Lumbosacral  Spine (Plain X-ray)

Relevant Social Security Medical Listings

  • Listing 1.04      Disorders of the Spine (Adults)
  • Listing 101.04 Disorders of the Spine (Children)
  • Listing 13.10   Breast Cancer (Adults)
  • Listing 13.11   Skeletal System Cancer (Adults)
  • Listing 13.24   Carcinoma of the Prostate Gland (Adults)
  • Listing 101.05 Disorders of the Spine (Children)
  • Listing 113.03 Malignant Solid Tumors (Children)

Type

Objective/X-ray (Spine)

Can SSA Purchase?

Yes. Most common use of this test by SSA is to evaluate adult back pain. Cancers that have spread to the spine in adults or children are usually documented by Computerized Tomographic (CT) Scanning of Spine, or Magnetic Resonance Imaging (MRI) of Bone provided to the SSA by the treating doctor along with biopsies and other evidence.

Purpose

Plain x-rays of the lumbar spine can be used to diagnose:

  • Metastatic cancerous lesions.
  • Osteoarthritis.
  • Inflammatory conditions such as ankylosing spondylitis.
  • Intervertebral disc disease.
  • Osteoporosis.
  • Vertebral body fractures.
  • Postsurgical changes.
  • Spondylolisthesis.

General

See Cervical Spine (Plain X-ray).

Technique

An anterior-posterior (AP) view of the spine is taken with the patient flat on his or her back (supine) and knees flexed. A lateral view is also taken with the patient lying, and an oblique view may additionally be taken in some instances.

Interpretation

See Cervical Spine (Plain X-ray), “Interpretation,” regarding spine abnormalities that may be present.

Additionally, spondylolisthesis may be found in the lumbosacral spine. Spondylolisthesis refers to slippage of one vertebral body over another, usually in the forward direction. Sometimes, retrolisthesis in the backward direction is observed. The most common location is at the L5 – S1 level with anterior (forward) slippage of the fifth lumbar vertebral body over the one below it at the first sacral level. Grade I spondylolisthesis refers to 0 -25% slippage, Grade II 25 – 50%, Grade III 50 – 75%, and Grade IV 75 – 100%.

Examples

Example 1
Lumbar Spine

History:
35-year-old female with back pain.

Findings:
AP and lateral views of the lumbar spine show a very minimal levoscoliosis with no rotation, probably a positional scoliosis. The vertebral body heights are well maintained. The disc spaces are normal. The pedicles, transverse processes, and spinous process are normal. The SI joints are normal.

Impression:
Normal study.

Example 2
Lumbosacral Spine

History:
45-year-old male with morning stiffness in the back, pain improved with exercise but worse at night.

Findings:
AP and lateral views of the lumbar spine show squaring of vertebra with some syndesmophytes at T12 – L4 and straightening of the normal lumbar lordosis. Early calcification is seen in the anterior longitudinal ligament. Vertebral height and intervertebral disc spaces are well maintained. There is early ankylosis of the SI joints bilaterally. Both hip joints appear narrowed.

Impression:
Ankylosing spondylitis. Recommend thoracic and cervical x-rays to establish overall extent and severity of disease.

Example 3
Lumbar Spine

History:
65-year-old female with sudden acute lower back pain after lifting a chair and no neurological abnormalities.

Findings:
Intervertebral disc spaces appear well maintained. There is no osteoarthritic spurring. Vertebrae T12 through the sacrum are seen and appear diffusely osteoporotic. The T12 vertebrae has a compression fracture of approximately 50%, and L2 has approximately a 10% compression fracture. No other abnormalities are seen.

Impression:
Osteoporosis with compression fractures of T12 and L2.

Example 4
Lumbosacral Spine

History:
66-year-old white male with a history of prostatic cancer and recent onset of low back pain.

Findings:
Vertebral bodies are intact with minor osteoarthritic spurring L2 – L4. There is narrowing of the L5 – S1 disc space, but disc spaces are otherwise well maintained. Vertebral bodies L4 – L5 appear to contain several small lesions that may represent metastatic disease. The pelvic bones contain numerous scattered areas of abnormality compatible with metastatic disease.

Impression:

  1. Mild osteoarthritis lumbar spine L2 – L4.
  2. Degenerative disc disease L5 – S1.
  3. Possible metastatic cancer in L4 – L5 and pelvic bones. Recommend bone scan.

Example 5
Lumbar Spine

History:
35-year-old female 6 months post anterior interbody fusion.

Findings:
There is a well-consolidated surgical anterior interbody fusion of L2 – L3 without evidence of fusion fracture or dissolution. Otherwise, vertebral bodies and disc spaces appear normal. The SI joints are normal bilaterally. There is no vertebral subluxation or other abnormality noted.

Impression:
Well-consolidated interbody fusion L2 – L3.

Example 6
Lumbar Spine

History:
55-year-old male with persistent back pain. No history of back surgery or injury.

Findings:
There are prominent osteophytes T12 – S1 with ankylosis of L4 – L5. Intervertebral disc spaces are severely narrowed throughout the lumbar spine, with almost obliteration of the L5 – S1 interspace. The SI joints are normal bilaterally. No subluxation of vertebral bodies or other abnormality is noted.

Impression:

  1. Severe osteoarthritis of the lumbosacral spine, with ankylosis of the L4 – L5 vertebrae.
  2. Severe degenerative disc disease at all levels, most prominent at L5 – S1.