BackgroundThere are established regional and racial/ethnic disparities in lower limb amputation due to diabetes; risk is higher in people of African American and Hispanic origin, particularly those in South Texas. The studies exposing these disparities in the Lower Rio Grande Valley are not current and are limited in number.MethodsWe collected data from 2011 to 2016 from the United States Census Bureau, Texas Department of State Health Services (DSHS), and Robert Wood Johnson Foundation (RWJF) databases. Demographic information related to gender, race, and Hispanic ethnicity was extracted from the Census Bureau, counts of minor and major amputations from DSHS, and socioeconomic data such as percent of unemployed, uninsured, and college education attainment from RWJF. Using multivariate Poisson regression, current rates of lower limb amputation secondary to diabetes in the Rio Grande Valley were analyzed, and the role of Hispanic ethnicity in county-level amputation rates was explored.ResultsThe Valley population living with diabetes had a significantly increased risk (1.334; CI 1.291, 1.378) of diabetes-related lower limb amputation compared to the rest of Texas when adjusting for the year. Similarly, Hispanic ethnicity was associated with an increased risk of amputation by a factor of 2.172 (CI 2.097, 2.248) compared to non-Hispanic ethnicity. However, when adjusting for Hispanic ethnicity, residing in the Valley is a protective factor for amputation, decreasing risk by a factor of 0.827 (CI 0.795, 0.86) compared to the rest of Texas.ConclusionWhile Hispanic ethnicity is associated with an increased individual risk of diabetes-related lower limb amputation in the Rio Grande Valley, residence in the Valley is simultaneously a protective factor from amputation.

INTRODUCTION:We previously published a model of how calcium from resorbing bone can enter and persist in the circulation with consequent precipitation in coronary arteries. The model was based on chronic inflammation as the source of continued bone resorption. We asked whether other forms of resorptive bone loss such as microgravity (disuse) might also be associated with bone calcium accumulation in coronary arteries. METHODS:We analyzed a de-identified database provided by NASA consisting of 52 astronauts who had flown a space mission around two determinations of coronary artery calcium (CAC) scores at 5-yr intervals and bone density determinations in the year prior to and 10 d and 1 yr following a space mission. RESULTS:We found that in 38.5% of the astronauts, their CAC scores changed between pre- and postflight, with 95% of the CAC scores increasing. These astronauts were significantly older than the 61.5% whose CAC scores did not change, although the mission length was not different between the groups. Both groups lost bone acutely but had partial recovery over the year postflight. DISCUSSION:Due to lack of uniform sampling times, we could not correlate changes in CAC score with bone loss and would advocate for synchronous determinations of CAC and bone density pre- and postflight. Klein GL, Jupiter DC. Elevated coronary artery calcium scores in astronauts. Aerosp Med Hum Perform. 2025; 96(4):356-359.

Diabetic foot ulcers (DFU) may lead to lower extremity amputation (LEA). Although minor LEAs (at or distal to the ankle) can carry a higher risk of perioperative complications compared to major LEAs (proximal to the ankle), they can increase patient independence and quality of life. This study aims to elucidate the impact of minor LEA on the time between DFU occurrence and major LEA to help determine the safer and more efficacious LEA choice for a given clinical situation. Data from 4,199 DFU patients from the TriNetX research platform were utilized. Kaplan-Meier curves and Cox regression were conducted to evaluate the impact of minor amputations on the likelihood of subsequent major amputations. Of the patients studied, 83 (23.85%) underwent minor LEAs, while 265 (76.15%) received major LEAs. DFU patients who had undergone a minor amputation were 28.1 times more likely (P < 0.001) in time-to-event analysis, 63.3 times more likely (P < 0.001) in time-varying analysis, with minor amputation as a time-varying covariate, and 60.8 times more likely (P < 0.001) in multivariate time-varying analysis to receive a major amputation than DFU patients who had not. DFU patients with minor LEAs were at higher risk for subsequent major LEAs. Clinically, these results imply that minor amputations are likely not the last step in a patient’s care and that their utilization should be improved. Shared decision-making with DFU patients should account for the potential for upfront major LEA to avoid complications of stepwise progression from DFU to minor to major LEA.

