Lumbar spine series

Mr 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, post operative 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 xrays are a part of general back pain work ups there is no evidence that obtaining x rays before other modalities will result in a superior patient outcomes 2.

Indications

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

Projections

Standard projections
  • PA/AP view

    • entire lumbar spine should be visible, with 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 asses 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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