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In this lumbar spine course and spine conference 2017 Colorado spine surgeon Dr. Donald Corenman discusses how to read an x-ray of the spine.
Other than the MRI, the x-ray is the most valuable diagnostic tool. The x-ray can define problems and pathologies. Dr. Corenman likes to refer to it as the poor mans MRI, because if you use it appropriately, you can come up with a number of diagnostic disorders if you carefully screen the images. In this lumbar spine course, Dr. Corenman is going to address how to read an x-ray of the spine.
First, an AP normal lumbar x-ray is presented. When the image is initially assessed, the physician should have an idea of what appears to be normal and what does not appear to be normal. The first thing that Dr. Corenman sees is the alignment of the spine and the level of the sacrum. If the sacrum is not level, it can raise questions such as a pelvic obliquity due to malformation of the pelvis or to a short leg.
Dr. Corenman recommends that physician use a scan when initially evaluating an x-ray. Dr. Corenman looks at:
- Pedicles
- Spinous processes for rotation
- Alignment of one vertebra to the next
- Congenital anomalies, such as Bertolotti syndrome
- Sacroiliac pathology
An x-ray is a very valuable film to look at alignment, especially for scoliosis. By developing a normal dictation of the spine, Dr. Corenman is able to identify what is abnormal in a x-ray of the lumbar spine. In children and adolescents, an x-ray will show growth plates open.
The lateral x-ray film is the most valuable image when assessing pathology. The lordosis can be measured. It is important to look at the alignment of the back of the vertebra, so that you can identify any displacement. You can also look at the disc heights to determine if there is any degenerative change.
Other than an MRI, flexion, extension films are extremely valuable, because if there is any instability, an MRI will not necessarily show those pathologies. When looking at the flexion and extension x-rays it is important to look at the alignment to make sure there is stability.
Once normal anatomy of the spine has been identified, the physician will look at congenital anomalies or other degenerative changes. In this example, you will see a patient with a normal transverse process on the right, and on the left there is very large transverse process that articulates with the sacrum. This generally means that the L5 vertebra is not moving.
You can then start to look at the pelvis. Look at the hips, look at the front joint (pubic symphysis) for any sclerosis narrowing or changes. Look at the "float" of the femoral head and the acetabular. The reason why this looks like it is floating is because the hip and the acetabulum are lined with highland cartilage. Highland cartilage does not show up on an x-ray, and the float is an indication of the health of the highland cartilage.
Mock lines, or lines that occur from shadows, make it appear that there are problems in the spine. In this example, shows the pedicle on one side and you cannot see the pedicle on the other side. If you look at the tracheal shadow overlies the pedicle, so it is highly unlikely that the pedicle has disappeared.
On the lateral x-ray, you can tell generalized disc health by measuring the center of the disc space. In this example, the disc height enlarge as the descend into the spine with the L4 and L5 level being the largest. If you think there are degenerative changes in the discs, you can measure these heights. Typical degenerative disc disease can occur in different forms with narrowing. In this example, it shows isolated disc resorption.
When you start to get disc narrowing, you can start to look for alignment changes. In this example, at L2 - L3 there is a slight angular change indicating some degeneration on the left side, and 51 still has some sclerosis and narrowing. In the lateral view, you can also notice mild degenerative changes due to the dis narrowing.
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To access more on this lumbar spine course and spine conference 2017 on how to read an x-ray of the spine, please visit Dr. Corenmans' website: [ Ссылка ]
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