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What role do X-Rays Play in my initial back or neck pain consultation?

As part of a comprehensive initial evaluation for back or neck pain, it is important to obtain a detailed health history and pain story, a comprehensive physical examination, and appropriate imaging studies (ie; x-rays, MRI, and/or CT scan). We know that almost 80% of diagnoses can be made with a thorough history and physical examination alone. But, in the very specialized field of spine care, x-rays can be a critical component in getting the most accurate diagnosis to offer the most effective treatment plan for a back or spine condition. Do not be surprised when x-rays are used as an important adjunct to your diagnosis. These are very important and guide us to more focused and effective treatment plans.

x-rays vs. mri

Some people ask whether an MRI is better than x-rays and if we should just skip the x-rays and go directly to an MRI. An MRI does not replace x-rays. An MRI is good at evaluating soft tissue and nerves, spinal discs, muscles, ligaments and other soft tissues. An MRI is not an effective study for specific bone information. MRI images are obtained based on radio waves that are emitted after using magnets to align the electrons in the cells of your body. In order to look at a bony structure, an x-ray and then sometimes a CT scan (very specialized form of x-ray) is used.

How are the x-rays taken?

Basic or routine spinal x-rays include an AP x-ray (a front/back x-ray), a lateral x-ray (taken from the side), and a lateral x-ray with you bending forward and bending backwards.  It is very important to note that all of these x-rays are obtained with you standing, not lying down.  When you are standing, there are different pressures on your body due to gravity. Areas of subtle instability are not seen when you are lying down, but can often be found on a standing x-ray and the dynamic bending forwards and bending backwards images. Additionally, an x-ray is taken of your pelvis to look at your hips.  Many people with back issues also have diagnoses related to the pelvis or hips.

Some specialty x-rays may be obtained. Oblique (angled side views) further identify the facet joints in the back of the spine and screen for stress fractures. Scoliosis films are long x-rays to define a curve in patients who have scoliosis, or see the overall spinal balance in someone who does not have the appropriate type of curves in their spine.

If other imaging studies, such as MRIs, CT scans, bone scans, or other tests are indicated, those would be ordered as appropriate.


AP Pelvis 
Standing AP Pelvis X-ray looking at the hips and pelvic alignment.

AP Lumbar
Standing AP Lumbar X-ray looking at the spine from the front.

Standing Lateral X-ray looking at the spine from the side.


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