The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts

Louise Fawcett,Nicola R Heneghan,Alison Rushton,Rajesh Botchu,James Martin,Steven James

doi:10.1007/s00586-021-06997-9

Abstract

PurposeTo investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics.MethodsA prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.ResultsForty (18 males) gymnasts aged 13–24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral.ConclusionFindings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.

Highlights

The prevalence of low back pain (LBP) in gymnastics is high with reports of 85% in male and 65% in female artistic gymnastics [1]
Lumbar spine magnetic resonance imaging (MRI) studies of gymnasts have demonstrated a high prevalence of abnormalities, including degenerative disc degeneration, facet joint and posterior bony element stress changes [3]
Research findings indicate athletic populations are predisposed to posterior element abnormality due to hormonal influences [5], and progression from pars interarticularis stress reaction through spondylolysis to spondylolisthesis is common in adolescent athletes [6]

Summary

Introduction

The prevalence of low back pain (LBP) in gymnastics is high with reports of 85% in male and 65% in female artistic gymnastics [1]. The unique physical challenges of gymnastics with repetitive multi-directional movements with up to 13 times body weight on landing, place extreme stresses on the spine contributing to high rates of LBP [2]. Lumbar spine MRI studies of gymnasts have demonstrated a high prevalence of abnormalities, including degenerative disc degeneration, facet joint and posterior bony element stress changes [3]. Research findings indicate athletic populations are predisposed to posterior element abnormality due to hormonal influences [5], and progression from pars interarticularis stress reaction through spondylolysis to spondylolisthesis is common in adolescent athletes [6]. One radiographical study reported low prevalence of spondylolysis (5.6%) and no evidence of spondylolisthesis in female elite gymnasts (n = 18) [9].

Methods

Results

Discussion

Conclusion