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.	沈江洁, 吴卉慧, 石桦. 高性能战斗机飞行员运动系统疾病谱分析. 空军医学杂志, 2020, 36(3): 188-190.
4.	衡伟, 杜明瑞, 魏飞龙, 等. 高性能战斗机飞行员椎间盘退变危险因素研究进展. 军事医学, 2021, 45(11): 878-881.
5.	刘侃. 陆航直升机飞行员颈腰痛及肩、膝关节损伤的流行病学调查. 北京: 中国人民解放军医学院, 2014.
6.	吴叶琪. 肌骨超声技术辅助评估解肌调颈法治疗颈型颈椎病疗效的临床研究. 杭州: 浙江中医药大学, 2022.
7.	程继伟, 王振林, 刘伟, 等. Oswestry 功能障碍指数的改良及信度和效度检验. 中国脊柱脊髓杂志, 2017, 27(3): 235-241.
8.	中华外科杂志编辑部. 颈椎病的分型、诊断及非手术治疗专家共识(2018). 中华外科杂志, 2018, 56(6): 401-402.
9.	中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南. 中华骨科杂志, 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, 季军, 田建全, 等. 军队飞行人员颈腰疾病流行病学调查分析. 华南国防医学杂志, 2019, 33(6): 407-410.
13.	陈立君, 卫杰, 龚成, 等. 军事飞行人员劳损退变性颈椎疾病荟萃分析. 空军医学杂志, 2013(4): 195-200.
14.	朱克顺, 徐先荣, 潘庆联, 等. 歼击机飞行员改装体检脊柱病症的医学鉴定. 中华航空航天医学杂志, 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.	Hämäläinen 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.	冯天有, 赵平, 张挽时, 等. 歼击机飞行员无症状腰椎间盘突出的 CT、X 线检查分析. 中华航空医学杂志, 1997(2): 44-48.
19.	杨崇格, 冯丽娟, 郭想民. 军事飞行人员颈椎病流行病学调查研究. 中国疗养医学, 2012, 21(6): 491-492.
20.	何劼, 孙景泰, 宋明芳, 等. 高性能战斗机飞行员腰椎退行性变调查与致病因素分析. 中国骨与关节损伤杂志, 2013, 28(11): 1013-1015.
21.	李中正, 邱联波. 军队飞行员腰椎间盘突出症病因分析及预防保健. 中国疗养医学, 2018, 27(1): 103-104.
22.	朱俐俐, 裴楠, 张婷勇, 等. 不同机型飞行员疾病流行病学调查和分析. 解放军预防医学杂志, 2016, 34(3): 424-425.
23.	何东东, 孟威宏, 刘德宝. 2000~2006 年东北地区军事飞行人员停飞疾病分布与特点. 中华航空航天医学杂志, 2008, 19(2): 81-85.
24.	朱克顺, 潘庆联, 徐先荣, 等. 303 例歼击机飞行员骨科病症谱分析. 中华航空航天医学杂志, 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.	陈鹏, 高秋平, 张莎莎. 256 例高性能战斗机飞行员颈椎 X 线表现分析. 中国疗养医学, 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.	张晔, 张雷, 孙明举, 等. 高性能歼击机飞行员颈椎病原因调查分析. 海军医学杂志, 2015(4): 298-299.
30.	王超, 冀建军, 邱小洪, 等. 高性能战斗机飞行员腰椎生理曲度检测意义. 中国疗养医学, 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.	朱克顺, 伍骥, 潘庆联, 等. 歼击机飞行员腰椎退行性病变随访观察. 中华航空航天医学杂志, 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.	孙景泰, 何劼, 宋明芳, 等. 战斗机飞行员颈椎退行性变调查与致病因素分析. 中国骨与关节损伤杂志, 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.	陈宏, 刘永平, 马建芳, 等. 歼击机飞行员腰腿痛的调查分析. 东南国防医药, 2009, 11(6): 508-509, 517.
38.	Shiri R, Falah-Hassani K, Heliövaara 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, Ihlebæk C. Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew. Occup Med (Lond), 2017, 67(2): 135-142.
42.	张燚德, 刘贤买. 颈椎病飞行人员睡眠及心理健康水平调查与分析. 人民军医, 2014, 57(5): 471-472.
43.	董燕, 方玉婷, 陈虹汝, 等. 歼击机飞行员睡眠质量危险因素分析. 中华航空航天医学杂志, 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. 沈江洁, 吴卉慧, 石桦. 高性能战斗机飞行员运动系统疾病谱分析. 空军医学杂志, 2020, 36(3): 188-190.
