Spine Injuries Related to High-Performance Aircraft Ejections: A 9-Year Retrospective Study

Manen O, Clément J, Bisconte S, Perrier É. Spine injuries related to high-performance aircraft ejections: a 9-year retrospective study. Aviat Space Environ Med 2014; 85:66–70.

Background: During an aircraft ejection, the pilot is exposed to accelerations to the point of human tolerance, which may cause spinal injuries. Many nations have reported a spinal trauma rate of about 20–30%, with plain radiography as the first-line exam. Insofar as ejection seats and diagnostic imaging have improved, the objectives of this study are to describe the spine injuries among recently ejected French aircrew, to analyze the spinal imaging used, and, if necessary, to propose a better standardized radiological procedure. Methods: A retrospective cohort study included all aircrews of the French forces who ejected from 2000 to 2008, with an authorized access to the technical reports of the investigations. Results: There were 36 ejections collected, 75% with an MK-10 seat and an arrival on dry land. All pilots were alive, but 42% of them sustained 24 spinal fractures, most of the time with a simple compression of the thoracic segment, but also 4 ligamentous or discal lesions. Computed tomography or RMI was used in 64% of cases and four fractures were missed or underestimated on X-ray. One complex fracture required surgical treatment. A return to flying duties was frequently possible within a period of 6 mo. Conclusions: New generation ejection seats remain highly traumatic for the spine. It is recommended that all ejected aircrews be assessed with computed tomography to improve the sensitivity of the screening for fractures. The risk of asymptomatic lesions makes necessary the systematic use of a stretcher for initial evacuation when possible.