{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:54:40Z","timestamp":1781744080468,"version":"3.54.5"},"reference-count":56,"publisher":"Aerospace Medical Association","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>\n                    <jats:bold>INTRODUCTION:<\/jats:bold>\n                    Fighter pilots are exposed to high +G\n                    <jats:sub>z<\/jats:sub>\n                    forces, helmet-mounted equipment, and extreme head positions that potentially cause cervical spine degeneration and pain. This study aimed to investigate whether individual +G\n                    <jats:sub>z<\/jats:sub>\n                    exposure, quantified by Fatigue Index (FI), predicts cervical spine degenerative changes and neck pain over a 10-yr follow-up.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    A total of 56 Finnish Air Force fighter pilots were followed prospectively for 10 yr. +G\n                    <jats:sub>z<\/jats:sub>\n                    exposure was recorded using flight hours and FI recordings. Cervical MRI was performed at the baseline and during the follow-up and evaluated by two radiologists. Annual health questionnaires were used to assess neck pain symptoms.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Pilots in the highest annual FI quartile had a significantly increased risk of flight-related neck pain (risk ratio 2.61) compared to others. In contrast, higher annual flight hours were not associated with flight-related neck pain. Before correction for multiple comparisons, new intervertebral disc herniations and foraminal stenosis at the C3\/C4 level were also associated with higher cumulative FI levels. Flight hours were at first associated with only intervertebral disc herniations at C3\/C4, but this association also lost significance after correction for multiple comparisons.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    To our knowledge, this is the first study to report harmful effects of +G\n                    <jats:sub>z<\/jats:sub>\n                    exposure using a metric other than flight hours. Higher cumulative +G\n                    <jats:sub>z<\/jats:sub>\n                    exposure, measured by FI, was significantly associated with flight-related neck pain. Although we observed a potential association between higher cumulative FI levels and cervical spine degeneration at C3\/C4 level, this finding did not remain statistically significant after correction for multiple comparisons.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      Keskim\u00f6l\u00f6 T, Kiviaho A, Karppinen J, Honkanen T, Sovelius R, Murto N, Kerttula L, Nykter M, Leino T.\n                      <jats:italic>\n                        +G\n                        <jats:sub>z<\/jats:sub>\n                        exposure and cervical spine degeneration on MRI among fighter pilots: a 10-year follow-up study\n                      <\/jats:italic>\n                      . Aerosp Med Hum Perform. 2026; 97(6):419\u2013428.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.6828.2026","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:31:02Z","timestamp":1780450262000},"page":"419-428","source":"Crossref","is-referenced-by-count":0,"title":["+Gz Exposure and Cervical Spine Degeneration on MRI Among Fighter Pilots: A 10-Year Follow-Up Study"],"prefix":"10.3357","volume":"97","author":[{"given":"Tuomas","family":"Keskim\u00f6l\u00f6","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Kiviaho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaro","family":"Karppinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomas","family":"Honkanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roope","family":"Sovelius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niko","family":"Murto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liisa","family":"Kerttula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Nykter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomo","family":"Leino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1911","reference":[{"issue":"5","key":"B1","series-title":"Aviat Space Environ Med.","first-page":"559","article-title":"Neck pain among fighter pilots after the introduction of the JHMCS helmet and NVG in their environment","volume":"82","author":"Lange B","year":"2011","unstructured":"Lange B, Torp-Svendsen J, Toft P. Neck pain among fighter pilots after the introduction of the JHMCS helmet and NVG in their environment. Aviat Space Environ Med. 2011 May; 82(5):559\u201363."