Lumbar spine series

Dr Henry Knipe and Andrew Murphy et al.

The lumbar spine series is comprised of two standard projections along with a range of additional projections depending on clinical indications. The series is often utilised in the context of trauma, postoperative imaging and for chronic conditions such as ankylosing spondylosis.

Lumbar spine x rays are the most commonly ordered radiographic investigation of the spine, however, it is widely documented that plain radiography is far inferior in the investigation of suspected lumbar spine pathology compared to that of MRI and CT 1.

Although lumbar spine x-rays are a part of general back pain workups there is no evidence that obtaining x rays before other modalities will result in higher patient outcomes 2.


Lumbar spine radiographs are performed for a variety of indications including 1,2:

  • fall from a height of greater than 3 metres
  • ejection from a motor vehicle or motorcycle
  • acute back pain
  • GCS less than 8
  • neurological deficit
  • postoperative imaging
  • chronic conditions
  • history of cancer and associated back pain


Standard projections
  • PA/AP view
    • the entire lumbar spine should be visible, with a demonstration of T11/T12 superiorly and the sacrum inferiorly
    • often performed erect unless otherwise indicated
  • lateral view
    • visualisation of lumbar vertebral bodies, pedicles, and facet joints
    • ideal projection when examining for suspected fractures
    • can be performed erect to assess stable fracture (under a specialist's guidance)
Modified trauma projections
  • horizontal beam lateral
    • visualisation of lumbar vertebral bodies, pedicles, and facet joints taken supine
    • used in the context of trauma
Additional projections
  • oblique view
    • used to visualise the articular facets and pars interarticularis of the lumbar spine
  • flexion-extension view
    • functional view used to assess spinal stability
Radiographic views
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Article information

rID: 49813
Section: Radiography
Synonyms or Alternate Spellings:

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Cases and figures

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    Figure 1: AP lumbar spine
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    Figure 2: laterallumbar spine
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    Figure 3: oblqiue lumbar spine
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