ABSTRACT Background: Medical screening for Special Forces (SF) has significant implications on operational competency of the soldiers. Two lumbar spine defects, spondylolysis and spondylolisthesis, are currently disqualifying from joining the SF in the Israeli Defense Force. Purpose: To evaluate the yield of four lumbar x-ray compared with two lumbar x-ray for the diagnosis of spondylolysis and spondylolisthesis. Design: Retrospective comparison of the diagnostic yield of the two modalities. Patient sample: Special forces unit candidates undergoing routine x-ray for the diagnosis of spinal defects. Outcome measures: The rate of diagnosis of spondylolysis and spondylolisthesis between the two groups. Methods: We retrospectively compared two lumbar spine radiographic screening protocols regarding the rate of diagnosis for disqualifying spinal defects in asymptomatic candidates for SF. All radiographs were obtained as part of a routine medical evaluation for SF. Results: 1026 candidates were examined with two lumbar spine radiographs (Anteroposterior (AP) and lateral). 338 candidates were examined with four lumbar radiographs (AP, lateral and oblique radiographs). Spondylolysis and spondylolisthesis were diagnosed at a significantly higher rate in the four-radiograph group than in the two-radiograph group (2.66%, 1.77% vs. 1.26%, 0.39% respectively, P = 0.003). Conclusions: Adding two oblique radiographs to the screening process of elite units candidates significantly increases the rate of diagnosis of spondylolysis and spondylolisthesis.
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nullO. Wand, A. Grossman, A. Prokupetz and A. Assa, "Comparison of Two Radiographic Lumbar Spine Screening Protocols for the Detection of Abnormalities in Special Forces Candidates," International Journal of Clinical Medicine, Vol. 2 No. 5, 2011, pp. 613-616. doi: 10.4236/ijcm.2011.25101.
 T. Heir P. Glomsaker, “Epidemiology of Musculoskeletal Injuries among Norwegian Conscripts Undergoing Basic Military Training,” Scandinavian Journal of Medicine and Science in Sports, Vol. 6, No. 3, 1996, pp. 186-191.
 H. Taanila, J. Suni, H. Pihlajamaki, V. M. Mattila, O. Oh- rank?mmen, P. Vuorinen and J. Parkkari, “Musculoskeletal Disorders in Physically Active Conscripts: A One Year Follow-up Study in the Finnish Defense Forces,” BMC Musculoskeletal Disorders, Vol. 10, 2009, p. 89.
 K. R. Kaufman, S. Brodine and R. Shaffer, “Military- Training Related Injuries: Surveillance, Research and Prevention,” American Journal of Preventive Medicine, Vol. 18, No. 3, 2000, pp. 54-63.
 A. P. Dignan, “A Decade of Experience of Examining Candidates for Entry to the Army,” Journal of the Royal Army Medical Corps, Vol. 138, No. 1, 1992, pp. 19-22.
 C. A. McTimoney, L. J. Micheli, “Current Evaluation and Management of Spondylolysis and Spondylolisthesis,” Curr Sports Med Rep, Vol. 2, No. 1, 2003, pp. 41-46.
 A. Saifuddin, J. White, S. Tucker and B. A. Taylor, “Orientation of Lumbar Pars Defects: Implications for Radiological Detection and Surgical Management,” Journal of Bone and Joint Surgery. British Volume, Vol. 80, No. 2, 1998, pp. 208-211. doi:10.1302/0301-620X.80B2.8219
 C. J. Harvey, J. L. Richenberg, A. Saifuddin and R. L. Wolman, “Pictoral Review: The Radiological Investigation of Lumbar Spondylolysis,” Clinical Radiology, Vol. 53, No. 10, 1998, pp. 723-728.
 W. J. Beutler, B. E. Fredrickson, A. Murtland, C. A. Sweeney, W. D. Grant and D. Baker, “The Natural History of Spondylolysis and Spondylolisthesis: A 45-Year Follow-up Evaluation,” Spine, Vol. 28, No. 10, 2003, pp. 1027-1035. doi:10.1097/01.BRS.0000061992.98108.A0
 Y. Weil, D. Weil, M. Donchin, G. Mann and A. Hashroni, “Correlation between Pre-Employment Screening X-Ray Findings of Spondylolysis and Sickness Absenteeism Due to Low Back Pain among Policemen of the Israeli Police Force,” Spine, Vol. 29, No. 19, 2004, pp. 2168-2172.
 E. Libson, R. A. Bloom and G. Dinari, “Symptomatic and Asymptomatic Spondylolysis and Spondylolisthesis in Young Adults,” International Orthopaedics, Vol. 6, No. 4, 1982, pp. 259-261.
 E. L. Steinberg, E. Luger, A. Arbel, A. Menachem and S. Dekel, “A Comparative Roentgenographic Analysis of the Lumbar Spine in Male Army Recruits with and without Lower Back Pain,” Clinical Radiology, Vol. 58, No. 12, 2003, pp. 985-989. doi:10.1016/S0009-9260(03)00296-4
 J. Iwamoto, H. Abe, Y. Tsukimura and K. Wakano, “Relationship between Radiographic Abnormalities of Lumbar Spine and Incidence of Low Back Pain in High School Rugby Players: A Prospective Study,” Scandinavian Journal of Medicine & Science in Sports, Vol. 15, No. 3, 2005, pp. 163-168.
 J. Iwamoto, H. Abe, Y. Tsukimura and K. Wakano, “Relationship between Radiographic Abnormalities of Lumbar Spine and Incidence of Low Back Pain in High School and College Football Players: A Prospective Study,” The American Journal of Sports Medicine, Vol. 32, No. 3, 2004, pp. 781-786.
 J. Hayton, “Reducing Medical Downgrading in a High Readiness Royal Marine Unit,” Journal of the Royal Army Medical Corps, Vol. 150, No. 3, 2004, pp. 164-167.
 C. Milgrom, A. Finestone, B. Lev, M. Weiner and Y. Floman, “Overexertional Lumbar and Thoracic Back Pain among Recruits: A Prospective Study of Risk Factors and Treatment Regimens,” Journal of Spinal Disorders & Techniques, Vol. 6, No. 3, 1993, pp. 187-193.