X-RAY OF LUMBER SPINE
X-ray Lumber Spine A/P View
Region: lumbar
vertebrae, intervertebral space, lumbosacral
joint, sacroiliac
joint
Pathology: fracture,
herniated inetervertebral disc, scoliosis,
osteoporosis, spondylolisthesis and spondylolysis of lumbar
vertebrae
SID: 100 cm (40
inches)
Central Ray: perpendicular
beam directed at the midpoint of bilateral iliac
crests
Respiration: suspended
expiration
Position
1. The patient is in a supine position with knee flexion.
2. Place the 4th~5th cervical
vertebrae at the center of the image receptor (IR).
Evaluation
1. Patient's body and pelvis should
not in rotation and sacroiliac
joint (S-I joint) should be aligned at the same distance from
the vertebral
body.
2. Spinous
process should be aligned along the center of the horizontal axis.
3. Transverse
process should be aligned symmetrically along the horizontal axis.
kVp-75, mAs-35
Tip
1. Apply shielding to genital gland not to be covered by
inspecting area.
2. For scoliosis patient,
hips and knees must be in flexion to straighten the spinal
column and to show intervertebral cavity wider.
3. When it is hard to find where 4th~5th cervical
vertebrae are, project the midpoint of bilateral iliac
crest or the center of umbilicus.
X-ray Lumber Spine Lateral View
Region: lumbar
vertebrae, intervertebral space, lumbosacral
joint
Pathology: fracture,
herniated inetervertebral disc, scoliosis,
osteoporosis, spondylolisthesis and spondylolysis of lumbar
vertebrae
SID: 100 cm (40
inches)
Central Ray: beam
directed at the iliac
crest with 5°caudal angulation (male) or 8°caudal angulation (female)
Respiration: suspended
expiration
Position
1. The patient is in a lateral decubitus position.
2. Align the coronal plane at the center of image receptor (IR).
3. Flex hips and knees to produce the true lateral position.
Evaluation
1. The first four intervertebral
foramens of lumbar
vertebrae must be visible but not the 5th lumbar vertebra.
2. Ilium should overlap on one another.
3. Intervertebral joint and spinous
process must be observable.
kVp-80, mAs-65
Tip
1. Apply shielding to genital gland not to be covered by
inspecting area.
2. Make sure pelvis and
patient's body are not rotated so the patient is in true lateral position.
3. Placing a support under the small of the back of IR side helps major axis
of spinal
column make parallel with vertical axis of IR.
3. When it is hard to find where 4th~5th cervical
vertebrae are, project the midpoint of bilateral iliac
crest or the center of umbilicus.
Anatomy Lumbar spine.
The lumbar spine is the third region of the vertebral column, located in the lower back
between the thoracic and sacral vertebral segments.
It is made up of five distinct vertebrae, which are the
largest of the vertebral column. This supports the lumbar spine in its main
function as a weight bearing structure.
This article will look at the osteology of the lumbar
vertebrae, examining their characteristic features, joints and their clinical
correlations.
Fig 1.0 – Overview of the location of the lumbar vertebrae
Characteristic Features
Although the lumbar vertebrae lack some of the more
distinctive features of other vertebrae, there are several characteristics that
help to distinguish them.
The vertebral bodies are large and kidney-shaped.
They are deeper anteriorly than posteriorly, producing the lumbosacral angle
(the angle between the long axis of the lumbar region and that of the sacrum).
The vertebral foramen is triangular in shape.
Other features of a typical lumbar vertebrae:
Transverse processes are long and slender.
Articular processes have nearly vertical facets.
Spinous processes are short and broad.
Accessory processes can be found on the posterior
aspect of the base of each transverse process. They act as sites of attachment
for deep back muscles.
Mammillary processes can be found on the posterior
surface of each superior articular process. They act as sites of attachment
for deep back muscles.
The fifth lumbar vertebrae, L5, has some distinctive
characteristics of its own. It has a notably large vertebral body and
transverse processes as it carries the weight of the entire upper body.
Fig 1.1 – Superior view of a lumbar vertebrae, showing its
characteristic features.
Joints
There are two types of joint in the lumbar spine. Both of
these articulations are not unique to the lumbar vertebrae, and are present
throughout the vertebral column.
Between vertebral bodies – adjacent vertebral bodies
are joined by intervertebral discs, made of fibrocartilage. This is a type of
cartilaginous joint,
known as a symphysis.
Between vertebral arches – formed by the articulation
of superior and inferior articular processes from adjacent vertebrae. It is a
synovial type joint.
Ligaments
The joints of the lumbar vertebrae are supported by several
ligaments. They can be divided into two groups; those present throughout the
vertebral column, and those unique to the lumbar spine.
Present throughout Vertebral Column
Anterior and posterior longitudinal ligaments: Long
ligaments that run the length of the vertebral column, covering the
vertebral bodies and intervertebral discs.
Ligamentum flavum: Connects the laminae of adjacent
vertebrae.
Interspinous ligament: Connects the spinous processes
of adjacent vertebrae.
Supraspinous ligament: Connects the tips of adjacent spinous
processes.
(Note: In the cervical spine, the interspinous and
supraspinous ligaments thicken and combine to form the nuchal ligament).
Unique to Lumbar Spine
The lumbosacral joint (between L5 and S1 vertebrae) is
strengthened by the iliolumbar ligaments. These are fan-like ligaments
radiating from the transverse processes of the L5 vertebra to the ilia of
the pelvis
Fig 1.2 – Ligaments of the lumbar vertebrae
Anatomical Relationships
Throughout the vertebral column, the spinal cord travels
through the vertebral canal (made up by the foramina of all vertebrae). At
around the level of L1, the spinal cord terminates and the cauda equina begins.
This is a bundle of lumbar, sacral and coccygeal nerve roots.
Spinal nerves exit the vertebral canal through
the intervertebral foramina.
Clinical Relevance: Abnormalities of the Lumbar Spine
Lumbar Spinal Stenosis
Thought to be hereditary, lumbar spinal stenosis results in
a stenotic (narrow) vertebral foramen in one or several lumbar vertebrae. This
can cause compression of the spinal cord and exiting nerves.
Fig 1.3 – Excessive lumbar lordosis.
This condition can be worsened by age-related degenerative
changes, such as bulging of the intervertebral discs.
Lumbar spinal stenosis can sometimes be treated surgically
with a decompressive laminectomy.
Excessive Lumbar Lordosis
This is an abnormal anterior curvature of the vertebral
column in the lumbar region, characterised by anterior tilting of the pelvis.
Women develop temporary excessive lumbar lordosis in late pregnancy, but this resolves after childbirth. In either sex, obesity can similarly cause lordosis due to the increased weight of the abdomen. Both examples can cause back pain, and occur as a result of an altered line of gravity.
