Docs work together to find a cure, get recognized

by Airman 1st Class Mariah Tolbert
4th Fighter Wing Public Affairs

10/30/2012 - SEYMOUR JOHNSON AIR FORCE BASE, N.C. -- An Airman from the 4th Fighter Wing at Seymour Johnson Air Force Base, N.C., has been chosen to present his research.

U.S. Air Force Lt. Col. (Dr.) Christian Lyons, 4th Medical Operations Squadron commander, will present his research on a patient with a potentially deadly side effect of ankylosing spondylitis, a rheumatogical disease, and how he, along with his coworkers, successfully placed a KC-135 pilot, stationed at Royal Air Force Lakenheath who was affected by the disease, back on flying status.

Lyons was first confronted by the affected pilot approximately three years ago when his lower back pain prevented him from doing his daily activities and kept him grounded. After an initial assessment of the pilot's condition, Lyons knew something more was going on.

"As a provider, whether you're working in family health, mental health, physical therapy or another clinic, you never quite know what's going to walk in the door," Lyons explained. "So when this young pilot who was a previously fit and active gymnast walked in, I knew he was going to need some further work given his ankylosing spondylitis, but I didn't know I would be facing a more concerning ligament instability issue in his cervical spine. I didn't know I would be looking at his neck and find something scary that could cause him to face death sooner if he didn't do something to stabilize that part of his spine."

Lyons identified the condition as Atlantoaxial Instability, which is due to weak ligaments, causing the top two vertebrae segments to loosen with excessive movement available to these bones, which lay very close to the brain stem and spinal cord. Using close coordination with flight surgery, radiology, and an off base rheumatologist, the team of providers confirmed the diagnosis and intervened immediately.

"A normal spine is like a chain link fence where all those links can move pretty well," Lyons described. "Usually with ankylosing spondylitis, as in the pilot's lower back, the vertebrae are like rusted links, where they stick together, sometimes fuse, and overall, don't move so well anymore. However, in this pilot's neck, due to the weakening ligaments, his vertebrae moved excessively to the point of pretty significant danger."

Loose ligaments made the pilot susceptible to a potentially life-threatening injury. When ligaments required to hold the vertebrae together become loose, a piece of second vertebra of the spine, called the dens, can push into the spinal cord resulting in death.

"By working with his flight surgeon and a radiologist, we were not only able to identify the condition early, but also act early enough to prevent future injury and restore this flyer's function," Lyons said. "We were able to coordinate using the international medical systems of Her Majesty's Health Services in the United Kingdom, to provide a rheumatology consult as well as gain a second confirmation of his condition with a military radiologist in California, employing the medical technology of teleradiology to view his films and make a definitive confirmatory diagnosis for him."

Using special medications to improve the pilot's freedom of movement in his lower back, and physical therapy to correctly train the muscles to stabilize his neck, the pilot was able to return to flying status. In 2010, he competed in the Marine Corps Marathon and according to Lyons, the pilot continues to fly missions and compete in racing events to this day.

"The most important parts of this case study is that it reinforces the need to look at the whole patient when they come in to be treated. Also, it vividly shows how powerful a multidisciplinary approach to health care can be," Lyons said. "This is something we do a very good job of in the Air Force Medical Service and in the Department of Defense Health System as a whole."

This research is not the first time Lyons has been recognized by AMSCON. Lyons previously conducted a case study involving young Airmen with lumbar vertebra fractures which made the spine unstable. This injury caused many Airmen not to deploy, or even be returned from deployment. However, in as little as six visits involving intense electrical stimulation to the lower back muscles, the Airmen were able to continue all functions related to their duties with significantly less pain enabling deployments to proceed.

"We are very fortunate to have Lyons," said Col. Leslie Claravall, 4th Medical Group commander. "From my perspective, he exercises a lot of forethought, and then takes the initiative to tackle any issue. I could not be more proud of him. He stays current as a trusted and outstanding physical therapist by allotting time in his schedule to take care of patients while excelling in his primary role as the commander of the 4th MDOS."

Lyons will present his case study at AMSUS, where he hopes his presentations will inspire other clinicians and serve as a good example of medical provider teamwork.

"I am very humbled at the opportunity to present at this national conference," Lyons said. "It is a great opportunity, and I hope that it excites other people about doing research, no matter what clinical field it is in."