Lumbar spine (lateral view)
Last revised by Andrew Murphy ◉ on 19 Sep 2021
Citation, DOI & article data
Citation:
McWilliam R, Murphy A, Er A, et al. Lumbar spine (lateral view). Reference article, Radiopaedia.org (Accessed on 09 Feb 2023) https://doi.org/10.53347/rID-49523
rID:
49523
Article created:
25 Nov 2016 by Rose McWilliam
Revisions:
6 times by 5 users - see full revision history
Systems:
Sections:
Synonyms:
- Lateral view of lumbar spine
The lumbar spine lateral view images the lumbar spine which generally consists of five vertebrae (see: lumbosacral transitional vertebra).
On this page:
Indications
This projection shows an orthogonal view of the AP/PA view and is utilized in many imaging contexts including trauma, postoperatively, and for chronic conditions. This view is also ideal in characterizing spinal alignment.
Note: Ideally, spinal imaging should be taken erect in the non-trauma setting to give a functional overview of the lumbar spine. Otherwise, patients with a suspected spinal injury must remain in the supine position without any movement.
Patient position
- the patient is positioned erect, supine or lateral recumbent, depending on clinical history
- in the lateral decubitus position, position the patient so that the humeri are extended 90 degrees to the thorax, with the elbows flexed so that the forearms are parallel to the thorax. Spinal curvature in the AP projection will determine if a right lateral or a left lateral is performed.
- when implementing horizontal beam technique, ensure the distal upper limbs are not overlying the region of interest. Ask the patient to cross their arms over their upper thorax, or to extend them in a similar position to that achieved in the lateral decubitus position
Technical factors
- lateral projection
- expiration (to minimize superimposition of the diaphragm over the upper lumbar spine)
-
centering point
- the level of the iliac crest
- coronal centering point is directly over the lumbar vertebra, which corresponds to the posterior third of the abdomen
- the central ray is perpendicular to the image receptor
-
collimation
- superiorly to include the T12/L1
- inferior to include the sacrum
- anterior to include the anterior border of the lumbar vertebral bodies
- posterior to include all elements of the posterior column, particularly the spinous processes
-
orientation
- portrait
-
detector size
- 35 cm x 43 cm
-
exposure
- 70-80 kVp
- 60-80 mAs
-
SID
- 110 cm
-
grid
- yes (ensure the correct grid is selected if using focused grids)
Image technical evaluation
- the entire lumbar spine should be visible from T12/ L1- L5/S1
- superimposition of the greater sciatic notches, the superior articulating facets and the superior and inferior endplates. This indicates a true lateral has been achieved
- adequate image penetration and image contrast is evident by clear visualization of lumbar vertebral bodies, with both trabecular and cortical bone demonstrated
Practical points
- the three-column concept of thoracolumbar spinal fractures is of particular importance when assessing this image for pathology
- utilize an erect bucky when performing horizontal beam laterals to utilize oscillating grids, automatic expose control, and CR/IR alignment
- if the patient demonstrates spinal scoliosis, ensure that the side with the convexity is closest to the IR. This will utilize the diverging beam and aid in achieving superimposition of the upper and lower endplates
- for particular patients, it is advisable to place a small radiolucent triangle sponge under the side in contact with the table at waist height to reduce spine convexity
- a spot radiograph may be required to show a clearer visualization of the L4/L5/S1 articulation
- try to remove as many possible image artefacts (i.e. ECG leads, urinary catheters), especially when performing horizontal beam technique in a trauma context
- a breathing technique is a radiographical technique employed in some departments if imaging equipment permits.
