Lumbar spine x-ray is an radiography method of examining the bone structures of the spinal column. The technique allows us to conclude about the density of bone tissue, the state of the cortical layer, the relative position of bone structures, the symmetry and integrity of individual vertebrae, the shape of the spine, the presence or absence of curvature (kyphosis, scoliosis, kyphoscoliosis). Visualizes fresh traumatic injuries and the consequences of injuries, bone growths, various degenerative, inflammatory, infectious processes. It can be film or digital.
Indications for lumbar spine x-ray are pain of various types, including increasing at night, stiffness, limited mobility, the appearance of tingling and numbness in the legs, changes in pain and / or temperature sensitivity of the lower extremities. The technique is used for spinal column injuries – compression fractures of vertebral bodies, fractures, injuries of arches and processes, as well as for all types of spinal curvature – lordosis, kyphosis, scoliosis.
The study is indicated for pain and discomfort in the lumbar region due to the development of various inflammatory processes. The procedure is used in cases of suspected spondylitis, spondylodiscitis and osteomyelitis. The technique is widely used to detect degenerative-dystrophic changes in the lumbar spine in osteochondrosis, spondylosis, spondyloarthrosis, as well as intervertebral hernias.
In addition, the study is carried out at the initial stage of the diagnosis of oncological processes to confirm the presence of primary tumors or distant metastases in the spine. Radiography allows you to determine the degree of pathological changes in the bone tissue of the spinal column, the localization of injury or developing disease.
An absolute contraindication to X-ray examination is pregnancy, especially its first trimester. If there are vital indications, a pregnant woman is, if possible, referred to CT, where the dose of the X-ray radiation received is significantly less, MRI or ultrasound (depending on the indications). Also, radiography is not indicated for use in children under 14 years of age. If this medical manipulation has no alternative, young patients are protected with special leaded devices. An apron is placed on the lower part of the body to protect the genitals, a collar is placed on the chest and neck, and a cap is placed on the head (if the spine is examined in an infant).
A relative contraindication of lumbar spine x-ray is a high degree of obesity of the subject, since in such cases the picture may not be reliable enough. It is impossible to use this technique in case of inadequacy of the patient, if he has nervous disorders that prevent even short-term preservation of a stationary position. Another significant limitation concerns persons who have taken barium suspension. At least four days should pass from the moment of contrast examination to the beginning of lumbar spine x-ray, since the remnants of contrast in the intestine can interfere and significantly reduce the image quality.
In order for the lumbar spine x-ray to be as informative as possible, it is necessary to unload the intestines on the eve, the image of which is superimposed on the area under study. You can drink a laxative and / or make a cleansing enema. Two or three days before the radiography, it is recommended to switch to a yeast-free diet, exclude foods that cause flatulence from the diet. The procedure should preferably be performed on an empty stomach, with an emptied bladder and intestines. Lumbar spine x-ray is performed on stationary (used in a specially equipped X-ray room) and mobile (field) X-ray machines.
Methodology of conducting
Standard lumbar spine x-ray is carried out in direct and lateral projections. For better visualization of bone structures in a direct projection, the patient lying on his back should bend his knees. In this position, the spine “loses” its physiological bend and is pressed as tightly as possible to the cassette. Very rarely (with pronounced lordosis) a direct picture is taken in a position on the stomach. When taking a picture in a lateral projection, the correct position is achieved by placing a special X-ray transparent pillow under the area under study. Sometimes there is a need to use oblique projections (right/left, front/back).
In some cases, images of the lumbar spine are taken in a standing and sitting position (in order to detect curvature of the spinal column). When conducting functional tests to assess the mobility of the examined area, the doctor may ask the patient to lean sideways (right-left in a straight projection), bend or unbend the lower back (in a lateral projection). For heavy bedridden patients, images are taken on mobile devices, but the quality of such a technique is inferior to stationary examination.
The procedure is short (no more than 10-15 minutes) and absolutely painless, except in cases when pain occurs when trying to take the right position. The patient releases the examined area from clothing, removes all jewelry, and leaves metal objects out of the field of examination. The area of the chest, neck, genitals are covered with a protective screen. Fully prepared, the patient freezes in a motionless position and briefly holds his breath. At this moment, an X-ray is taken, which, depending on the type of radiography (film, digital), appears in the darkroom or appears on the computer screen.
Interpretation of results
The study is conducted by an X-ray technician, the pictures are described by a radiologist. Then the attending physician, who received a picture with a description from the patient, interprets the results of radiography. Radiographs, depending on the nature of the pathology, reveal a change in the size and shape of the vertebrae, a change in the relationship between different structures or a violation of the integrity of individual structures. A two-dimensional lumbar spine x-ray allows us to identify standardized indicators of the first, second and third stages of osteochondrosis, in which the intervertebral space narrows by 1/3 or less, by 1/2, 2/3 of the size of the vertebra.