Our next speaker is Dr. Menger, who will talk to us about astronaut Michael Collins, Apollo 8, and the anterior cervical fusion that changed the history of human spaceflight. Thank you so much, and two terrific talks to try and follow. So, I'll talk about something that I find just absolutely fascinating, and hopefully I can share that with you. My name is Richard Menger, I'm one of the graduating chiefs at LSU in Shreveport. So, no disclosures, two of the authors have military commitments, but this is strictly our own opinion. So, we actually saw General McChrystal reference this yesterday in his oration. So, it's 1961, and America, for all intents and purposes, is losing the space race. The Russians went up first, you're guaranteed orbits around the Earth. But Al Shepard had just gone up for 15 minutes in a suborbital flight, and at Rice University, John F. Kennedy says, we're going to go to the moon, and we're going to do it before 1970. And that was ambitious. And of course, they did that. July 20th, 1969, Apollo 11 landed on the moon successfully and came back to Earth. And the astronauts involved in that were, of course, Neil Armstrong, Buzz Aldrin, and in the center, our protagonist, Michael Collins. The thing that's fascinating about this is that is not the initial rotation of astronauts, and history was changed because of a neurosurgical procedure. And I'll go so far as to say, too, that that was not even America's most daring moment in space. So, the Apollo space program, like I was hinting at, was dedicated to get to the moon, and it was aggressive in doing so, not afraid to take risks with cost. Apollo 1 was a tragedy that killed astronauts Gus Grissom, Ed White, and Roger Chaffee in 1966. This was a reeling moment for the U.S. space program. Apollo 4 and 6 were unmanned missions. Apollo 7 was the first manned mission of the Apollo sequence. And it took the astronauts, it did an orbital flight in just the command service module. And Apollo 8 was the logical next step where the command service module would go up and meet the lunar module, which was pre-released. And you can see kind of a depiction of that there. Again, the lunar module lands on the moon and is launched before the astronauts go up in the command service module. The issue and the backbone of all this pressure is that the lunar module wasn't ready. The engineers couldn't develop it, it wasn't going to be ready on time, and this risked the United States meeting that goal that they had ambitiously set. So George Lowe had a pretty innovative and aggressive idea. He said, we're going to fly to the moon in just the command service module. We're going to fly to the moon with our three astronauts. And this is way out of order. This was going to be the Apollo 10 mission. This was something that NASA was not sure they were capable of doing. But the lunar module wasn't available and they were going to do it. Well, maybe. So Chris Kraft is the director of manned spaceflight at Johnson Space Center, gives the mission a 50-50 chance. Astronaut Anders, who was on the flight, gives the mission a one-third chance of survival, one-third chance of success, one-third chance of surviving an accident, and a one-third chance of never coming back. There's an iconic discussion that occurs with the astronauts who are going to go on that mission of whether or not they're willing to accept that risk, and they do that. They accept that risk and obviously return successfully. So why was it so challenging? First, it was going to be the first manned spaceflight of the Saturn V rocket, the biggest rocket to escape the Earth's orbit, and no one had ever ridden that before. So that's one. They had to enter the Earth's orbit. That had been done before. They had to leave Earth's orbit for the first time, enter into a lunar orbit, and most importantly, be able to exit that lunar orbit. These were all new things. NASA liked to do things in stages and steps, and they had a plan for that. They had to go beyond all of that. And I think, without a doubt, it was an enormous success. So they orbited the moon for 20 hours. This was taken from the book of Genesis, which at the time was one of the most watched television broadcasts. Astronaut Bill Anders shot the iconic Earthrise photograph that we see, and it gave NASA energy and it gave them life, and they were the first to get astronauts to the moon before the Russians, obviously. But Michael Collins watched that from Earth. And at the end of the year, 1968, wore astronaut Anders, astronaut Borman, but Jim Lovell. I can only imagine what he thought when he saw and listened to those space broadcasts. He started developing cervical myelopathy. So he's an astronaut. He's a fighter pilot. He's a test pilot. So he is active. He's playing handball. And he said, you know, my legs just aren't working the right. So what did he do? Obviously, he ignored it. He said, I'm going to go to a flight surgeon who's going to