},{"issue":"11","key":"B2","series-title":"Aviat Space Environ Med.","first-page":"1092","article-title":"+Gz-induced spinal symptoms in fighter pilots: operational and individual associated factors","volume":"83","author":"Wagstaff AS","year":"2012","unstructured":"Wagstaff AS, Jahr KI, Rodskier S. +Gz-induced spinal symptoms in fighter pilots: operational and individual associated factors. Aviat Space Environ Med. 2012 Nov; 83(11):1092\u20136."},{"issue":"11","key":"B3","series-title":"Aerosp Med Hum Perform.","first-page":"1000","article-title":"Risk factors for cervical pain in F-15C pilots","volume":"88","author":"Chumbley EM","year":"2017","unstructured":"Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform. 2017 Nov 1; 88(11):1000\u20137."},{"issue":"5","key":"B4","series-title":"Aerosp Med Hum Perform.","first-page":"431","article-title":"Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform","volume":"96","author":"den Bult-van Wieren GB","year":"2025","unstructured":"den Bult-van Wieren GB, van Rijswijk A, Kuypers MI, Steinman Y, Wingelaar TT, Nelissen RGHH. Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform. Aerosp Med Hum Perform. 2025 May; 96(5):431\u20135."},{"issue":"6","key":"B5","series-title":"Aerosp Med Hum Perform.","first-page":"552","article-title":"+Gz exposure and spinal injury-induced flight duty limitations","volume":"89","author":"Honkanen T","year":"2018","unstructured":"Honkanen T, Sovelius R, M\u00e4ntysaari M, Kyr\u00f6l\u00e4inen H, Avela J, Leino TK. +Gz exposure and spinal injury-induced flight duty limitations. Aerosp Med Hum Perform. 2018 Jun 1; 89(6):552\u20136."},{"issue":"4","key":"B6","series-title":"Aerosp Med Hum Perform.","first-page":"390","article-title":"+Gz exposure and flight duty limitations","volume":"93","author":"Sovelius R","year":"2022","unstructured":"Sovelius R, Honkanen T, Janhunen M, M\u00e4ntyl\u00e4 M, Huhtala H, Leino T. +Gz exposure and flight duty limitations. Aerosp Med Hum Perform. 2022 Apr 1; 93(4):390\u20135."},{"issue":"5","key":"B7","series-title":"Aviat Space Environ Med.","first-page":"477","article-title":"Functional assessment of the cervical spine in F-16 pilots with and without neck pain","volume":"80","author":"De Loose V","year":"2009","unstructured":"De Loose V, Van den Oord M, Burnotte F, Van Tiggelen D, Stevens V,  Functional assessment of the cervical spine in F-16 pilots with and without neck pain. Aviat Space Environ Med. 2009 May; 80(5):477\u201381."},{"issue":"3\u20134","key":"B8","series-title":"Mil Med.","first-page":"e766","article-title":"Burden and risk factors of cervical spine conditions in military aircrew from 1997 to 2015: a retrospective cohort study","volume":"190","author":"Lang RW","year":"2025","unstructured":"Lang RW, Porensky P, Fraser JJ. Burden and risk factors of cervical spine conditions in military aircrew from 1997 to 2015: a retrospective cohort study. Mil Med. 2025 Feb 27; 190(3\u20134):e766\u2013e776."},{"issue":"5\u20136","key":"B9","series-title":"Mil Med.","first-page":"e930","article-title":"Association between cumulative G-force exposure and cervical spine degenerative changes","volume":"190","author":"Keskim\u00f6l\u00f6 T","year":"2025","unstructured":"Keskim\u00f6l\u00f6 T, Oura P, Honkanen T, Niinim\u00e4ki J, Sovelius R,  Association between cumulative G-force exposure and cervical spine degenerative changes. Mil Med. 2025 Apr 23; 190(5\u20136):e930\u20137."