Comparison of Two Radiographic Lumbar Spine Screening Protocols for the Detection of Abnormalities in Special Forces Candidates

Background: Medical screening for Special Forces (SF) has significant implications on operational competency of the soldiers. Two lumbar spine defects, spondylolysis and spondylolisthesis, are currently disqualifying from joining the SF in the Israeli Defense Force. Purpose: To evaluate the yield of four lumbar x-ray compared with two lumbar x-ray for the diagnosis of spondylolysis and spondylolisthesis. Design: Retrospective comparison of the diagnostic yield of the two modalities. Patient sample: Special forces unit candidates undergoing routine x-ray for the diagnosis of spinal defects. Outcome measures: The rate of diagnosis of spondylolysis and spondylolisthesis between the two groups. Methods: We retrospectively compared two lumbar spine radiographic screening protocols regarding the rate of diagnosis for disqualifying spinal defects in asymptomatic candidates for SF. All radiographs were obtained as part of a routine medical evaluation for SF. Results: 1026 candidates were examined with two lumbar spine radiographs (Anteroposterior (AP) and lateral). 338 candidates were examined with four lumbar radiographs (AP, lateral and oblique radiographs). Spondylolysis and spondylolisthesis were diagnosed at a significantly higher rate in the four-radiograph group than in the two-radiograph group (2.66%, 1.77% vs. 1.26%, 0.39% respectively, P = 0.003). Conclusions: Adding two oblique radiographs to the screening process of elite units candidates significantly increases the rate of diagnosis of spondylolysis and spondylolisthesis.