4. 衡伟, 杜明瑞, 魏飞龙, 等. 高性能战斗机飞行员椎间盘退变危险因素研究进展. 军事医学, 2021, 45(11): 878-881.
5. 刘侃. 陆航直升机飞行员颈腰痛及肩、膝关节损伤的流行病学调查. 北京: 中国人民解放军医学院, 2014.
6. 吴叶琪. 肌骨超声技术辅助评估解肌调颈法治疗颈型颈椎病疗效的临床研究. 杭州: 浙江中医药大学, 2022.
7. 程继伟, 王振林, 刘伟, 等. Oswestry 功能障碍指数的改良及信度和效度检验. 中国脊柱脊髓杂志, 2017, 27(3): 235-241.
8. 中华外科杂志编辑部. 颈椎病的分型、诊断及非手术治疗专家共识(2018). 中华外科杂志, 2018, 56(6): 401-402.
9. 中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南. 中华骨科杂志, 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, 季军, 田建全, 等. 军队飞行人员颈腰疾病流行病学调查分析. 华南国防医学杂志, 2019, 33(6): 407-410.
13. 陈立君, 卫杰, 龚成, 等. 军事飞行人员劳损退变性颈椎疾病荟萃分析. 空军医学杂志, 2013(4): 195-200.
14. 朱克顺, 徐先荣, 潘庆联, 等. 歼击机飞行员改装体检脊柱病症的医学鉴定. 中华航空航天医学杂志, 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. Hämäläinen 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. 冯天有, 赵平, 张挽时, 等. 歼击机飞行员无症状腰椎间盘突出的 CT、X 线检查分析. 中华航空医学杂志, 1997(2): 44-48.
19. 杨崇格, 冯丽娟, 郭想民. 军事飞行人员颈椎病流行病学调查研究. 中国疗养医学, 2012, 21(6): 491-492.
20. 何劼, 孙景泰, 宋明芳, 等. 高性能战斗机飞行员腰椎退行性变调查与致病因素分析. 中国骨与关节损伤杂志, 2013, 28(11): 1013-1015.
21. 李中正, 邱联波. 军队飞行员腰椎间盘突出症病因分析及预防保健. 中国疗养医学, 2018, 27(1): 103-104.
22. 朱俐俐, 裴楠, 张婷勇, 等. 不同机型飞行员疾病流行病学调查和分析. 解放军预防医学杂志, 2016, 34(3): 424-425.
23. 何东东, 孟威宏, 刘德宝. 2000~2006 年东北地区军事飞行人员停飞疾病分布与特点. 中华航空航天医学杂志, 2008, 19(2): 81-85.
24. 朱克顺, 潘庆联, 徐先荣, 等. 303 例歼击机飞行员骨科病症谱分析. 中华航空航天医学杂志, 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. 陈鹏, 高秋平, 张莎莎. 256 例高性能战斗机飞行员颈椎 X 线表现分析. 中国疗养医学, 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. 张晔, 张雷, 孙明举, 等. 高性能歼击机飞行员颈椎病原因调查分析. 海军医学杂志, 2015(4): 298-299.
30. 王超, 冀建军, 邱小洪, 等. 高性能战斗机飞行员腰椎生理曲度检测意义. 中国疗养医学, 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. 朱克顺, 伍骥, 潘庆联, 等. 歼击机飞行员腰椎退行性病变随访观察. 中华航空航天医学杂志, 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. 孙景泰, 何劼, 宋明芳, 等. 战斗机飞行员颈椎退行性变调查与致病因素分析. 中国骨与关节损伤杂志, 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. 陈宏, 刘永平, 马建芳, 等. 歼击机飞行员腰腿痛的调查分析. 东南国防医药, 2009, 11(6): 508-509, 517.
38. Shiri R, Falah-Hassani K, Heliövaara 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, Ihlebæk C. Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew. Occup Med (Lond), 2017, 67(2): 135-142.
42. 张燚德, 刘贤买. 颈椎病飞行人员睡眠及心理健康水平调查与分析. 人民军医, 2014, 57(5): 471-472.
43. 董燕, 方玉婷, 陈虹汝, 等. 歼击机飞行员睡眠质量危险因素分析. 中华航空航天医学杂志, 2016, 27(3): 174-179.

West China Medical Journal

Prevalence and risk factors of degenerative disc disease in pilots

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