Indication
1. See Low Back Pain Red Flags
2. Acute Low Back Pain with radiculopathy
  1. XRay not helpful in first 4 weeks of symptoms
Efficacy
1. Low yield test
Views (Includes lower thoracic vertebrae to sacrum)
1. Anterior-Posterior (AP) L-S Spine
  1. Vertical alignment of spinous processes
    1. Rotational injury (unilateral facet dislocation)
    2. Scoliosis
  2. Intervertebral disc space uniformity
  3. Includes pelvis
    1. Acetabulum and femoral heads
    2. Pelvis degenerative changes
2. Lateral L-S Spine
  1. Vertebral body
  2. Facet joint
  3. Lordotic curvature of L-S Spine
  4. Intervertebral foramen
  5. Intervertebral disc space height shortening
    1. Lumbosacral disc disease (degenerative)
    2. Spinal Osteomyelitis
  6. Spondylolisthesis (anterior slippage of L5 on S1)
3. Oblique L-S Spine (tube angled at 45 degrees)
  1. Neural foramina narrowing
  2. Pars interarticularis defect
  3. Spinal tumor
  4. Facet hypertrophy
  5. Spondylosis
  6. Spondylolysis
  7. Spondylolisthesis
4. Flexion and extension views
  1. Used to assess ligamentous and bony injury
  2. Contraindications
    1. Other XRay abnormalities are present
    2. Decreased Level of Consciousness
References
1. Humphreys (2002) Am Fam Physician 65(11):2299
2. Inaoka (2000) Arch Orthop Trauma Surg 120:380

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 2/26/2010. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.