Return to flight duty rates after posterior lumbar spine surgery for symptomatic lumbar disc herniation and lumbar isthmic spondylolisthesis in Chinese military pilots

Background: Symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) can ground active-duty military pilots if not properly managed. Surgically treated LDH and LIS may be waivable conditions and allow return to full flight status, but waivers are based on expert opinion rather than recent published data. The purpose of this study was to determine the rates of return to flight status among Chinese military pilots who had undergone lumbar spine surgery for symptomatic LDH and LIS. Methods A single-center retrospective review was conducted by the authors for all active-duty pilots who underwent either isolated decompressive or fusion procedures at an authorized military medical center between March 1, 2007 and March 1, 2023. Descriptive statistics were obtained for patients to evaluate demographic, occupational, surgical, and outcome data with particular attention to preoperative flight status, days to recommended clearance by spine surgeons, and days to return to active flight duty. Results Between March 1, 2007, and March 1, 2023, a total of 24 cases of active-duty pilots with LDH or LIS treated by lumbar surgery were identified. Of these, 16 underwent isolated decompressive procedures and 8 underwent fusion procedures. Seventeen (70.8%) of the 24 pilots treated with lumbar spine surgeries were able to return to flight duty (RTFD). Excluding the 1 pilot who retired within 1 year of surgery and the 2 pilots who did not return to active flight duty for reasons other than lumbar conditions, the RTFD rate is actually 81.0% (17 of 21). The average time to clearance by the spine surgeons was 256 days and average time to return to full flight was 339 days. The average follow-up time was 2.6 years. Conclusion Lumbar surgery appears to be safe for military aviators with symptomatic LDH or LIS, and return to flight status is the most likely outcome for the majority of postoperative pilots.