Patients with a suspected spinal injury must remain immobilised in the supine position. Spinal imaging should be taken erect in the non-trauma setting to give a functional overview of the lumbar spine. Transverse processes are often obscured by gas from the abdomen. The spinous processes (red) should be central and there should be equal distance between transverse processes (green). In an AP/PA view, the entire lumbar spine should be visible from T12 superiorly and the sacrum inferiorly. Lateral projection of a normal lumbar spine highlighting the vertebrae in yellow 2 Anterior-posterior (AP)/posterior-anterior (PA) Each vertebra (highlighted in yellow) should be examined looking for a loss of height which could indicate a compression fracture commonly associated with osteoporosis (see fractures section below).Ĭompression fractures are often seen in the upper lumbar or lower thoracic vertebrae. Lateral views are particularly useful for identifying fractures. In a lateral view, the entire lumbar spine should be visible from T12-S1. In the case of trauma, additional views can be sought including oblique and horizontal beam lateral views.

Anterior-posterior (AP)/posterior-anterior (PA).There are two standard projections produced when a lumbar spinal X-ray is performed: If previous radiographs are available, these should also be reviewed to provide a point of reference. Patient details (name, date of birth, unique identification number).You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.īegin by confirming you have the correct patient and the correct radiograph by assessing the following: An episode of back pain ongoing for 6 weeks or longer without improvement.Chronic corticosteroid use (increased risk of fracture).Past medical history of malignancy, ankylosing spondylitis or osteoporosis.Significant trauma (not “lifting something” or “bending to pick up something” etc).Indications for a lumbar spine X-rayĪppropriate clinical indications for lumbar spine X-ray include: 1 The relevant literature suggests that lumbar spine X-rays are not routinely indicated for uncomplicated back pain which resolves in about 90% of cases within 2 months, regardless of treatment.

It is important to remember that lumbar spine X-rays involve a significant radiation dose (approximately 70 chest X-rays). This area includes the lumbar region and the sacrum. Lumbar spine X-rays are one of the most commonly requested radiographic investigations of the spine, however, it should be noted that projectional radiography has limitations and other imaging modalities such as MRI and CT should be considered if further evaluation is required.Ī lumbar spine X-ray is a picture of the vertebrae in the lower part of the spine.

Lumbar spine x ray