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Lumbosacral Spine XRay

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Lumbosacral Spine XRay, LS Spine XRay, Lumbar Spine XRay, L-Spine XRay, Oblique Lumbar Spine XRay, Scotty Dog

  • Indication
  1. See Low Back Pain Red Flags
  2. Vertebral Fracture
  3. Spondylolisthesis
  4. Lumbar Spine Anatomy
  • Efficacy
  1. XRay is a low yield test in non-Traumatic back disorders
  • Anatomy
  1. See Lumbar Spine Anatomy
  2. Thoracic Spine Vertebrae are interpreted in similar fashion to lumbar Vertebrae
  3. Images
    1. Lumbar SpineVertebra cross section and lateral view
      1. LumbarSpineAnatomyVertebra.gif
    2. Lumbar Spine nerve roots and intervertebral discs
      1. LumbarSpineAnatomyDisc.gif
    3. Spinal Ligaments
      1. orthoSpineVertebraeLumbarLateralXsGrayBB301.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  1. Anterior-Posterior (AP) L-S Spine
    1. Appears as a totem pole of vertically stacked owl heads
      1. Vertebral body (owl head)
      2. Pedicles (owl eyes)
      3. Spinous process (owl nose)
      4. Transverse process (owl ear)
    2. Vertical alignment of spinous processes
      1. Rotational injury (unilateral facet dislocation)
      2. Scoliosis
    3. Other Vertebral injury findings
      1. Intervertebral disc space uniformity (similar between each Vertebral body)
      2. Burst Fractures may result in narrowed Vertebral height or pedicle separation
      3. Chance Fracture may demonstrate Fracture line through pedicle
      4. Spinous process Fractures
    4. Lumbar Spine imaging Includes Pelvis
      1. Acetabulum and femoral heads
      2. Pelvis degenerative changes
  2. Lateral L-S Spine
    1. Landmarks
      1. Vertebral body (including symmetric height)
      2. Facet joint
      3. Intervertebral foramen
      4. Spinous process (observe for Fracture lines)
    2. Alignment and structure
      1. Lordotic curvature of L-S Spine
      2. Vertebral alignment
    3. Findings
      1. Spondylolisthesis (anterior slippage of L5 on S1)
      2. Intervertebral disc space height shortening
        1. Lumbosacral disc disease (degenerative)
        2. Spinal Osteomyelitis
  • Views
  • Specifically Indicated Views
  1. 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
  2. Oblique L-S Spine
    1. Tube angled at 45 degrees (midway between an AP and Lateral view)
    2. Interpretation
      1. Oblique spine view appears as Scotty Dogs stacked on top of one another
        1. Scotty Dog appearance of the posterior Vertebra overlapping the Vertebral body
        2. Scotty Dog oriented with the buttocks to the right side
          1. Demonstrates the right lamina, pedicle and pars interarticularis
        3. Scotty Dog oriented with the buttocks to the left side
          1. Demonstrates the left lamina, pedicle and pars interarticularis
      2. Scotty Dog
        1. Inferior intervertebral articular processes (Scotty Dog's front and hind legs)
        2. Superior intervertebral articular processes (Scotty Dog's ears and tail)
        3. One lamina (Scotty Dog's body)
        4. One pedicle (Scotty Dog's eye)
        5. One transverse process (Scotty Dog's nose)
        6. One Pars interarticularis (Scotty Dog's neck)
          1. Scotty Dog with a collar (Fracture line), suggests a Pars Defect (Spondylolysis)
          2. Pars Defect on both sides is associated with Spondylolisthesis
    3. Findings/Indications (has been replaced by CT and MRI)
      1. Neural foramina narrowing
      2. Pars Interarticularis Defect
      3. Spinal Tumor
      4. Facet hypertrophy
      5. Spondylosis
      6. Spondylolysis
      7. Spondylolisthesis
    4. Resources
      1. Oblique Lumbar Spine View (Radiopaedia)
        1. https://radiopaedia.org/articles/lumbar-spine-oblique-view-2?lang=us
  • References
  1. Humphreys (2002) Am Fam Physician 65(11):2299-306 [PubMed]
  2. Inaoka (2000) Arch Orthop Trauma Surg 120:380-5 [PubMed]