},{"issue":"17","key":"B10","series-title":"Spine (Phila Pa 1976).","first-page":"1873","article-title":"Magnetic resonance classification of lumbar intervertebral disc degeneration","volume":"26","author":"Pfirrmann CW","year":"2001","unstructured":"Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001 Sep 1; 26(17):1873\u20138."},{"issue":"4","key":"B11","series-title":"Korean J Spine.","first-page":"148","article-title":"Whole spine disc degeneration survey according to the ages and sex using Pfirrmann disc degeneration grades","volume":"14","author":"Oh CH","year":"2017","unstructured":"Oh CH, Yoon SH. Whole spine disc degeneration survey according to the ages and sex using Pfirrmann disc degeneration grades. Korean J Spine. 2017 Dec; 14(4):148\u201354."},{"issue":"25","key":"B12","series-title":"Spine (Phila Pa 1976).","first-page":"2180","article-title":"Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults?","volume":"36","author":"Takatalo J","year":"2011","unstructured":"Takatalo J, Karppinen J, Niinim\u00e4ki J, Taimela S, N\u00e4yh\u00e4 S,  Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine (Phila Pa 1976). 2011 Dec 1; 36(25):2180\u20139."},{"issue":"4","key":"B13","series-title":"BMJ Mil Health.","first-page":"291","article-title":"Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up","volume":"169","author":"Keskim\u00f6l\u00f6 T","year":"2023","unstructured":"Keskim\u00f6l\u00f6 T, Pernu J, Karppinen J, Niinim\u00e4ki J, Oura P,  Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up. BMJ Mil Health. 2023 Aug; 169(4):291\u20136."},{"issue":"11","key":"B14","series-title":"Spine J.","first-page":"2525","article-title":"Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology","volume":"14","author":"Fardon DF","year":"2014","unstructured":"Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014 Nov 1; 14(11):2525\u201345."},{"issue":"6","key":"B15","series-title":"Korean J Radiol.","first-page":"1294","article-title":"A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images","volume":"16","author":"Kim S","year":"2015","unstructured":"Kim S, Lee JW, Chai JW, Yoo HJ, Kang Y,  A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images. Korean J Radiol. 2015 Nov\u2013Dec; 16(6):1294\u2013302."},{"issue":"1025","key":"B16","series-title":"Br J Radiol.","first-page":"20120515","article-title":"A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images","volume":"86","author":"Park HJ","year":"2013","unstructured":"Park HJ, Kim SS, Lee SY, Park NH, Chung EC,  A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images. Br J Radiol. 2013 May; 86(1025):20120515."},{"issue":"4","key":"B17","series-title":"Diagn Interv Imaging.","first-page":"411","article-title":"MR imaging of Schmorl\u2019s nodes: imaging characteristics and epidemio-clinical relationships","volume":"97","author":"Moustarhfir M","year":"2016","unstructured":"Moustarhfir M, Bresson B, Koch P, Perozziello A, Barreau G,  MR imaging of Schmorl\u2019s nodes: imaging characteristics and epidemio-clinical relationships. Diagn Interv Imaging. 2016 Apr; 97(4):411\u20137."},{"issue":"3","key":"B18","series-title":"Osteoarthritis Cartilage.","first-page":"237","article-title":"Osteophytes: relevance and biology","volume":"15","author":"van der Kraan PM","year":"2007","unstructured":"van der Kraan PM, van den Berg WB. Osteophytes: relevance and biology. Osteoarthritis Cartilage. 2007 Mar; 15(3):237\u201344."},{"issue":"12","key":"B19","series-title":"Eur Spine J.","first-page":"2999","article-title":"Relationship between modic changes and facet joint degeneration in the cervical spine","volume":"24","author":"Park MS","year":"2015","unstructured":"Park MS, Moon SH, Kim TH, Lee SY, Jo YG, Riew KD. Relationship between modic changes and facet joint degeneration in the cervical spine. 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Aerosp Med Hum Perform. 2017 May 1; 88(5):476\u201380."},{"issue":"1","key":"B22","series-title":"AJR Am J Roentgenol.","first-page":"W134","article-title":"New MRI grading system for the cervical canal stenosis","volume":"197","author":"Kang Y","year":"2011","unstructured":"Kang Y, Lee JW, Koh YH, Hur S, Kim SJ,  New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol. 2011 Jul; 197(1):W134\u201340."