BackgroundTibiotalocalcaneal (TTC) nails are commonly used implants for hindfoot arthrodesis. This study evaluated the relationship between the sagittal placement of the nail-specifically, more anterior versus more posterior positioning within the talus-and patient outcomes following surgery.MethodsWe conducted a retrospective, single-center study involving patients aged 18 years and older who underwent hindfoot nail fusion. Variables analyzed included smoking status, body mass index (BMI), diabetes mellitus (DM) status, age, cause of surgery, surgical complications including nonunion, and need for revision surgery. Postoperative X-rays were assessed to calculate the talar-to-nail ratio (tnR), defined as the distance between the anterior margin of the talus and the center of the hindfoot nail (nL) relative to the total length of the talus (tL), expressed as tnR = nL/tL.ResultsThe study included 53 patients (24 male, 29 female) aged 18-92 years. The mean tnR was 54.635% (SD = 9.925), with a range from 23.89% to 76.71%. Bivariate analysis showed no significant relationship between the analyzed variables and nonunion or revision surgery, with the exception of tnR, which was significantly positively associated with revision surgery (59.130 ± 8.253 vs 51.912 ± 9.967, P = .009). In multivariable logistic regression, while DM and age were not significantly associated with revision surgery (P > .05), tnR demonstrated a significant association, with an odds ratio of 1.093 (95% CI: 1.017-1.193) and a P-value of .026.ConclusionMore posterior nail placement, as indicated by a higher tnR, is significantly associated with an increased likelihood of revision surgery, potentially due to an increased foot lever arm. These findings suggest that more anterior nail placement may lead to improved surgical outcomes in TTC arthrodesis.Level of Evidence:Level III, Prognostic.

BACKGROUND:Diabetic foot ulcers (DFUs) often lead to lower-limb amputation (LLA), and comorbid foot infections increase this risk. The chronological timeline from ulceration to amputation has not been well studied, especially when accounting for foot infections. This study aims to analyze the timing between diagnosis of DFU, subsequent foot infection, and LLA. METHODS:Records of 3,156 patients with DFU treated at a single institution from 1996 to 2023 were used via the TriNetX research platform. Patients were stratified by whether they received a diagnosis of concomitant foot infection during or after DFU diagnosis (DFU+i) or not (DFU-i). Infection after ulceration was used as a time-varying covariate, and the two groups were analyzed for differences in time to LLA, rates of LLA, and patient characteristics (age at ulceration, sex, race, ethnicity, and amputation or infection before the first identified ulcer). RESULTS:A diagnosis of comorbid foot infection was given to 51.1% of patients either during or after DFU diagnosis, and 8.7% of patients required an amputation. Patients with a history of pre-DFU foot infections were more likely to develop a post-DFU infection (72.2% versus 32.7%; P < .001). Patients with pre-DFU amputations were also more likely to develop a post-DFU infection (67.6% versus 48.7%; P = .028). The amputation rate reached 50% in the DFU+i group by 4,857 days. The DFU-i group never exceeded an amputation rate of 6% by almost 10,000 days. When accounting for patient characteristics, post-DFU infections were 12 times more likely (P < .001) than noninfected ulcers to require amputation. CONCLUSIONS:Patients who developed a subsequent foot infection during or after DFU diagnosis were likelier to require an amputation and had these earlier than those without infection. Great care is required to ensure that patients with DFUs minimize risk of infection and amputation.

BACKGROUND:Deep venous thrombosis (DVT) and pulmonary embolism (PE) are relatively rare after foot and ankle surgery, especially after trauma. Diagnosing DVT is difficult, and even when it is discovered it does not necessarily clinically manifest on, for example, duplex ultrasound. Thus, it is often recommended that prophylaxis use be assessed on a case-by-case basis based on risk profile rather than being uniformly given or not prescribed. METHODS:We searched the National Trauma Data Bank Trauma Quality Programs Participant Use File for patients experiencing foot and ankle trauma from 2013 to 2017. Patients were identified using the International Classification of Diseases, 9th Revision codes. Procedures undergone by patients were classified into five categories: closed reduction with fixation, open reduction with or without fixation, closed reduction without fixation, immobilization or no treatment, and soft-tissue procedures (eg, wound debridement). RESULTS:Roughly 60% of trauma admissions for foot and ankle injury included use of prophylaxis. Female sex and increased age predisposed a patient to prophylaxis use. Hispanic and self-pay patients were less likely to have prophylaxis prescribed. Those with risk factors such as hypertension or smoking and those with open injuries or rearfoot injuries were also more likely to receive prophylaxis. Approximately half of the foot and ankle trauma patients in this cohort were treated with DVT prophylaxis, including those without additional risk factors for DVT/PE. CONCLUSIONS:Further study is needed to better elucidate whether prophylaxis use is driven by protocol or clinical decision-making. Although it is important to understand the epidemiology of DVT/PE, effectiveness of prophylaxis, and recommendations from associations, understanding community practice patterns can promote discussion with policymakers to create new or alter current institutional protocols that may not be specific to the foot and ankle.

Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder leading to dementia. The existence of individuals who remain cognitively intact despite presenting histopathological signs of AD, here referred to as “Non-demented with AD neuropathology” (NDAN), suggests that some mechanisms are triggered to resist cognitive impairment. These individuals are distinguished by the presence of highly phagocytic microglia capable of clearing damaged synapses near plaques, mitigating further damage to axons and dendrites. We conducted a comparative analysis of dendritic spines morphology in the post-mortem frontal cortex of NDAN individuals, AD patients, and age-matched healthy controls. Our investigation included an in-depth examination of synaptic structures both near and far from Aβ plaques, quantifying aspects such as dendrite length, diameter, spine density, and types. We expanded our research to investigate levels and distribution of Pin1, identified as a potential key player in the protective mechanisms against AD, influencing the regulation of dendritic spine formation and maintenance. Within 100 µm of Aβ plaques, significant synaptic toxicity was observed in all groups. However, in areas distal to plaques, NDAN exhibited significantly higher spine density than AD, suggesting the existence of a compensatory mechanism. We also measured the relative abundance of four spine types: mushroom, stubby, filopodia, and long thin, finding stubby spines to be the most common across all groups. Mushroom spines, the least dynamic, were significantly more abundant in AD compared to NDAN and control subjects. Conversely, NDAN individuals showed a higher density of more dynamic and plastic spines, such as filopodia and long thin spines, than AD. These findings suggest that the rearrangement of dynamic dendritic spines in NDAN may underlie the ability of these individuals to replace damaged synapses and preserve cognitive integrity. Furthermore, our results revealed lower expression of Pin1 in AD patients than control and NDAN groups, across regions, proximal and distal to plaques. This finding suggests that reduced Pin1 expression in AD may contribute to the compromised synaptic integrity and plasticity observed in these individuals. This study sheds light on the potential mechanisms allowing NDAN individuals to retain cognitive function despite AD pathology, offering insights for future therapeutic strategies.

BACKGROUND:Osteomyelitis (OM) is a complex bone disease most often caused by microorganism-based infections; it poses significant challenges for diagnosis and treatment. Previous epidemiologic studies have identified upward temporal trends in the diagnosis of OM. This study examined these trends in diabetic OM and OM-related amputations in Texas, a state with one of the highest rates of diabetes in the United States. METHODS:Retrospective analysis was conducted on Texas diabetic inpatient hospital data from 2006 to 2016. Data were extracted for patients who had diagnostic codes for diabetes and for foot and ankle OM, along with data for OM-related major or minor amputations. Rates were calculated per 1,000 people and standardized using 2019 population estimates. RESULTS:The prevalence of diabetic OM increased from 2006 to 2016, as did total, major, and minor amputations in patients with OM. Decreases were noted in 2014 to 2016. Age-standardized rates demonstrated the same trends, as did rates across all of the age groups. Osteomyelitis increased most in 45- to 64-year-olds. Amputation rates increased similarly in 45- to 64-year-olds, 65- to 74-year-olds, and those 75 years and older. Poisson regression analysis reinforced these trends, with significant increases in risk ratios for OM and amputation rates in all of the age groups. CONCLUSIONS:This preliminary analysis highlights the increasing prevalence of OM and OM-related amputations in diabetic patients from 2006 to 2016 and for all age groups (18-75 years and older) in Texas. Although increasing diabetes rates may contribute to the observed trends in OM, it does not exclusively explain them. Further research should investigate possible interventions to mitigate the rise in diabetic OM and associated amputations.

