Background

High velocity vertical aircraft ejection seat systems are credited with aircrew survival of 80-95% in modern times. Use of these systems is associated with exposure of the aircrew to vertical acceleration forces in the order of 15-25G. The rate of application of these forces may be up to 250G per sceond. Up to 85% of crew ejecting suffer skeletal injury and vertebral fracture is relatively common (20-30%) when diagnosed by plain radiograph. The incidence of subtle spinal injury may not be as apparent.

High velocity vertical aircraft ejection seat systems are credited with aircrew survival of 80–95% in modern times. Use of these systems is associated with exposure of the aircrew to vertical acceleeration forces in the order of 15–25G. The rate of application of these forces maybe upto 250G per sceond. Upto 85% of crew ejecting suffer skeletal injury and vertebral fracture is relatively common (20–30%) when diagnosed by plain radiograph. The incidence of subtle spinal injury may not be as apparent.

A prospective case series, admitted to QMC Nottingham, from 1996 to 2006 was evaluated. During this interval 26 ejectees from 20 aircraft were admitted to the spinal studies unit for comprehensive examination, evaluation and management. The investigations included radiographs of the whole spine and magnetic resonance Imaging (incorporating T1, T2 weighted and STIR saggital sequences). All ejections occurred within the ejection envelope and occurred at an altitude under 2000 feet (mean 460 feet) and at an airspeed less than 500 knots (mean 275 knots).

In this series 6 ejectees (24%) had clinical and radiographic evidence of vetebral compression fractures. These injuries were located in the thoracic and thoracolumbar spine. 4 cases required surgery ( indicated for angular kyphosis greater than 30 degrees, significant spinal canal compromise, greater than 50% or neurological injury. 1 patient had significant neurological compromise, following an AO A3.3 injury involving the L2 vertebra.

11 ejectees (45 %) had MRI evidence of a combined total of 22 occult thoracic and lumbar fractures. The majority of these ejectees with occult injury had multilevel injuries.

This study confirms a high incidence if spinal fracture and particularly occult spinal injury. Evidently vertical emergency aircraft ejection imposes major insults on the spinal column. Once, appropriately prioritised, life preservation measures have been undertaken, an early MRI of the spne is mandatory as part of comprehensive patient evaluation.

Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.

Study Design: Long-term retrospective case review of function in children with early onset scoliosis managed by selective anterior epiphysiodesis and posterior ‘Luque trolley’ growing instrumentation

Method: spinal and clinical function was assessed utilising SRS-22 and SF-36 outcome measures. The rates of secondary surgical procedures and further definitive fusion were recorded. Pulmonary function was assessed by standardised and averaged spirometric data at follow up.

Results: 25 patients have been clinically reviewed and functionally assessed (age range 6–35 years) mean age 17.7 years at follow up. 16 patients have reached skeletal maturity (8males, 8females) with mean follow up 11.8 years, to a mean age of 22.4 years. clinically 80% of cases were well balanced. At maturity the average loss of axial spinal growth measured 10.25cm (arm span- standing height) (range +4 cm to −21cm). In the immature cohort still growing, median shortening was 0.75%, with average height loss 1.63% of predicted. SRS- 22 and SF-36 questionnaires indicated moderate – good functional outcomes in 80% of patients. Spirometric data, with one case incapable of test compliance, demonstrates 24 % of patients had normal spirometric functional parameters, 32% had mild restrictive deficits, 12% had moderate and 28% had severe restrictive deficits. Poor spirometric function did not correlate with poor outcome measures. Over 50% had required further surgery.

Conclusions: Poor functional outcomes occurred in patients requiring early and multiple surgical revision procedures associated with loss of control or fixation of primary and secondary spinal deformities.