Abnormal Pattern of Spondylosis and Postflight Neck Flexibility in Fifth-Generation Fighter Pilots

Cervical spine degeneration occurs naturally, often has biomechanical effects on spinal function, and can be accelerated by daily loading environments such as whole-body vibration. Military fighter pilots routinely experience high-magnitude Gz loading with added helmet mass and head-neck in nonneutral orientations. This study characterized spinal degeneration in fighter pilots and identified functional consequences.

A total of 18 fifth-generation fighter pilots received cervical spine MRI scans with secondary clinical reviews. Type and location of degenerative changes were noted. Cervical spine range of motion (CROM) was measured before flight and as soon as possible postflight. Cervical spine degenerative changes were correlated to preflight CROM and changes in postflight CROM.

All enrolled pilots had 2 or more cervical spine disc bulges (average 3.5 per pilot), foraminal stenosis occurred in 17/18 pilots (average 2.8 cervical spine levels), and uncovertebral hypertrophy was evident in 17/18 pilots (average 2.4 cervical spine levels). Spinal degenerative findings were not correlated to preflight CROM. Total incidence of degenerative findings was strongly negatively correlated to postflight reductions in extension, lateral bending, and axial rotation CROM.

The pattern of degenerative changes in fighter pilots was remarkably different from that of civilians and was characterized by much higher incidence of degenerative changes and degenerative changes biased toward the upper cervical spine, despite the severity of individual degenerative findings being relatively modest. Correlation to postflight CROM changes, but not preflight CROM, implies a pain-mediated mechanism as opposed to altered biomechanics associated with degeneration of spinal tissues. Stemper BD, Muftuler LT, Cutlan R, Strother C, Sherman KA, Meier TB, Raff H, Yoganandan N, Gerds B, Dooley C, Le P, Hainsworth KR, Vedantam A. Abnormal pattern of spondylosis and postflight neck flexibility in fifth-generation fighter pilots. Aerosp Med Hum Perform. 2025; 96(10):884-893.