},{"issue":"5","key":"B23","series-title":"J Bone Joint Surg Br.","first-page":"678","article-title":"Modic changes in the cervical spine: prospective 10-year follow-up study in asymptomatic subjects","volume":"94","author":"Matsumoto M","year":"2012","unstructured":"Matsumoto M, Okada E, Ichihara D, Chiba K, Toyama Y,  Modic changes in the cervical spine: prospective 10-year follow-up study in asymptomatic subjects. J Bone Joint Surg Br. 2012 May; 94(5):678\u201383."},{"issue":"5","key":"B24","series-title":"Aviat Space Environ Med.","first-page":"443","article-title":"Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study","volume":"72","author":"Petr\u00e9n-Mallmin M","year":"2001","unstructured":"Petr\u00e9n-Mallmin M, Linder J. Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study. Aviat Space Environ Med. 2001 May; 72(5):443\u20136."},{"issue":"11","key":"B25","series-title":"Aviat Space Environ Med.","first-page":"1057","article-title":"Degenerative changes of the spine of fighter pilots of the Royal Netherlands Air Force (RNLAF)","volume":"70","author":"Hendriksen IJ","year":"1999","unstructured":"Hendriksen IJ, Holewijn M. Degenerative changes of the spine of fighter pilots of the Royal Netherlands Air Force (RNLAF). 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Aviat Space Environ Med. 2011 May; 82(5):559\u201363."},{"issue":"11","key":"B2","series-title":"Aviat Space Environ Med.","first-page":"1092","article-title":"+Gz-induced spinal symptoms in fighter pilots: operational and individual associated factors","volume":"83","author":"Wagstaff AS","year":"2012","unstructured":"Wagstaff AS, Jahr KI, Rodskier S. +Gz-induced spinal symptoms in fighter pilots: operational and individual associated factors. Aviat Space Environ Med. 2012 Nov; 83(11):1092\u20136."},{"issue":"11","key":"B3","series-title":"Aerosp Med Hum Perform.","first-page":"1000","article-title":"Risk factors for cervical pain in F-15C pilots","volume":"88","author":"Chumbley EM","year":"2017","unstructured":"Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform. 2017 Nov 1; 88(11):1000\u20137."},{"issue":"5","key":"B4","series-title":"Aerosp Med Hum Perform.","first-page":"431","article-title":"Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform","volume":"96","author":"den Bult-van Wieren GB","year":"2025","unstructured":"den Bult-van Wieren GB, van Rijswijk A, Kuypers MI, Steinman Y, Wingelaar TT, Nelissen RGHH. Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform. Aerosp Med Hum Perform. 2025 May; 96(5):431\u20135."},{"issue":"6","key":"B5","series-title":"Aerosp Med Hum Perform.","first-page":"552","article-title":"+Gz exposure and spinal injury-induced flight duty limitations","volume":"89","author":"Honkanen T","year":"2018","unstructured":"Honkanen T, Sovelius R, M\u00e4ntysaari M, Kyr\u00f6l\u00e4inen H, Avela J, Leino TK. +Gz exposure and spinal injury-induced flight duty limitations. Aerosp Med Hum Perform. 2018 Jun 1; 89(6):552\u20136."},{"issue":"4","key":"B6","series-title":"Aerosp Med Hum Perform.","first-page":"390","article-title":"+Gz exposure and flight duty limitations","volume":"93","author":"Sovelius R","year":"2022","unstructured":"Sovelius R, Honkanen T, Janhunen M, M\u00e4ntyl\u00e4 M, Huhtala H, Leino T. +Gz exposure and flight duty limitations. Aerosp Med Hum Perform. 2022 Apr 1; 93(4):390\u20135."},{"issue":"5","key":"B7","series-title":"Aviat Space Environ Med.","first-page":"477","article-title":"Functional assessment of the cervical spine in F-16 pilots with and without neck pain","volume":"80","author":"De Loose V","year":"2009","unstructured":"De Loose V, Van den Oord M, Burnotte F, Van Tiggelen D, Stevens V,  Functional assessment of the cervical spine in F-16 pilots with and without neck pain. Aviat Space Environ Med. 2009 May; 80(5):477\u201381."