Whole-spine dynamic magnetic resonance study of contortionists: anatomy and pathology

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Object

Whole-spine magnetic resonance (MR) images were obtained using a cylindrical 3-T MR imaging system in 5 contortionists to assess the pathological changes possibly associated with the practice of contortion. Whole-spine dynamic MR images were obtained using a 1-T open MR imaging system in 2 of these contortionists with the purpose of defining the range of motion (ROM) achieved during extreme contortion. The range of spinal motion in this unique population was then quantified.

Methods

The study included 5 female contortionists 20–49 years of age. Imaging was performed using open 1-T and cylindrical 3-T high-field MR imaging systems. Data were viewed and analyzed with DICOM-compliant tools. Real-time, dynamic, and standard MR imaging allowed for quantification of the contortionists' ROM.

Results

There was a difference of 238° between full spinal extension and full flexion. Three of the 5 contortionists had 4 anterosuperior limbus vertebrae at T-11 and the upper lumbar levels.

Conclusions

Whole-spine dynamic MR imaging is a valuable tool for the evaluation of the extreme ROM in contortionists, allowing for the quantification of extreme mobility. The limbus fractures present in 3 of the 5 contortionists is postulated to be due to avulsion on hyperextension. Future research may open the use of whole-spine dynamic MR imaging into such areas as pain management and traumatic spinal injuries.

Abbreviations used in this paper: FFE = fast field echo; FOV = field of view; MR = magnetic resonance; ROM = range of motion; TF = turbo factor; TSE = turbo spin echo; VB = vertebral body.

Article Information

Address correspondence to: Eric H. Hanson, M.D., M.P.H., Amigenics, Inc., 5495 South Rainbow Boulevard, Suite 102, Las Vegas, Nevada 89118. email: eric.hanson@amigenics.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Upper: Fused sagittal T2-weighted whole-spine 3-T MR images obtained in 5 contortionists (ordered 1–5 from left to right). Lower: Curved reformatted coronal T2-weighted 3-T MR images with Cobb angle measurements demonstrating scoliosis. Curved reformatting allows for the visualization of the midcoronal plane for evaluation of the VBs. Note the presence of dextroscoliosis in all 5 of the contortionists.

  • View in gallery

    Contortionist 3 (23 years of age). A: Sagittal T2-weighted supine-position 3-T MR image showing the anterosuperior limbus vertebrae at T-11 and L-1 (arrows). B: Coronal T2-weighted supine-position spine 3-T MR image showing a healed and asymptomatic L-1 limbus vertebra (arrows). C: A 0.4-second sagittal T2-weighted MR image obtained using an open 1-T unit and showing the spine in flexion. Note the increased vertebral angles in the region of the limbus vertebrae, especially at L-1.

  • View in gallery

    Contortionist 1. A: Photograph showing the contortionist in spine extension position within the open 1-T MR imaging unit. B: Sagittal FFE 1-T MR image demonstrating full spinal extension. C: Enlargement of sagittal FFE 1-T MR image showing full cervical spine extension. D: Sagittal FFE fused 1-T MR image showing the spine in full flexion.

  • View in gallery

    Graph illustrating the vertebral angles measured from the MR images obtained in Contortionist 1 and shown in Fig. 3. For the purposes of this study, flexion vertebral angles have a positive value. Flexion vertebral angles are indicated by triangles and extension vertebral angles by squares.

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