- if using a CR system, a smaller cassette 30x35 can be used when the sacral region does not need to be demonstrated. When centering, place the height of the CR 2.5cms above the iliac crests
Related articles: Imaging in practice
- imaging in practice
-
general radiography (adult)
- portable radiography
- chest radiography
- abdominal radiography
-
upper limb radiography
-
shoulder girdle radiography
- scapula series
-
shoulder series
- shoulder (AP view)
- shoulder (internal rotation view)
- shoulder (external rotation view)
- shoulder (superior-inferior axial view)
- shoulder (inferior-superior axial)
- shoulder (West Point view)
- shoulder (Velpeau view)
- shoulder (modified trauma axial view)
- shoulder (supine lateral view)
- shoulder (modified transthoracic supine lateral)
- shoulder (lateral scapula view)
- shoulder (AP glenoid view)
- shoulder (Garth view)
- shoulder (outlet view)
- shoulder (Stryker notch view)
- acromioclavicular joint series
-
clavicle series
- clavicle (AP view)
- clavicle (AP cephalic view)
- clavicle (oblique view)
- sternoclavicular joint series
- arm and forearm radiography
- wrist and hand radiography
- wrist series
- scaphoid series
- hand series
- thumb series
- fingers series
- rheumatology hands series
- bone age (radiograph)
-
shoulder girdle radiography
-
lower limb radiography
- pelvic girdle radiography
- thigh and leg radiography
- ankle and foot radiography
- skull radiography
-
paranasal sinus and facial bone radiography
- facial bones
- mandible
- nasal bone
- zygomatic arches
- paranasal sinuses
- temporal bones
- dental radiography
- orthopantomography
- temporomandibular joints
- temporomandibular joint (AP axial view)
- temporomandibular joint (axiolateral oblique view)
-
spinal radiography
- cervical spine series
-
thoracic spine series
- thoracic spine (AP view)
- thoracic spine (lateral view)
- thoracic spine (oblique view)
- lumbar spine series
- sacrococcygeal radiography
- scoliosis radiography
-
pediatric radiography
- radiographic positioning terminology
- systematic radiographic technical evaluation (mnemonic)
- pediatric immobilization
- foreign body ingestion series (pediatric)
- foreign body inhalation series (pediatric)
- shunt series
- chest radiograph (pediatric)
- abdomen radiograph (pediatric)
- upper limb radiography (pediatric)
-
lower limb radiography (pediatric)
- pelvis radiograph (pediatric)
- femur series (pediatric)
- pediatric femur (AP view)
- pediatric femur (lateral view)
- leg length view
- knee series (pediatric)
- pediatric knee (AP view)
- pediatric knee (lateral view)
- tibia fibula series (pediatric)
- pediatric tibia fibula (AP view)
- pediatric tibia fibula (lateral view)
- pediatric tibia fibula (oblique view)
- ankle series (pediatric)
- foot series (pediatric)
- skull radiography (pediatric)
- spine radiography (pediatric)
-
skeletal survey
-
skeletal survey (non-accidental injury)
- torso
- pediatric chest (AP erect view)
- pediatric chest (oblique ribs view)
- pediatric abdomen (AP supine view)
- pediatric spine (whole lateral view)
- upper limb (both sides)
- lower limb (both sides)
- pediatric femur (AP view)
- pediatric knee (lateral view)
- pediatric tibia fibula (AP view)
- pediatric ankle (lateral view)
- pediatric foot (DP view)
- torso
-
skeletal survey (non-accidental injury)
-
CT
- iodinated contrast media
- CT IV contrast media administration
-
CT protocol
- composite
- whole-body CT (protocol)
- CT Chest abdomen-pelvis (protocol)
- CT NCAP (neck, chest, abdomen and pelvis)
- head & neck
- chest
- abdomen and pelvis
- CT abdomen-pelvis (protocol)
- CT abdominal aorta
- CT adrenals (protocol)
- CT cholangiography (protocol)
- CT colonography (protocol)
- CT enteroclysis (protocol)
- CT enterography (protocol)
- CT gastrography (protocol)
- CT kidneys, ureters and bladder (protocol)
- CT urography (protocol)
- CT Renal mass (protocol)
- CT angiography of the splanchnic vessels (protocol)
- CT renal split bolus
- CT pancreas (protocol)
- liver
- composite
- barium studies
-
MRI
- cine imaging
-
brain
- screen protocol
- stereotaxis protocol
- tumor protocol
- stroke protocol
- infection protocol
- trauma protocol
- demyelination protocol
- epilepsy protocol
- neurodegenerative protocol
- trigeminal neuralgia protocol
- posterior fossa protocol
- temporal bone/IAM/CPA protocol
- pineal and tectal plate protocol
- pituitary gland protocol
- CSF flow
- angiographic protocols
- MRA
- circle of Willis (COW)
- carotid-vertebral system
- MRV
- MRA
- head and neck
- orbits protocol
- sinonasal tract protocol
- salivary glands protocol
- oropharynx and oral cavity protocol
- suprahyoid neck protocol
- infrahyoid neck protocol
- chest
- mediastinum
- cardiac
- abdomen and pelvis
- abdomen
- liver and biliary tree
- liver protocol
- MRCP: cholangiopancreatography
- pancreas protocol
- elastography
- anus and rectum
- uterus and ovaries
- urological
- prostate cancer protocol
- bladder cancer protocol
- kidneys protocol
- musculoskeletal
-
ultrasound
- ultrasound signs
-
obstetric ultrasound
- other
- placenta
-
second trimester
- fetal biometry
- fetal morphology assessment
-
soft markers
- nuchal fold thickness
- ventriculomegaly
- absent nasal bone
- echogenic intracardiac focus
- choroid plexus cysts
- echogenic bowel
- aberrant right subclavian artery
- amnioreduction
- echogenic fetal bowel
- umbilical artery Doppler assessment
