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Taking Sides on Low Back X-rays

Spine X-rays are the key to diagnosing many spine conditions. They let doctors see the way the spine is balanced. But spine X-rays done from the side require a patient to raise the arms out of the way to provide a clear view of the spine. Does this position really give a true picture of spine position while standing and moving in everyday life?

These authors wanted to answer that question. They tested adolescent girls, a group that is at high risk for spine problems. Spine position during X-rays was studied in four different positions. The positions were then compared to relaxed standing and walking positions.

The results showed a range of natural standing spinal positions. However, there were differences of several centimeters between relaxed standing and X-ray positions. That means that the spine position changed to compensate for the change in arm position during X-rays. And that means X-rays don't truly show how a patient's spine is balanced.

This issue is especially important because there is no standard way that doctors do spine X-rays. Research like this could lead to developing a standard. Doing X-rays the same way would help doctors compare X-rays from different patients and from different hospitals, which would allow them to learn more about spine positioning. The authors recommend further research on using hand supports and ways of positioning the body to help make sure X-rays give a realistic picture of the spine.

References: Michelle C. Marks, PT, MA, et al. Standing Lateral Radiographic Positioning Does Not Represent Customary Standing Balance. In Spine. June 1, 2003. Vol. 28. No. 11. Pp. 1176-1182.

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