FAA Medicals and Orthopedic/Neurosurgical Issues

What happens to our FAA medical when we have an orthopedic or neurosurgical problem? 

The pilot population is another year older, and our bones are subject to more injuries and the wear and tear of life.

I just had a cervical (neck) laminectomy and fusion—not because I was having significant symptoms but when I had some minor ones, investigation showed I needed a procedure to prevent further deterioration. So where do I stand for flying?

First, I need full recovery and a release from my treating physicians. Obviously, if I am wearing a neck brace, I am not fully recovered! Also, if I had any paralysis or numbness, I am not fully recovered (more on that later). Of course, the big one is that I must be off any sedating medications like narcotics for pain or muscle relaxers like Valium or Robaxin. That is why we self-certify between medicals under FAR 61.53 and why I have grounded myself until I get the OK from my docs and myself.

What about at my next medical? Orthopedic issues are not necessarily grounding or disqualifying, but it is important to bring these issues to the attention of the AME. You might even call the AME ahead of time to see what might be necessary. AOPA’s Pilot Protection Services (PPS) can also be very helpful in these situations. The biggest issue is that you should never go into an FAA AME exam without knowing the ins and outs of what is necessary. A “yes” response to any item on the 8500-8 medical application without good supporting documentation can result in a deferral of your application to the FAA for review, an exercise that is no friend to anyone as it creates a lot of heartache and wasted time and energy. Check things out first.

If the procedure and recovery are relatively proximal to the exam, you will need to show good wound healing and good function. For instance, if you have had a total hip or knee procedure, the AME will test you for the ability to operate rudder pedals. If you have had a spine procedure, the AME will test for weakness and numbness in the extremities that can be affected. Bringing a letter from the operating surgeon or treating physician which states full recovery will help immensely, and should be considered required information. Sometimes, numbness can be long lasting but does not affect function. Even mild paralysis of a hand or a leg may not be an issue but may require further FAA review and possibly a medical flight test as well; again, a process you really don’t want to endure!

What about amputations? Suppose you cut off you little finger in the table saw. Once healed, that would not be a problem. However, if you cut off your thumb, it affects your ability to grip and may need further evaluation. If you lose a foot or hand, it will usually require a deferral of the medical to the FAA. This usually will mean a medical flight test to see if you can operate the aircraft or need to operate one with special equipment.

Although orthopedic/spinal surgeries do not usually have complications, they can. Deep venous thrombosis (DVT) is unfortunately common and can cause blood clots in the lung. If this were to happen, the pilot will have to show full recovery plus what blood thinning medicines have been used and/or continue to be used. Medical records, such as pulmonary function testing, may also need to be provided showing how much lung damage has occurred, if any, and prognosis for the future.

Ongoing pain is always an issue. Is it a minor inconvenience or does it impair your functional abilities? Medications like plain acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen (Aleve) (always buy the generics) are not grounding, but mind-altering medications like opiates are (FAR 91.17). It is the pilot’s responsibility to determine before each flight whether they are safe to fly, even if medication is not taken. Is the pain or discomfort going to make a flight difficult or affect decisions in the sky?

As we age, we are not as spry as we used to be, nor do we heal as fast. Even though we may be 60 years old, in our brain, we may think of ourselves as being 40. When my surgeon told me my neck bones were soft, I was insulted! Now I am taking vitamin D and calcium. Soft bones indeed! Aging is just a function of aging! We get over it and get on with it by making the necessary adjustments to offset the creaks and groans.

photo of brent blue

Dr. Brent Blue

Senior Aviation Medical Examiner
Dr. Brent Blue is an FAA senior aviation medical examiner and airline transport pilot with more than 9,000 hours of flight time. Through his company,, he introduced pulse oximetry and digital carbon monoxide detection to general aviation in 1995.

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