Spinal X-Ray

Spinal X-rays are pictures of the spine. They may be taken to find injuries or diseases that affect the discs or joints in your spine. These problems may include spinal fractures, infections, dislocations, tumors, bone spurs, or disc disease. Spinal X-rays are also done to check the curve of your spine (scoliosis) or for spinal defects. X-rays are a form of radiation, like light or radio waves, that are focused into a beam, much like a flashlight beam. X-rays can pass through most objects, including the human body. Dense tissues in the body, such as bones, block (absorb) many of the X-rays and look white on an X-ray picture. Less dense tissues, such as muscles and organs, block fewer of the X-rays (more of the X-rays pass through) and look like shades of gray on an X-ray. X-rays that pass only through air look black on the picture. The spine is divided into four parts. So there are four common types of spinal X-rays:

Cervical spine X-ray. This X-ray test takes pictures of the 7 neck (cervical) bones. Thoracic spine X-ray. This X-ray test takes pictures of the 12 chest (thoracic) bones. Lumbosacral spine X-ray. This X-ray test takes pictures of the 5 bones of the lower back (lumbar vertebrae) and a view of the 5 fused bones at the bottom of the spine (sacrum). Sacrum/coccyx X-ray. This X-ray test takes a detailed view of the 5 fused bones at the bottom of the spine (sacrum) and the 4 small bones of the tailbone (coccyx). The most common spinal X-rays are of the cervical vertebrae (C-spine films) and lumbosacral vertebrae (LSspine films). Why It Is Done A spinal X-ray is done to:

Find the cause of ongoing pain, numbness, or weakness. Check for arthritis of the joints between the vertebrae and the breakdown (degeneration) of the discs between the spinal bones. Check injuries to the spine, such as fractures or dislocations. Check the spine for effects from other problems, such as infections, tumors, or bone spurs. Check for abnormal curves of the spine, such as scoliosis, in children or young adults. Check the spine for problems present at birth (congenital conditions), such asspina bifida, in infants, children, or young adults. Check changes in the spine after spinal surgery. How To Prepare Before the X-ray test, tell your doctor if you:

Are or might be pregnant. The risk of radiation exposure to your unborn baby (fetus) must be considered. The risk of damage from the X-rays is usually very low compared with the potential benefits of the test. If a spinal Xray is absolutely necessary, a lead apron will be placed over your belly to shield your baby from the X-rays. Have had an X-ray test using barium contrast material (such as a barium enema) in the past 4 days. Barium shows up on X-ray films and makes it hard to get a clear picture of the lower back (lumbar spine). You don't need to do anything else before you have this test. How It Is Done

A spinal X-ray is taken by a radiology technologist. The X-ray pictures are usually read by a doctor who specializes in reading X-rays (radiologist). You will need to remove any jewelry that may be in the way of the X-ray picture. You may need to take off some of your clothes, depending on which area is examined. You will be given a cloth or paper gown to use during the test. You may be allowed to keep on your underwear if it does not get in the way of the test. During the X-ray test, you will lie on an X-ray table. If the X-ray is being taken because of a possibly serious injury to your neck or back, to prevent causing more injury a radiologist will look at the first X-ray pictures before taking others. If you have a neck brace (cervical collar) in place, X-ray pictures may be taken and aphysical exam done to see whether the brace can be taken off without hurting the spine. Usually 3 to 5 X-ray pictures are taken. You need to lie very still to avoid blurring the pictures. A spinal X-ray usually takes about 15 minutes. You will wait about 5 minutes until the X-rays are processed in case more pictures need to be taken. In some clinics and hospitals, X-ray pictures can be shown right away on a computer screen. How It Feels You will feel no discomfort from the X-rays. The X-ray table may feel hard, and the room may be cool. You may find that the positions you need to hold are uncomfortable or painful, especially if you have an injury. Risks There is always a slight risk of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. But the risk of damage from the X-rays is usually very low compared with the potential benefits of the test. For example, the radiation exposure from a chest X-ray is about equal to the natural radiation exposure received during a round-trip airline flight from Boston to Los Angeles (or Montreal to Vancouver) or 10 days in the Rocky Mountains (Denver, Colorado). Results In an emergency, a doctor can see the results of a spinal X-ray in a few minutes. Otherwise, a radiologist usually has the official X-ray report ready the next day.

Spinal X-ray Normal:

The bones of the spine (vertebrae) are normal in number, size, shape, appearance, and how they are lined up. No broken bones, dislocations, or foreign objects are present. The soft tissues around the vertebrae look normal. The spine is not abnormally curved.

Abnormal: Broken bones, dislocations, or foreign objects are present.

The spine is abnormally curved, such as from scoliosis. Diseases that affect the spine, such as thin bones (osteoporosis) orarthritis, are present. One or more bones in the spine may be abnormal because of a condition you were born with or because

ofcancer, infection, or trauma. Disc disease, which is fairly common, can sometimes be seen on a spinal X-ray as a narrowed space between the bones of the spine. Bone spurs can also be seen.