- chorionic villus sampling (CVS) and amniocentesis
- nuchal translucency
- failed early pregnancy
- subchorionic hematoma
- multiple gestations
- ectopic pregnancy
-
first trimester and early pregnancy
- gestational sac
- yolk sac
- embryo/fetus
- amnion
- chorion
- Beta-hCG levels
- gynecologic ultrasound
- vascular ultrasound
- carotids
- extremities
- mesenteric vessels
- other
- breast ultrasound
-
musculoskeletal ultrasound
- technique/artifacts
- ultrasound of arthropathies
- skin/soft tissue ultrasound
- lipoma
- parasitic infection
- other
- pediatric musculoskeletal ultrasound
- ankle/foot ultrasound
-
knee ultrasound
- Baker cyst (popliteal cyst)
- infrapatellar bursitis
- hip ultrasound
- hand ultrasound
- wrist ultrasound
- elbow ultrasound
- shoulder ultrasound
- liver ultrasound
- hyperechoic liver lesion
- sonographic halo sign
- ultrasound appearances of liver metastases
- periportal hyperechogenicity
- periportal hypoechogenicity
- generalized increase in hepatic echogenicity
- generalized reduced hepatic echogenicity
- coarsened hepatic echotexture
- starry sky appearance (ultrasound)
- normal hepatic vein Doppler
- hepatic arterial resistive index
- gallbladder ultrasound
- pancreatic ultrasound
- gastrointestinal ultrasound
- renal ultrasound
- bladder ultrasound
-
testicular and scrotal ultrasound
- other
- epididymis
- paratesticular lesions
- bilateral testicular lesion
-
unilateral testicular lesion
- testicular torsion
- orchitis
- testicular rupture
-
germ cell tumor of the testis
- testicular seminoma
-
non seminomatous germ cell tumors
- mixed germ cell tumor
- yolk sac tumor (endodermal sinus tumor)
- embryonal cell carcinoma
- choriocarcinoma
- testicular teratoma
- testicular epidermoid (teratoma with ectodermal elements only)
- burned out testis tumor
- sex cord / stromal tumors of the testis
- prostate ultrasound
- neck and thyroid ultrasound
- echocardiography
- speckle tracking echocardiography
- fetal echocardiography
- contrast-enhanced echocardiography
- epicardial echocardiography
- three dimensional (3D) echocardiography
- transesophageal echocardiography (TEE)
- transthoracic echocardiography (TTE)
- left ventricular systolic and diastolic function
- structure and morphology
- systolic function
- diastolic function
- right ventricular assessment
- right and left atria
- valvular structure and function
- mitral valve
- aortic valve
- pulmonic valve
- tricuspid valve
- hemodynamics
- pericardium
- cardiomyopathies
- congenital heart disease
- great vessels
- pediatric ultrasound
- ultrasound interventions
- ultrasound-guided biopsy
- ultrasound-guided percutaneous drainage
- ultrasound-guided musculoskeletal interventions
- joint injection
- nerve blocks
- ultrasound-guided intravenous cannulation
- contrast-enhanced ultrasound
- physics and imaging modes
- grey-scale (B-mode)
- motion mode (M-mode)
- color flow Doppler (CFD)
-
spectral Doppler
- pulsed wave Doppler (PWD)
- continuous wave Doppler (CWD)
- superb microvascular imaging (SMI)
- tissue Doppler imaging (TDI)
- nuclear medicine
-
radiation therapy
- external beam radiation therapy (EBRT)
- sealed source radiation therapy (brachytherapy)
- unsealed source radiation therapy
-
interventional
- procedure overview
- neck
- thyroid gland
- breast
- chest
- hepatobiliary
- splenic interventions
- gastrointestinal
- urogenital
- bladder
- kidney
- prostate
- musculoskeletal
-
arthrogram
- MR arthrogram
- CT arthrogram
- anesthetic arthrogram
- bone biopsy (CT-guided)
-
arthrogram
- upper limb
- lower limb
-
hip
- hip joint injection (technique)
- greater trochanteric bursa injection
- gluteus minimus/medius tendon calcific tendinopathy barbotage
- iliopsoas tendon bursa injection
- lateral cutaneous femoral nerve of the thigh injection
- piriformis injection
- common hamstrings origin injections
-
knee
- common peroneal (fibular) nerve injection
- knee joint injection
- patella tendon microtenotomy
- quadriceps tendon microtenotomy
- tibial nerve injection
-
ankle
- achilles hydrodilation & microtenotomy
- ankle joint injection
- extensor tendon sheath injection
- flexor tendon sheath injection
- os trigonum injection
- peroneal tendon sheath injection
- subtalar joint injection
- tibial nerve injection
-
foot
- calcaneocuboid joint injection
- metatarsophalangeal joint (MTPJ) injection
- naviculocuneiform joint injection
- plantar fascia microtenotomy
- subtalar joint injection
- talonavicular joint injection
- tarsometatarsal joint (TMTJ) injection
-
hip
- spine
- breast imaging
-
mammography
- breast screening
- breast imaging and the technologist
- forbidden (check) areas in mammography
-
mammography views
- craniocaudal view
- mediolateral oblique view
- additional (supplementary) views
- true lateral view
- lateromedial oblique view
- late mediolateral view
- step oblique views
- spot view
- double spot compression view
- magnification view
- exaggerated craniocaudal (axillary) view
- cleavage view
- tangential views
- caudocranial view
- bullseye CC view
- rolled CC view
- elevated craniocaudal projection
- caudal cranial projection
- 20° oblique projection
- inferomedial superolateral oblique projection
- Eklund technique
- normal breast imaging examples
-
mammography
- digital breast tomosynthesis
- breast ultrasound
- breast ductography
- breast MRI
- breast morphology
- breast intervention