Plain lumbosacral x-rays

see also Standing full-spine X-ray

Unexpected findings occurred in only 1 in 2500 adults < 50 years age ¹⁾. Diagnosis of surgical conditions of lumbar disc herniation and lumbar spinal stenosis cannot be made from plain films (although they may be inferred, further study would be required). Various congenital abnormalities of uncertain significance may be identified (e.g. spina bifida occulta), and evidence of degenerative changes (including osteophytes) are as frequent in symptomatic as in asymptomatic patients. Gonadal radiation is significant. Seldom indicated during pregnancy.

Not recommended for routine evaluation of patients with acute low back problems during the first month of symptoms unless a “red flag” is present. Reserve LS x-rays for patients with a likelihood of having spinal malignancy, infection, inflammatory spondylitis, or clinically significant fracture. In these cases, plain x-rays are often just a starting point, and further study (CT, Lumbar MRI…) may be indicated even if the plain x-rays are normal.

see “Red flags” for these conditions.

When spine x-rays are indicated, AP and lateral views are usually adequate ²⁾. Obliques and coneddown L5-S1 views more than double the radiation exposure, and add information in only 4–8% of cases, ³⁾ and can be obtained in specific instances where warranted (e.g. to diagnose spondylolysis when spondylolisthesis is found on the lateral film).

Abnormal wear on the cartilage and bones of the lower spine, such as bone spurs and narrowing of the joints between the vertebrae Cancer (although cancer often cannot be seen on this type of x-ray) Fractures Signs of thinning bones (osteoporosis) Spondylolisthesis, in which a bone (vertebra) in the lower part of the spine slips out of the proper position onto the bone below it.

see Cobb angle

see Lumbar lordosis

see Pelvic incidence

see Pelvic tilt

see Sacral slope.