, 34(3): 424-425.
23. 何東東, 孟威宏, 劉德寶. 2000~2006 年東北地區軍事飛行人員停飛疾病分布與特點. 中華航空航天醫學雜志, 2008, 19(2): 81-85.
24. 朱克順, 潘慶聯, 徐先榮, 等. 303 例殲擊機飛行員骨科病癥譜分析. 中華航空航天醫學雜志, 2008, 19(1): 13-16, 73.
25. Hendriksen IJ, Holewijn M. Degenerative changes of the spine of fighter pilots of the Royal Netherlands Air Force (RNLAF). Aviat Space Environ Med, 1999, 70(11): 1057-1063.
26. Lawson BK, Scott O, Egbulefu FJ, et al. Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison. Aviat Space Environ Med, 2014, 85(12): 1185-1189.
27. 陳鵬, 高秋平, 張莎莎. 256 例高性能戰斗機飛行員頸椎 X 線表現分析. 中國療養醫學, 2017, 26(4): 410-411.
28. Hermes ED, Webb TS, Wells TS. Aircraft type and other risk factors for spinal disorders: data from 19, 673 military cockpit aircrew. Aviat Space Environ Med, 2010, 81(9): 850-856.
29. 張曄, 張雷, 孫明舉, 等. 高性能殲擊機飛行員頸椎病原因調查分析. 海軍醫學雜志, 2015(4): 298-299.
30. 王超, 冀建軍, 邱小洪, 等. 高性能戰斗機飛行員腰椎生理曲度檢測意義. 中國療養醫學, 2016, 25(8): 819-820.
31. Petrén-Mallmin M, Linder J. Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study. Aviat Space Environ Med, 2001, 72(5): 443-446.
32. 朱克順, 伍驥, 潘慶聯, 等. 殲擊機飛行員腰椎退行性病變隨訪觀察. 中華航空航天醫學雜志, 2005(1): 42-44, 81.
33. Yang Y, Liu S, Ling M, et al. Prevalence and potential risk factors for occupational low back pain among male military pilots: a study based on questionnaire and physical function assessment. Front Public Health, 2021, 9: 744601.
34. 孫景泰, 何劼, 宋明芳, 等. 戰斗機飛行員頸椎退行性變調查與致病因素分析. 中國骨與關節損傷雜志, 2013, 28(3): 238-239.
35. Thoolen SJ, van den Oord MH. Modern air combat developments and their influence on neck and back pain in f-16 pilots. Aerosp Med Hum Perform, 2015, 86(11): 936-941.
36. Lange B, Torp-Svendsen J, Toft P. Neck pain among fighter pilots after the introduction of the JHMCS helmet and NVG in their environment. Aviat Space Environ Med, 2011, 82(5): 559-563.
37. 陳宏, 劉永平, 馬建芳, 等. 殲擊機飛行員腰腿痛的調查分析. 東南國防醫藥, 2009, 11(6): 508-509, 517.
38. Shiri R, Falah-Hassani K, Heli?vaara M, et al. Risk factors for low back pain: a population-based longitudinal study. Arthritis Care Res (Hoboken), 2019, 71(2): 290-299.
39. Elmasry S, Asfour S, de Rivero Vaccari JP, et al. Effects of tobacco smoking on the degeneration of the intervertebral disc: a finite element study. PLoS One, 2015, 10(8): e0136137.
40. de Loose V, van den Oord M, Burnotte F, et al. Individual, work-, and flight-related issues in F-16 pilots reporting neck pain. Aviat Space Environ Med, 2008, 79(8): 779-783.
41. Omholt ML, Tveito TH, Ihleb?k C. Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew. Occup Med (Lond), 2017, 67(2): 135-142.
42. 張燚德, 劉賢買. 頸椎病飛行人員睡眠及心理健康水平調查與分析. 人民軍醫, 2014, 57(5): 471-472.
43. 董燕, 方玉婷, 陳虹汝, 等. 殲擊機飛行員睡眠質量危險因素分析. 中華航空航天醫學雜志, 2016, 27(3): 174-179.

West China Medical Journal

Prevalence and risk factors of degenerative disc disease in pilots

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