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While existing aeromedical guidelines focus primarily on helicopter (rotor-wing) transport, there is limited evidence consolidating the effects of fixed-wing aircraft transport, which exposes patients to unique physiological stressors due to higher operational altitudes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a recognised framework for scoping reviews, a European-based research team conducted biweekly discussions to ensure a comprehensive approach.\u00a0This scoping review utilized a four-phase framework: identification, screening, data extraction, and contextualisation. A systematic literature search via OVID databases up to September 19, 2024, and manual searches of 15 journals identified studies involving fixed-wing aircraft transport for spinal pathology patients, excluding helicopter or animal studies.\u00a0Additionally, a panel of experts in neurosurgery and aviation reflected on their experiences and transferable lessons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>12 studies were included, covering 105 spinal injury cases and 1 spinal tuberculosis case. Key physiological factors unique to fixed-wing transport include reduced atmospheric pressure, low humidity, extended transport duration, smoother acceleration\/deceleration, and better medical accessibility compared to rotor-wing transport. Recommendations from the literature and expert experiences emphasise respiratory stability, humidification, oxygen supplementation, pressure injury prevention, bowel\/bladder management, airway cuff pressure management, and venous thromboembolism prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is an urgent need for evidence-based recommendations tailored to fixed-wing transportation of spinal pathology patients, emphasizing altitude-induced physiological changes to optimize patient safety. Further targeted research is essential to develop comprehensive clinical protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06852-0","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T12:05:00Z","timestamp":1775131500000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fixed-wing air transport of patients with spinal pathologies: a scoping review of current evidence and future research priorities"],"prefix":"10.1007","volume":"168","author":[{"given":"Ashviniy","family":"Thamilmaran","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zak","family":"Hodgson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Peramatzis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Karampouga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Jarratt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni","family":"Tsianaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Insa K.","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia","family":"Tasiou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nese","family":"Keser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"6852_CR1","unstructured":"Air Force Materiel Command (2023) AFRL-developed physiological monitoring system undergoes flight tests. 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