BACKGROUND:Three-dimensional CT (3D-CT) has enhanced medical imaging by producing detailed surface renderings from two-dimensional CT scans. As an advancement beneficial in orthopaedic trauma, 3D-CT offers improved visualization of fracture geometry, size, and spatial relationships. For trimalleolar ankle fractures, specifically, 3D-CT could refine surgical planning and classification. Multiple studies have investigated the effect of 3D-CT on various injuries, yet the effect on trimalleolar fractures remains underexplored. METHODS:Our study examined the influence of 3D-CT on preoperative planning for trimalleolar ankle fractures, comparing it with preoperative planning using radiographs and CT. Patient records were reviewed from January 1, 2017, to May 24, 2021. Four orthopaedic surgeons analyzed preoperative imaging in two phases: initially with radiographs and CT and then with the inclusion of 3D-CT. Each reviewer then completed a questionnaire consisting of fracture classification and surgical planning questions. Statistical analysis was completed using Cohen kappa coefficient. RESULTS:Analysis of 42 patient cases revealed notable differences in surgical approaches, posterior fixation methods, and fixation sequences when using 3D-CT (1-[ k ] > 0.70). Changes in Mason classification (1-[ k ] = 0.62) and order of lateral fixation (1-[ k ] = 0.67) approached significance; however, variability in intraobserver reliability was noted among reviewers. CONCLUSIONS:3D-CT markedly influences preoperative planning for trimalleolar ankle fractures, specifically involving decisions about the posterior malleolus fragment. Future research should be aimed toward a comparison of preoperative planning with real-world surgical outcomes while also weighing the cost of 3D-CT. LEVEL OF EVIDENCE:Diagnostic level III.

Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.

Patient -centered care will continue to grow, and medical research will focus more on patients' perspectives. For this reason, results and conclusions stemming from PROs will be valued and used in policymaking and by insurance companies more often in the future. At the same time, we cannot completely disregard provider -based measures because we need these measures to understand the science and to identify factors associated with improving PROs. At the same time, a lack of association between provider -based and patient -centered measures will more likely result in a reevaluation of provider -perceived outcome measures than in that of patient -centered ones. On the other hand, identifying these associations would confirm the importance of the objective measures and enable the providers to better manage patients by improving these specific parameters. PROs will be more widely incorporated not only in medical/surgical research but also in daily clinical practice. Patients will become accustomed to filling out short item -response surveys more often. The results of these surveys will be available for the physician as feedback and as a tool to communicate with the patients. Provider -based measures should continue to be vetted for validity and reliability. Those provider -based measures strongly correlated with PROs are more likely to be refined and used further in medical research. Those measures with poor quality or association with PROs will become less popular, and studies using these measures will have a more challenging time being accepted by clinical journals.

BACKGROUND:Results of recent studies suggest that high levels of endogenous testosterone decrease the risk of diabetes. Testosterone therapy may delay the transition from prediabetes to diabetes and accelerate healing of diabetic foot ulcers in hypogonadal men. We investigated whether testosterone therapy in this population decreases the occurrence of diabetic foot complications within 1 and 5 years of diabetes diagnosis. METHODS:Optum's deidentified Clinformatics Data Mart database was searched for male patients with diabetes. Associations between testosterone therapy and the occurrence of ulceration or the use of wound care were explored in the entire population and in those with and without hypogonadism using both bivariate and multivariate analyses. RESULTS:Contrary to the hypotheses, testosterone therapy seems to confer increased risk of diabetic foot complications. In hypogonadal men with at least 1 year of follow-up after diabetes diagnosis, any use of testosterone therapy increased the odds of wound care utilization by a factor of 1.10 (95% confidence interval, 1.03-1.17), and the odds of ulceration by a factor of 1.13 (95% confidence interval, 1.03-1.24). Similar results are seen in all men, both with and without hypogonadism. Further exploration reveals that hypogonadism also increases the risk of wounds among people with diabetes with care utilization in the entire population. CONCLUSIONS:Further research is needed to elucidate the mechanisms by which hypogonadism and testosterone therapy impact diabetic foot complications, and whether these mechanisms are mediated by vascular or neurologic factors.

