Lumbar spine (oblique view)
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The lumbar spine oblique view is used to visualise the articular facets and pars interarticularis of the lumbar spine.
IndicationIndications
This view is used most commonly to assess for a pars interarticularis defect, although this has largely been superseded by CT and MRI. Additionally Additionally, it is a frequently used view for needle placement in fluoroscopic guided procedures 2, such as transforaminal epidural steroid injections.
Patient position
- the radiographs can be performed with the patient in the posteroanterior (PA) erect or supine position
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PA erect
- two radiographs performed with patient at RAO 35-45° and LAO 35-45°
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supine
- two radiographs performed with patient at RPO 35-45° and LPO 35-45°
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PA erect
- ensure arms are removed from the region of interest
- using a 45° radiolucent sponge in the supine position will assist the patient in maintaining the correct position, whilst flexing the knees will also provide stability.
Technical factors
- left and right oblique positions
- expiration (to minimise superimposition of the diaphragm over the upper lumbar spine)
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centring point
- PA erect
- 2.5 cm above the iliac crests and 3 cm lateral from the spinous processes towards the upside. RAO and LAO will demonstrate the facet joints on the upside, for example, the LAO position will show the right facet
jointjoints
- 2.5 cm above the iliac crests and 3 cm lateral from the spinous processes towards the upside. RAO and LAO will demonstrate the facet joints on the upside, for example, the LAO position will show the right facet
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APsupine- 2.5 cm above the iliac crests and 5 cm medial from the ASIS on the upside. RPO and LPO will demonstrate the
facetsfacet joints on the downside, for examplefor, the RPO position will show the right facetjointjoints
- 2.5 cm above the iliac crests and 5 cm medial from the ASIS on the upside. RPO and LPO will demonstrate the
- PA erect
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collimation
- superiorly to include the T12/L1 junction
- inferior to include the L5/S1 junction
- anterior to include the anterior border of the lumbar vertebral bodies
- posterior to include all elements of the posterior column, particularly the spinous processes
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orientation
- portrait
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detector size
- 35 cm x 43 cm
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exposure
- 70-80 kVp
- 60-80 mAs
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SID
- 110 cm
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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/L1 - L5/S1- check department protocol before imaging, as focused imaging of the lower lumbar vertebrae may be required
- a well-positioned oblique lumbar radiograph will demonstrate the scottie dog sign, showing the articular processes and facet joints
- adequate image penetration and image contrast is evident by clear visualisation of lumbar vertebral bodies, with both trabecular and cortical bone demonstrated
- pedicles should be in the central of the vertebral bodies
Practical points
- to correct poor positioning consider the location of the pedicles
- if they are anterior on the vertebral body- rotate the patient more
- if they are posterior on the vertebral body- rotate the patient less
-<p>The <strong>lumbar spine oblique view </strong>is used to visualise the articular facets and pars interarticularis of the lumbar spine. </p><h4>Indication</h4><p>This view is used most commonly to assess for a pars interarticularis defect, although this has largely been superseded by CT and MRI. Additionally, it is a frequently used view for needle placement in fluoroscopic guided procedures <sup><span style="font-size:10.8333px">2</span></sup>, such as <a title="Transforaminal epidural steroid injection" href="/articles/transforaminal-epidural-steroid-injection">transforaminal epidural steroid injections</a>. </p><h4>Patient position</h4><ul>-<li>the radiographs can be performed with the patient in the erect or supine position<ul>- +<p>The <strong>lumbar spine oblique view </strong>is used to visualise the articular facets and pars interarticularis of the lumbar spine. </p><h4>Indications</h4><p>This view is used most commonly to assess for a pars interarticularis defect, although this has largely been superseded by CT and MRI. Additionally, it is a frequently used view for needle placement in fluoroscopic guided procedures <sup>2</sup>, such as <a href="/articles/transforaminal-epidural-steroid-injection">transforaminal epidural steroid injections</a>. </p><h4>Patient position</h4><ul>
- +<li>the radiographs can be performed with the patient in the posteroanterior (PA) erect or supine position<ul>
-<strong>erect</strong><ul><li> two radiographs performed with patient at RAO 35-45° and LAO 35-45° </li></ul>- +<strong>PA erect</strong><ul><li> two radiographs performed with patient at RAO 35-45° and LAO 35-45° </li></ul>
-<li>PA erect<ul><li>2.5 cm above the iliac crests and 3 cm lateral from the spinous processes towards the upside. RAO and LAO will demonstrate the facet joints on the upside, for example, the LAO position will show the right facet joint</li></ul>- +<li>PA erect<ul><li>2.5 cm above the iliac crests and 3 cm lateral from the spinous processes towards the upside. RAO and LAO will demonstrate the facet joints on the upside, for example, the LAO position will show the right facet joints</li></ul>
-<li>AP supine<ul><li>2.5 cm above the iliac crests and 5 cm medial from the ASIS on the upside. RPO and LPO will demonstrate the facets joints on the downside, for example for RPO will show the right facet joint </li></ul>- +<li>supine<ul><li>2.5 cm above the iliac crests and 5 cm medial from the ASIS on the upside. RPO and LPO will demonstrate the facet joints on the downside, for example, the RPO position will show the right facet joints </li></ul>
-<li>the entire lumbar spine should be visible from T12/ L1- L5/S1<ul><li>check department protocol before imaging, as focused imaging of the lower lumbar vertebrae may be required </li></ul>- +<li>the entire lumbar spine should be visible from T12/L1 - L5/S1<ul><li>check department protocol before imaging, as focused imaging of the lower lumbar vertebrae may be required </li></ul>
-<li>a well-positioned oblique lumbar radiograph will demonstrate the <a href="/articles/scottie-dog-sign-spine">s</a><a href="/articles/scottie-dog-sign-spine">cottie</a> dog sign, showing the articular processes and facet joints </li>- +<li>a well-positioned oblique lumbar radiograph will demonstrate the <a href="/articles/scottie-dog-sign-spine">s</a><a href="/articles/scottie-dog-sign-spine">cottie</a><a title="Scottie dog sign (spine)" href="/articles/scottie-dog-sign-spine"> dog sign</a>, showing the articular processes and facet joints </li>
References changed:
- 2. Shim E, Lee W, Lee E, et al. Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine. (2016) RadioGraphics. 37 (2): 537-561. <a href="https://doi.org/10.1148/rg.2017160043">doi:10.1148/rg.2017160043</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27935769">Pubmed</a> <span class="ref_v4"></span>
- 2. Shim E, Lee W, Lee E, et al. Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine. (2016) RadioGraphics. 37 (2): 537-561. <a href="https://doi.org/10.1148/rg.2017160043">doi:10.1148/rg.2017160043</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27935769">Pubmed</a> <span class="ref_v4"></span>
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