Determinants of cervical spine disorders in military pilots: A systematic review

Background: Neck pain and cervical spine disorders are widespread among military cockpit aircrew pilots and are often recognized as occupational stressors. Aims: This systematic review aimed to identify significant determinants for military pilot neck pain and cervical spine disorders determined through multivariable logistic regression studies. Methods: This systematic review was conducted according to the recommendations of the Statement of Systematic Review and Meta-analysis Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]-P). The following databases were searched for literature: Medline and Embase. We included studies that studied neck pain, cervical spine disorders, and/or radiological abnormalities and associated exposures (adjusted odds ratios, ORadj) in military cockpit aircrew. The trustworthiness, relevance and results of the published papers were evaluated using the Joanna Briggs Institute critical checklist. Results: A total of three studies quantified the strength of the correlations between exposures and outcomes. Significant determinants/risk factors of neck pain, cervical spine disorders and radiological abnormalities were identified as age (ORadj: 1.092 [95% CI 1.054, 1.132]), fighter type (ORadj: 3.9 [95% CI 1.1, 13.9]) and absolute rotation angle of C2-7 (ARA) (ORadj: 0.91 [CI 0.85, 0.98]). The following variables were unable to demonstrate statistical significance: flying hours, body height and body mass index. Conclusions: Military cockpit aircrew's frequent neck pain after a flight raises concerns about cervical spine disorders. Age, fighter type and ARA C2-7 are strong predictors of neck pain and cervical spine disorders. More research is needed on occupational determinants and risk factors for neck pain and cervical spine disorders in military cockpit aircrew.