Background: Preclinical evidence suggests calcineurin inhibitors (CNIs) combat α-synuclein-induced neuronal dysfunction and motor impairments. However, whether CNIs prevent or treat Parkinson’s disease (PD) in humans has never been investigated. Objective: We seek to ascertain if prescription of CNIs is linked to a decreased prevalence of PD in a varied patient population and to glimpse into the mechanism(s) and target site through which CNIs might decrease PD prevalence. Methods: We analyzed electronic health records (EHRs) from patients prescribed the brain penetrant CNI tacrolimus (TAC), the peripherally restricted CNI cyclosporine (CySp), or the non-CNI sirolimus (SIR). For comparison, EHRs from a diverse population from the same network served as a general population-like control. After propensity-score matching, prevalence, odds, and hazards of PD diagnoses among these cohorts were compared. Results: Patients prescribed CNIs have decreased odds of PD diagnosis compared to the general population-like control, while patients prescribed SIR do not. Notably, patients prescribed TAC have a decreased prevalence of PD compared to patients prescribed SIR or CySp. Conclusions: Our results suggest CNIs, especially those acting within the brain, may prevent PD. The reduced prevalence of PD in patients prescribed TAC, compared to patients prescribed SIR, suggests that mechanisms of calcineurin inhibition— other than immunosuppression, which is common to both drugs— are driving the reduction. Therefore, CNIs may provide a promising therapeutic approach for PD.

AIMS:Charcot neuroarthropathy (CN) is a complex disease of the bone and joints that can lead to serious and life-threatening complications. This study investigates epidemiologic trends in diabetic CN in Texas and the impact of age on these values. METHODS:A retrospective analysis was conducted using the Texas Department of State Health Services Hospital Discharge Data Public Use Data File. Using International Classification of Diseases, Ninth (ICD-9) and Tenth (ICD-10) Revision codes, we identified patients with diabetes and Charcot ankle or foot. Data extracted included diagnoses, race, and gender. Population rates were estimated using census data, calculated per 1000 population and standardized by age. RESULTS:Overall and age-standardized rates of CN increased each year from 2006 to 2016, except for a downward trend from 2014 to 2016. Poisson regression revealed significant increases in the incidence rate ratio compared to 2006 for each year from 2008 to 2016. When age group is included, all years except 2007 show a significant increase relative to 2006, and all age groups have increased rates relative to ages 18-44. Major and minor amputations in patients with CN have increased. CONCLUSIONS:The increasing rates of CN and amputations highlight the need for further research and standardized strategies for diagnosis and management.

INTRODUCTION:Individuals referred to as Non-Demented with Alzheimer's Neuropathology (NDAN) exhibit cognitive resilience despite presenting Alzheimer's disease (AD) histopathological signs. Investigating the mechanisms behind this resilience may unveil crucial insights into AD resistance. METHODS:DiI labeling technique was used to analyze dendritic spine morphology in control (CTRL), AD, and NDAN post mortem frontal cortex, particularly focusing on spine types near and far from amyloid beta (Aβ) plaques. RESULTS:NDAN subjects displayed a higher spine density in regions distant from Aβ plaques versus AD patients. In distal areas from the plaques, NDAN individuals exhibited more immature spines, while AD patients had a prevalence of mature spines. Additionally, our examination of levels of Peptidyl-prolyl cis-trans isomerase NIMA-interacting 1 (Pin1), a protein associated with synaptic plasticity and AD, showed significantly lower expression in AD versus NDAN and CTRL. DISCUSSION:These results suggest that NDAN individuals undergo synaptic remodeling, potentially facilitated by Pin1, serving as a compensatory mechanism to preserve cognitive function despite AD pathology. HIGHLIGHTS:Spine density is reduced near Aβ plaques compared to the distal area in CTRL, AD, and NDAN dendrites. NDAN shows higher spine density than AD in areas far from Aβ plaques. Far from Aβ plaques, NDAN has a higher density of immature spines, AD a higher density of mature spines. AD individuals show significantly lower levels of Pin1 compared to NDAN and CTRL.