What Affects the Test Reasons you may not be able to have the test or why the results may not be helpful include:

If you are pregnant. The X-rays may not be safe for the fetus. If you have had a test with barium contrast material in the past 4 days. Barium shows up on X-ray films and can make it hard to get a clear picture. If you can't remain still during the test. The pictures may not be clear. If you are very overweight. This can make it hard to see the details of the spinal X-ray. What To Think About

Sometimes your X-ray results may be different because you were tested at a different medical center or because earlier test results are not available to compare to the new test findings. The most common causes of low back pain, such as strained back muscles or ligaments, do not show up on a spinal X-ray. Other tests, such as a CT scan, an MRI, or a myelogram, provide more information about the spinal bones, joints, nerves, discs, muscles, and ligaments than a spinal X-ray. For more information, see the topics Computed Tomography (CT) Scan of the Spine, Magnetic Resonance Imaging (MRI) of the Spine, andMyelogram. Spinal X-rays have been used by some employers to screen healthy people for possible future back problems. But most health professionals do not believe that this is appropriate. If a potential employer wants you to have a spinal X-ray before you can start working, you may want first to discuss the matter with the employer and your doctor. Other Works Consulted

Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

X-rays of the Spine, Neck, or Back

(Cervical, Thoracic, Lumbar, Sacral, or Coccygeal X-ray Studies)

Procedure overview
What are X-rays of the spine, neck, or back?
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. Standard X-rays are performed for many reasons, including diagnosing tumors or bone injuries.

X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially-treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film). Instead of film, X-rays may also be made by using computers and digital media. When the body undergoes X-rays, different parts of the body allow varying amounts of the x-ray beams to pass through. Images are produced in degrees of light and dark, depending on the amount of x-rays that penetrate the tissues. The soft tissues in the body (such as blood, skin, fat, and muscle) allow most of the X-ray to pass through and appear dark gray on the film. A bone or a tumor, which is denser than the soft tissues, allows few of the X-rays to pass through and appears white on the X-ray. At a break in a bone, the x-ray beam passes through the broken area and appears as a dark line in the white bone. X-rays of the spine may be performed to evaluate any area of the spine (cervical, thoracic, lumbar, sacral, or coccygeal). Other related procedures that may be used to diagnose spine, back, or neck problems include myelography (myelogram), computed tomography (CT scan), magnetic resonance imaging (MRI), or bone scans. Please see these procedures for additional information.

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Anatomy of the spine

The spinal column is made up of 33 vertebrae that are separated by spongy disks and classified into distinct areas:

The cervical area consists of seven vertebrae in the neck. The thoracic area consists of 12 vertebrae in the chest area. The lumbar area consists of five vertebrae in the lower back area. The sacrum has five small, fused vertebrae. The four coccygeal vertebrae fuse to form one bone, called the coccyx or tailbone.

The spinal cord, a major part of the central nervous system, is located in the vertebral canal and reaches from the base of the skull to the upper part of the lower back. The spinal cord is surrounded by the bones of the spine and a

sac containing cerebrospinal fluid. The spinal cord carries sense and movement signals to and from the brain and controls many reflexes.

Reasons for the procedure

X-rays of the spine, neck, or back may be performed to diagnose back or neck pain, fractures or broken bones, arthritis, spondylolisthesis (the dislocation or slipping of one vertebrae over the one below it), degeneration of the disks, tumors, abnormalities in the alignment of the spine such as kyphosis or scoliosis, or congenital abnormalities. There may be other reasons for your physician to recommend an X-ray of the spine, neck, or back.

Risks of the procedure

You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time. If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects. If it is necessary for you to have a spinal X-ray, special precautions will be made to minimize the radiation exposure to the fetus. There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the procedure

Your physician will explain the procedure to you and offer you the opportunity to ask questions that you might have about the procedure. Generally, no prior preparation, such as fasting or sedation, is required. Notify the radiologic technologist if you are pregnant or suspect you may be pregnant. Notify the radiologic technologist if you have had a recent barium x-ray procedure, as this may interfere with obtaining an optimal x-ray exposure of the lower back area. Based on your medical condition, your physician may request other specific preparation.

During the procedure

An X-ray may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices. Generally, an x-ray procedure of the spine, neck, or back follows this process:

You will be asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or other metal objects that may interfere with the procedure.

If you are asked to remove any clothing, you will be given a gown to wear. You will be positioned on an x-ray table that carefully places the part of the spine that is to be X-rayed between the x-ray machine and a cassette containing the x-ray film or digital media. Your physician may also request x-ray views to be taken from a standing position. Body parts not being imaged may be covered with a lead apron (shield) to avoid exposure to the X-rays. The radiologic technologist will ask you to hold still in a certain position for a few moments while the x-ray exposure is made. If the X-ray is being performed to determine an injury, special care will be taken to prevent further injury. For example, a neck brace may be applied if a cervical spine fracture is suspected. Some spinal x-ray studies may require several different positions. It is extremely important to remain completely still while the exposure is made, as any movement may distort the image and even require another study to be done to obtain a clear image of the body part in question. The x-ray beam will be focused on the area to be photographed. The radiologic technologist will step behind a protective window while the image is taken.

Lumbar X-ray While the x-ray procedure itself causes no pain, the manipulation of the body part being examined may cause some discomfort or pain, particularly in the case of a recent injury or invasive procedure such as surgery. The radiologic technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

After the procedure

Generally, there is no special type of care following an X-ray of the spine, back, or neck. However, your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition. This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here. American Academy of Orthopaedic Surgeons American Cancer Society Arthritis Foundation National Cancer Institute (NCI) National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institute of Child Health and Human Development National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke National Library of Medicine Osteoporosis and Related Bone Diseases - National Resource Center - NIH Scoliosis Research Society