risk his flying status. And he just went on with his day, but things got worse, and they got worse quickly. He talks very openly about this in his book. And, you know, he had problems walking up and down the stairs. You can imagine trying to keep up in that competitive environment and having those medical issues. He fell on numerous occasions. He had numbness and tingling. And the parisees were getting worse, and essentially, he had significant cervical myelopathy. So he kind of listened to his wife a little bit and went to the flight surgeon, who initially sent him to a neurologist. At the time, they got an x-ray, showed a 5-6 osteophyte. And immediately, they sent him to a civilian neurosurgeon. And he was scheduled for surgery immediately. It was a screaming cervical myelopathy. But this was not well received by NASA. You know, Michael Collins is still an Air Force officer. He is a national investment. And they required that he see an Air Force neurosurgeon. And this actually saved his flying career and allowed him to go to the moon, essentially. So the initial plan from the civilian neurosurgeon was a posterior approach, a cervical laminectomy. But that would have grounded him from any high-velocity flying in jets or obviously in any spacecraft. So he went to then-Colonel Paul Myers and eventual Surgeon General of the Air Force for evaluation. And he recommended an anterior cervical fusion with an iliac bone graft. And that's exactly the procedure that he had. He first had a myelogram. Obviously, the technology available at the time showed a very large disc. And then he underwent the anterior cervical procedure. They put him in a soft collar for a little while. He was discharged about a week after. His main complaint was the iliac graft pain at the site. So his flying status was still not secured. They needed to have bony imaging. They needed to have imaging on the x-rays that showed bony fusion across that 5'6 graft. Thankfully, you know, he's in prime physical condition. He's got the best resources available to him. So he did well. He was cleared to fly on, you know, regular transport airplanes and eventually flew on high-speed jet planes. And it took him only 125 days from the time of his surgery to being cleared to fly again on NASA's aircraft. The only thing that he states and he still has to this day is that he has a temperature asymmetry in one leg. So this kind of left him in a lurch, though, is had I missed my chance, did he, you know, miss his window in history? So the kind of something about the rotation of the astronauts. So the original crew of that Apollo 8 flight was Commander Frank Borman, Command Module Pilot Michael Collins, and Lunar Module Pilot William Anders. The backup crew, which may look familiar, is Commander Neil Armstrong, Command Module Pilot James Lovell, and Lunar Module Pilot Buzz Aldrin. So when astronaut Collins went out with cervical myelopathy, it is James Lovell that went in his place. And then subsequently down the line kind of changed the rotation of astronauts. Buzz Aldrin went up to Command Module Pilot and Fred Hayes went to Backup Lunar Module Pilot. So what does this mean? The rotation that NASA had set up in this sort of historic circumstance is that, with general certain exceptions, the backup crews became the prime crew three flights later. So Neil Armstrong was the commander of Apollo 11. Buzz Aldrin went back to his original position as Lunar Module Pilot. But then, somewhat of a kind gesture from Deke Slayton, who was in charge of these scheduling issues, since astronaut Lovell had just flown in Apollo 8, our protagonist, Michael Collins, went and substituted in Apollo 11. So what that meant, though, is that Collins flew to the moon, but he would not walk on the moon. Obviously, we know Neil Armstrong and Buzz Aldrin as being the first two people on the moon. That lunar module would separate, land on the moon, and Michael Collins would circle, kind of waiting for his comrades to come back. So, kind of in summary, I think it's a fascinating story to me, but it did three real things, I think, in the history of human spaceflight. So the first thing is it took James Lovell and put him into Apollo 8 and made him part of the famous first voyage to the moon. And allowed him to participate in the broadcast that was the most watched television broadcast of all time. It circulated Michael Collins into the crew of Apollo 11 and ushered him into the spaceflight history. But importantly, it also dropped James Lovell into the rotation for Apollo 13 and the ill-fated mission there. So a very interesting sort of snowball effect of a neurosurgical procedure. And I thank you for listening. I know it's late in the day. And if it interests anybody, these are three kind of fascinating resources that really go into this further. So, thank you. Thank you very much.

neurosurgical procedure

human spaceflight

Michael Collins

Apollo 8 mission

cervical myelopathy