"Limb salvage " efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients ' quality of life and the costeffectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas Hospital Discharge Data Public Use Data File. Population estimates were obtained from the Texas Population Estimates Program from 2011 to 2015 and from intercensal estimates provided by the U.S. Census Bureau from 2006 to 2010. Raw numbers of minor, major, and all NLEA surgeries and the ratio of major amputations to total amputations per year were reported for each age group. Poisson regression and Joinpoint analyses were performed to capture these changes in trends. Rates of amputations increased, with signi ficant decreasing relative prevalence of major amputations. Patients aged 45 to 64 with diabetes are likely driving these increases. Rates of lower extremity amputation in patients with diabetes increased from 2009 to 2015. This holds for all and minor amputations. In contrast, the ratio of major to all amputations decreased from 2010. Utilization of major and minor amputation differs between age groups, remaining stable in the youngest subjects, with minor amputation rates increasing in those aged 45 to 64. (c) 2024 by the American College of Foot and Ankle Surgeons. All rights reserved.

INTRODUCTION Women have historically been underrepresented in orthopaedics. This study analyzes the geographic distribution of female orthopaedic foot and ankle (OFA) surgeons, as well as geographic patterns between their training locations and current practices. METHODS American Orthopaedic Foot and Ankle Society (AOFAS) data regarding fellowship completion from 1988 to 2021 were analyzed. Internet searches were then performed to identify medical school, residency, and current practice locations of individual surgeons. States were categorized into regions and divisions based on US Census Bureau guidelines. RESULTS Of the 1088 OFA surgeons analyzed, 166 (15.26%) were women and 922 (84.74%) were men. The South has a higher number of female OFA surgeons; however, this region and the Midwest have the lowest percentages of female representation. The West and Northeast had significantly higher percentages of female representation and higher retention rates for women. There was high variability in the number and percentage of female OFA surgeons in divisions both within and between regions. CONCLUSION Although the number of female OFA surgeons has increased, their representation remains low. Geographically, the East South Central division of the United States consistently had the least number of OFA surgeons, whereas the South Atlantic division had the highest.Level of Evidence: Not applicable.

Purpose: Basilar thumb arthritis is a common condition that can be associated with significant disability. While surgical management has historically consisted of trapeziectomy-type procedures, hemiarthroplasty has become an increasingly common alternative. While outcomes have been promising, they vary according to the implant used. We sought to evaluate the performance of the BioPro® Modular Thumb implant. Methods: This was a retrospective review of 110 thumbs with carpometacarpal arthritis that underwent hemiarthroplasty between the years 2008 and 2016 with the BioPro® device. All thumbs had Eaton-Little Stage II or III arthritis. Patients were asked to complete preoperative and postoperative assessments using QuickDASH, as well as complete strength measurements using a dynamometer. Results: Mean age was 61 years, with average final follow-up at 3.8 years. Forty thumbs completed QuickDASH and showed a 34.78-point improvement at average 2-year follow-up. Implant survivorship was 88.18% at average 3.8-year follow-up. The most common cause of revision was titanium metal allergy. No implants dislocated. Conclusion: Outcomes of hemiarthroplasty using the BioPro® device were comparable or superior to alternatives and support its continued use.

INTRODUCTION:Cervical disc displacement (CDD) may disqualify pilots from flying and have a profound impact on military unit capability. The objective of this retrospective database review is to characterize the incidence and demographic predictors of symptomatic cervical spine disc displacement in pilots of fixed- and rotary-wing aircraft and ground-based controls. MATERIALS AND METHODS:The Defense Military Epidemiology Database was queried for first-occurrence ICD-9 code 722.0: CDD cases from 2007 to 2015. Injury count rates among aircraft groups and overall incidence per 1,000 person-years were calculated and standardized for age, gender, and military rank, and 95% confidence intervals (CIs) were compared to determine significance. RESULTS:There were 934 new cases of CDD among active duty U.S. Military pilots during the study period. The overall incidence of CDD in all pilots during this time frame was 2.715 per 1,000 person-years (95% CI, 2.603-2.830). Helicopter pilots had a significantly higher incidence compared to all other aircraft pilots and crew at 3.79 per 1,000 person-years (95% CI, 3.48-4.13). This finding remained statistically significant after standardizing for age, gender, and rank. Among all military officers, increasing age was a risk factor for CDD. CONCLUSIONS:The U.S. Military helicopter pilots have an increased risk compared to fixed-wing pilots and non-pilot controls. CDD remains a rare, though career-threatening, condition. Increased education and awareness training are warranted for both helicopter pilots and flight physicians to recognize signs and symptoms of cervical pathology. Continued investigations into preventive measures to minimize injury and time unfit for flight are warranted.