Lower Back (Lumbar Spine) X-ray (4 or more views)

What it is

Low back pain is extremely common and most of it never needs a picture. When a picture is taken, this series is the standard one: a view from the front, a view from the side, and angled views that show the small joints at the back of the spine, sometimes with additional images centered on the lowest level where the spine joins the sacrum. Four or more exposures is what separates this code from a shorter series. It answers bone questions — alignment, height of the spaces between vertebrae, the shape of each vertebral body, whether one has slipped forward on another. Herniated discs, sciatica, and narrowing around the nerves are soft tissue problems, and CT or MRI is what shows those.

Why it is done

• To look for a fracture or a collapsed vertebra after an injury, or in someone with thinning bones
• To investigate back pain that has persisted for weeks rather than days, or that began with an injury
• To check whether one vertebra has slipped out of line with the one below
• To look at the spine before or after surgery, or to check implanted hardware

What to expect

The patient changes into a gown and removes metal. Most of the series is taken lying on the x-ray table, rolling from the back onto each side and being repositioned between exposures; some departments take the standing views first. For each picture the patient is asked to hold a breath so the image is not blurred by movement. Nothing is felt. The table is hard and often cold, and for someone whose back already hurts, the turning is the uncomfortable part. Plan on ten to fifteen minutes in the room, plus changing time.

Questions worth asking

• Does the order specify four or more views? A shorter series is a different, cheaper code, and the difference is decided when the study is set up.
• Are standing bending views part of this study or an add-on with its own charge?
• Is a hospital outpatient department or a freestanding imaging center doing this? A facility fee often applies in one and not the other.
• If an MRI of the same region is already planned, is this x-ray adding information, or is it a step I am paying for twice?