},{"issue":"3\u20134","key":"B8","series-title":"Mil Med.","first-page":"e766","article-title":"Burden and risk factors of cervical spine conditions in military aircrew from 1997 to 2015: a retrospective cohort study","volume":"190","author":"Lang RW","year":"2025","unstructured":"Lang RW, Porensky P, Fraser JJ. Burden and risk factors of cervical spine conditions in military aircrew from 1997 to 2015: a retrospective cohort study. Mil Med. 2025 Feb 27; 190(3\u20134):e766\u2013e776."},{"issue":"5\u20136","key":"B9","series-title":"Mil Med.","first-page":"e930","article-title":"Association between cumulative G-force exposure and cervical spine degenerative changes","volume":"190","author":"Keskim\u00f6l\u00f6 T","year":"2025","unstructured":"Keskim\u00f6l\u00f6 T, Oura P, Honkanen T, Niinim\u00e4ki J, Sovelius R,  Association between cumulative G-force exposure and cervical spine degenerative changes. Mil Med. 2025 Apr 23; 190(5\u20136):e930\u20137."},{"issue":"17","key":"B10","series-title":"Spine (Phila Pa 1976).","first-page":"1873","article-title":"Magnetic resonance classification of lumbar intervertebral disc degeneration","volume":"26","author":"Pfirrmann CW","year":"2001","unstructured":"Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001 Sep 1; 26(17):1873\u20138."},{"issue":"4","key":"B11","series-title":"Korean J Spine.","first-page":"148","article-title":"Whole spine disc degeneration survey according to the ages and sex using Pfirrmann disc degeneration grades","volume":"14","author":"Oh CH","year":"2017","unstructured":"Oh CH, Yoon SH. Whole spine disc degeneration survey according to the ages and sex using Pfirrmann disc degeneration grades. Korean J Spine. 2017 Dec; 14(4):148\u201354."},{"issue":"25","key":"B12","series-title":"Spine (Phila Pa 1976).","first-page":"2180","article-title":"Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults?","volume":"36","author":"Takatalo J","year":"2011","unstructured":"Takatalo J, Karppinen J, Niinim\u00e4ki J, Taimela S, N\u00e4yh\u00e4 S,  Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine (Phila Pa 1976). 2011 Dec 1; 36(25):2180\u20139."},{"issue":"4","key":"B13","series-title":"BMJ Mil Health.","first-page":"291","article-title":"Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up","volume":"169","author":"Keskim\u00f6l\u00f6 T","year":"2023","unstructured":"Keskim\u00f6l\u00f6 T, Pernu J, Karppinen J, Niinim\u00e4ki J, Oura P,  Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up. BMJ Mil Health. 2023 Aug; 169(4):291\u20136."},{"issue":"11","key":"B14","series-title":"Spine J.","first-page":"2525","article-title":"Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology","volume":"14","author":"Fardon DF","year":"2014","unstructured":"Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014 Nov 1; 14(11):2525\u201345."},{"issue":"6","key":"B15","series-title":"Korean J Radiol.","first-page":"1294","article-title":"A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images","volume":"16","author":"Kim S","year":"2015","unstructured":"Kim S, Lee JW, Chai JW, Yoo HJ, Kang Y,  A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images. Korean J Radiol. 2015 Nov\u2013Dec; 16(6):1294\u2013302."},{"issue":"1025","key":"B16","series-title":"Br J Radiol.","first-page":"20120515","article-title":"A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images","volume":"86","author":"Park HJ","year":"2013","unstructured":"Park HJ, Kim SS, Lee SY, Park NH, Chung EC,  A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images. Br J Radiol. 2013 May; 86(1025):20120515."},{"issue":"4","key":"B17","series-title":"Diagn Interv Imaging.","first-page":"411","article-title":"MR imaging of Schmorl\u2019s nodes: imaging characteristics and epidemio-clinical relationships","volume":"97","author":"Moustarhfir M","year":"2016","unstructured":"Moustarhfir M, Bresson B, Koch P, Perozziello A, Barreau G,  MR imaging of Schmorl\u2019s nodes: imaging characteristics and epidemio-clinical relationships. 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