How Cervical Myelopathy Led to Michael Collins’ Placement on Apollo 11

Peer Reviewed

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’ cervical myelopathy, which developed in a year earlier in July 1968 and subsequent surgery, 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.

SpineUniverse spoke with lead author Richard Menger, MD, MPA, to understand more about how Mr. Collins’ cervical disc herniation, which is common condition among astronauts, changed the history of American spaceflight and how his cervical myelopathy would be repaired today. Dr. Menger recently completed his orthopedic spine fellowship at Columbia University. He will be Assistant Professor of Neurosurgery and Assistant Professor of Political Science at the University of South Alabama focusing on spinal deformity.

Background

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 first consulted with a civilian neurosurgeon who recommended posterior cervical laminectomy, which would have grounded him from future spaceflights per Air Force protocol, as bony fusion was required for flying status. However, Collins saw two more surgeons, including Air Force surgeon Lieutenant General Paul Myers, MD, who eventually performed an anterior cervical fusion with iliac bone graft on Collins in August 1968.

His 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, the length of his recovery excluded him from joining the Apollo 8 mission, and Astronaut James Lovell took his place.

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

How did Collins’ anterior cervical discectomy and fusion change the history of American spaceflight?

Dr. Menger: The cervical fusion of Astronaut Collins changed the history of human spaceflight in 3 distinct ways. After Mr. Collins had surgery, he was removed from the crew of Apollo 8. This thrusted James Lovell from the backup crew into the prime crew for the Apollo 8 mission. As such, it was Lovell, not Collins, who became one of the first 3 humans to reach the moon and take part in what one of the most-watched television broadcasts in the history of mankind. 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. He was not originally not supposed to be part of that flight. 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.

Astronaut Michael Collins sits in the hatch of the Apollo 11 command moduleAstronaut Michael Collins sits in the hatch of the Apollo 11 command module after its return to the Manned Spacecraft Center's Lunar Receiving Laboratory for detailed examination. Photo Source: NASA, scan by J.L Pickering [Public domain]. Available at https://commons.wikimedia.org/wiki/File:Michael_Collins_hatch_Columbia.jpg and https://www.hq.nasa.gov/office/pao/History/alsj/a11/ap11-S69-45495.jpg.

Why are astronauts at increased risk for disc herniation? And why is the risk higher in the cervical spine than lumbar spine?

Dr. Menger: Data from the 2010 Longitudinal Study of Astronaut Health illustrated that astronauts saw a 21.4 times higher risk for cervical disc herniation than their civilian counterparts.1

Former U.S. Navy Flight Surgeon, now practicing in Aerospace Medicine at Mayo Clinic in Minnesota, Michael E. Wolf, MD, explained the following:
“Astronauts (and aviators in certain types of aircraft) are subjected to physiologic demands that are not experienced by the general population, even on commercial airliners. These air- and spacecraft may subject the body to forces that are many times the force of gravity at sea level (under normal operation, nine times the force of gravity while maneuvering in some types of tactical aircraft; three times the force of gravity during spacecraft launch). This mechanical stress may be compounded by the wearing of protective and functional equipment—namely protective helmets that may also include technologies for navigation and other aircraft systems where this weight is carried by the cervical spine. While astronauts, aviators, and designers attempt to minimize these high skeletal loads particularly in non-axial directions, job tasks sometimes make this impossible to control. Even small, unintended, head movements for a required view of a cockpit display will quickly subject the wearer to a tremendous amount of off-axis loading.

A further and significant consideration are changes to bone mineralization and sequelae from the lack of any load in zero-g (weightless) flight such as muscle atrophy, changes to spinal curvature, and increases to disc height. Studies are ongoing to better evaluate the impact of these phenomenon, but they have not yet discerned the relative contributions of confounding factors such as repetitive stress incurred in sub-orbital tactical aircraft during prior military careers or pre-spaceflight training, from injuries that have resulted from exposure to a weightless environment. Furthermore, while some studies suggest mechanisms for lumbar spinal injury, there is limited data to demonstrate the same causality in the cervical spine.”

How would Collins’ cervical disorder be diagnosed and treated today?

Dr. Menger: The modality used to diagnosis Astronaut Collins was primarily with x-ray and myelography. Today, the radiographic standard of care would involve MRI. Treatment for an isolated disc herniation in this setting would generally be through the anterior approach to the cervical spine with either an anterior cervical discectomy and fusion (ACDF) or a cervical artificial disc replacement (C-ADR).

If today’s cervical artificial disc technology was available, do you think it would have been considered in Collins’ case? Why or why not?

Dr. Menger: I had the privilege of discussing this with K. Daniel Riew, MD, Director of Cervical Spine Surgery and Professor of Orthopedic Surgery at Columbia University Medical Center, who explained that “with an arthroplasty, one does not have to wait until the fusion is solid to train. 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.”

Dr. Wolf added the following:
“Considerations for an aviator’s return to flying include those related to general safety of flight. While six weeks may be a starting point for adequate bone healing following spinal surgery, most aeromedical qualifying bodies will want to assure that even unintended stresses of flight would be unlikely to compromise any surgical repair, particularly in a way that could jeopardize the pilot’s ability to do his or her job in an environment where intervention or rescue is impossible. Further, even if complications were to present and a flight could be aborted, we would want to assure that the pilot has the unimpeded ability for egress and escape (eg, climb out of a burning aircraft or survive an ejection).

“We work closely with surgeons and often perform functional testing of the patient to find this point within a pilot’s recovery. Towards this end, modern technologies for spine surgery have greatly aided our ability to return patients to flying on even shorter timelines than previously were possible.”

Is there anything else you would like to emphasize to our readers?

Dr. Menger: This story embodies the absolute best of the American spirit. 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: 08/06/19
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