JFK's back problems: A new look

Scarlet fever, long-standing gastrointestinal disease, Addison's disease, and chronic back pain -- these are some of the medical issues faced by JFK during his short life.

In a new article in the Journal of Neurosurgery: Spine, "John F. Kennedy's back: chronic pain, failed surgeries, and the story of its effects on his life and death," authors T. Glenn Pait, MD, and Justin T. Dowdy, MD, focus primarily on JFK's back problems, which remained a constant companion from his college years until his death. In preparing this paper, Pait and Dowdy reviewed case notes written by various physicians who undertook care of JFK's back. They also examined spinal imaging studies obtained over decades of treatment, documenting a history of debilitating structural changes. In addition, the authors discuss JFK's other intermittent and chronic health problems, their relationships to his spinal disorder, and the possible effects that his ill health may have played on his career and even on his death.

JFK first experienced low-back pain while an undergraduate student at Harvard University, perhaps as a result of a football injury sustained in 1937. His back problems initially prevented wartime enlistment in the armed services in 1940, but his father's political influence helped JFK obtain a commission in the US Naval Reserve in 1941.

History books recount the events on PT-109 that earned JFK a medal for heroic conduct. During World War II, the PT (patrol torpedo) boat to which Kennedy was assigned was rammed by a Japanese destroyer in 1943. JFK rescued an injured crewman by swimming for 5 hours with the crewman in tow. The impact of the ship collision and the physical exertion of the rescue exacerbated the future president's back problems, and less than one year later, JFK underwent the first of four spine surgeries.

The authors describe preoperative and postoperative physical and imaging findings associated with these surgeries, which spanned the years of 1944 through 1957. The first two surgeries did little to improve JFK's condition and in fact resulted in severe complications and additional pain. The third operation was performed to remedy the effects of the second operation, and the fourth operation to clear out infection at the previous operative site.

The authors discuss the relative value of diagnostic tests of the time and the decisions leading to the spine surgeries. They also discuss the means used to reduce JFK's chronic pain so that he could function as president and maintain his image of a strong, vibrant leader at the top of his game. Last, the authors address the controversy over whether JFK's use of a back brace contributed to his death at the hands of an assassin in 1963.

When asked about the paper, Dr. Dowdy said, "The most surprising finding during the research for this paper was the overall amount of severe pain JFK endured throughout his short life and, frankly, how he was able to hide his pain and medical ailments from the general public so well."