A Review on Reading Lumbar X-rays
Low back pain is an common complaint in both athletes and the general public. Some will present after an acute fall or injury, while others will complain of chronic symptoms that may be lingering. Different protocols may exist in sports medicine and orthopedic practices depending on the background and whether or not trauma was involved.
The region included will depend on the film size and centering used by the radiographer. Some providers prefer longer and narrow films that include more of the lumbar spine, while others may want smaller films. Three views (AP, lateral, focused lateral lumbosacral) will cover most causes of lumbar pain. Focused lateral views allow optimal viewing of the L5-S1 disc space. For the AP view, the provider should be able to see the L1-5, T12 vertebral body, T11/T12 space and the sacrum. For the lateral view, the vertebral bodies, transverse processes, facet joints and pedicles should be clearly seen. Oblique views may be added to exclude spondylolysis. Flexion and extension views may be added that may exacerbate spondylolisthesis and help determine instability. The value of plain films of the lumbosacral spine are questioned in the assessment of sciatica and more advanced imaging may be needed.
For each series, a general pattern that is reproducible should be followed. The vertebrae should be identified and counted slowly and bodies should be looked at from top to bottom. It should be checked that the alignment is in order and may be different depending on the view. To do this, one should draw an imaginary line joining the anterior aspects of the vertebral bodies (anterior body line), the posterior aspects of the bodies (posterior body line), and the line joining the short interfaces where the spinous processes join the laminae posteriorly (spinolaminar line) . The lumbar spine should curve in a light lordotic configuration.
Figure 1. Lateral lumbar radiographs (labeled)
Figure 2. AP lumbar radiographs (labeled)
The AP View
Image 3. AP Spine Alignment
Image 4. Dextroscoliosis vs levoscoliosis
Image 5. ‘Winking Owl’ sign
Image 6. Measuring the Cobb angle (adopted from )
The Lateral View
Image 7. Lateral xray alignment
Image 8. Labeled lateral xray
The Oblique View
Image 9. Spondylosis with fracture of neck of “Scottie Dog” (adopted from )
Image 10. Spondylolisthesis of L5 (adopted )
Image 11. Flexion Extension views
Figure 12. Flexion and extension views with measurements on xray and MRI (adopted from )
Figure 13. Wedge fracture (adopted from )
Figure 14. Chance fracture (adopted from )
Figure 15. Burst fracture of L2 (Adopted from )
Read More: http://wikism.org/Back_Pain_(Main)