Editor’s Note: The following questions are from different people but are under the same general category. The answer for Q1 also applies to Q2.
Q1. I have been diagnosed with spinal stenosis. Can I still fly? I have been doing so for more than 50 years.
Q2. My post-surgery stenosis comes and goes, and cyclobenzaprine seems to give me some relief. Is this medication completely disqualifying until it is out of my system (rule of 5 says that 8 hours between doses means 40 hours after taking it), or is it the case that if I feel okay within that 40 hours, I’m probably okay to fly, just like driving? The stenosis does not interfere with normal activities, it just hurts.
A1/2. Spinal stenosis is not a disqualifying diagnosis; however, pain, muscle weakness, and sensory changes associated with spinal stenosis can become a safety issue. You should discuss these with your AME if you develop them. We are in the process of reviewing some of our wait times on medications in view of new information from our laboratories at the Civil Aerospace Medical Institute (CAMI). Indications are that we will be able to shorten some wait times.
However, I need to caution you that there is convincing evidence that, at least with diphenhydramine (Benadryl), individuals demonstrate significant impairment even when they report feeling “fine.” Therefore you should stick to the published wait times rather than just deciding that you feel “OK.” Driving and flying just aren’t the same.
Q3. I’ve recently had a five level spinal fusion surgery with a nominal three month recovery to some level of functionality. Also, I’m a high time general aviation ATP/CFII, but for obvious reasons, the first flight post-surgery will be with a CFI.
In order to fly safely, I believe I will need to:
be able to get in and out, reach all the controls, look all around, etc. (Physical therapy should address these issues.)
have basic flying skills intact after some months off. (This is the least of the concerns, given extensive experience and high skill levels.)
make sure that, post-surgery, I will have enough energy for each flight. (I’ll assess this based on ability to perform daily activities and by endurance when walking.)
and the real question — make sure that I am neurologically recovered from the inflammatory response to surgery, as well as anesthesia and drugs. (Only when my driving is as easy and confident as it was pre-surgery will I get back into the airplane.)
Does this plan cover everything, or is there something else I should check? And I renewed my medical right before surgery to minimize paperwork.
A3. This is an excellent plan. I would repeat that the ability to drive a car does not necessarily mean you are safe to fly, but as you say, is one reasonable indicator. You need to be sure you are no longer taking any medications that are potentially impairing such as pain medications or muscle relaxants. Do not underrate pain as a significant distractor. More than just reaching the controls, you need to be sure that you have the muscle strength to perform emergency procedures should that become necessary.
Penny Giovanetti, D.O., received a Bachelor’s Degree from Stanford, a Master’s in Environmental Health and Preventive Medicine from the University of Iowa and Doctorate from Des Moines University. She completed a 27-year career as an Air Force flight surgeon. She is board certified in aerospace medicine, occupational medicine and physical medicine/rehabilitation. She is also a Fellow of the Aerospace Medical Association and a licensed private pilot.