How Disc Herniation Changed the History of the Apollo 11 Spaceflight

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Astronaut Michael Collins is well-known for being part of the Apollo 11 mission that landed the first man on the moon on July 20, 1969. What is little known about this story is that Mr. Collins’ disc herniation and cervical myelopathy (compression of the spinal cord in the neck causing pain, numbness, and weakness in the arms and legs), which developed in a year earlier in July 1968, caused a rotation in astronaut assignments that landed him into a prime position on the historic flight. This story is described in the July issue of the Journal of Neurosurgery: Spine.

Astronaut Michael Collins, 1969 NASAOfficial NASA portrait of Astronaut Michael Collins. This 1969 NASA photograph (S69-31742) is available from https://spaceflight.nasa.gov/gallery/images/apollo/apollo11/html/s69_31742.html. Mr. Collins’ first spaceflight was on Gemini 10 in 1966. He was then scheduled to fly on Apollo 8 but developed symptoms of cervical myelopathy at the age of 37. He was reluctant to report his symptoms out of fear of being grounded, but when his symptoms quickly worsened causing numbness and tingling in both legs, falls, and problems walking up and down stairs, he sought help from a neurologist and was diagnosed with a significant C5-C6 posterior osteophyte (a bony outgrowth or bone spur) and disc herniation.

The first surgeon he saw recommended a surgery called a posterior cervical laminectomy, which would have grounded him from future spaceflights per Air Force protocol, as this operation was thought to leave the neck too weak to sustain the force of an ejection seat and bony fusion was required for flying status. Fortunately, Collins saw two more surgeons, including Air Force surgeon Paul Myers who eventually performed an anterior cervical discectomy and fusion (ACDF) with iliac bone graft on Mr. Collins in August 1968.

Collins’ recovery went well, and he was able to resume his role in the United States Air Force Reserve by flying transport planes that were considered low impact and did not have an ejection seat. By November 1968, he resumed flying jets.

However, “he was removed from the crew of Apollo 8,” said lead author Richard Menger, MD, MPA, who recently completed his orthopedic spine fellowship at Columbia University and will be Assistant Professor of Neurosurgery and Assistant Professor of Political Science at the University of South Alabama focusing on spinal deformity. “This thrusted James Lovell from the backup crew into the prime crew for the Apollo 8 mission. As such, it was Mr. Lovell, not Mr. Collins, who became one of the first 3 humans to reach the moon and take part in one of the most-watched television broadcasts in the history of mankind.”

What Mr. Collins’ didn’t know at that time, was the shuffle of Astronaut schedules caused by his surgery led to him being in position to fly on Apollo 11.

“This surgery had a cascading effect that circulated Michael Collins into the crew of Apollo 11 and into the annals of history as the Command Module Pilot of man’s first mission that landed men on the moon,” Dr. Menger told SpineUniverse. “He was not originally not supposed to be part of that flight.”

On the Apollo 11 mission, Mr. Collins orbited the moon in a command module, while Neil Armstrong and Buzz Aldrin took the Apollo Lunar Module to the moon and made the first crewed landing on its surface.

“Ironically, it also changed the rotation of other astronauts, placing James Lovell in the position where he was to become the Commander of the fated Apollo 13 flight,” Dr. Menger said.

Cervical Disc Herniation Is Common Among Astronauts

Research shows that astronauts have a 21.4 times higher risk for cervical disc herniation than the general population.1 This is likely due to the mechanical stress on the body from the force of spaceflight, as well as possibly disc expansion and the result of bone mineral loss that occurs in a zero-gravity environment, Dr. Menger and his colleagues explained.

If Mr. Collins’ cervical myelopathy was treated today, he would likely have undergone either an ACDF or a cervical artificial disc replacement (C-ADR). The C-ADR may have allowed Mr. Collins to resume flying sooner, according to K. Daniel Riew, MD, Director of Cervical Spine Surgery and Professor of Orthopedic Surgery at Columbia University Medical Center.

“With ADR, one does not have to wait until the fusion is solid to train,” Dr. Riew explained. “I’ve performed artificial disc replacement on an Olympic class swimmer who dives, a medal-winning high jumper, professional baseball players, and several UFC fighters. All were allowed to return to training within one week and I let the UFC athletes fight at 3 to 6 months. I would have let an astronaut go to space at 6 weeks, because astronauts are subject to G-forces, but not as much flexion/extension/rotational stress.”

Mr. Collins Is a Testament to the American Spirit

“This story embodies the absolute best of the American spirit,” Mr. Menger concluded. “One can only imagine the relentless, quiet frustration Astronaut Collins felt in watching someone else go to the moon in his place on Apollo 8 and perform the mission he trained for his whole military career. All the while, he never really knew if he would ever get another chance. It’s a testament to character, dedication, and perseverance of all those who took park in the America’s Space Race.”

Disclosure
Dr. Menger has no relevant disclosures.

Updated on: 08/08/19
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How Spine Surgery Treats Cervical Myelopathy and Deformity
Richard Menger, MD, MPA
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How Spine Surgery Treats Cervical Myelopathy and Deformity

Neurosurgeon explains his diagnosis and treatment of a patient with cervical myelopathy and deformity.
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