Lower Back (Lumbar Spine) X-ray

What it is

This study images the five lumbar vertebrae and the sacrum below them. X-ray is a bone test: the vertebral bodies, the gaps between them, the alignment of the column, and the density and shape of the bone all show clearly, and so does a break or a vertebra that has slipped forward on the one beneath it. What an X-ray cannot show is the soft material — the discs themselves, the nerve roots, the spinal canal. A narrowed gap between two vertebrae hints that a disc has thinned, but a bulging or herniated disc pressing on a nerve is invisible here, and diagnosing one means a different and more expensive scan. Knowing that boundary is what makes this study either the right first test or a wasted one.

Why it is done

• To look for a fracture after a fall or an injury to the lower back
• To check alignment, including a vertebra that has slipped out of position
• To assess arthritic change and bone wear in the spinal joints
• To investigate back pain that has persisted for weeks despite treatment, or pain in an older patient where bone loss is a concern
• To look at spinal curvature or a suspected abnormality in the shape of the bones

What to expect

There is no preparation beyond removing metal and changing into a gown. The technologist positions the patient on an X-ray table or standing, and asks for a few different positions — flat on the back, on the side, and sometimes leaning forward or backward. Each exposure requires holding still and holding a breath for a second or two. Three to five images are typical, and the visit is usually over in about fifteen minutes. The table can feel cold; otherwise nothing about it is uncomfortable. Anyone who is or might be pregnant should say so first. A radiologist reads the films and reports afterward.

Questions worth asking

• How many views is the order for? Lumbar spine X-rays are billed in different tiers depending on the number of views, and bending or oblique views push the study into a higher-priced code.
• If the X-ray is normal and an MRI follows, will I have paid for two studies to answer one question — and is going straight to the MRI an option worth pricing?
• Will the radiologist's reading be billed separately from the images themselves, and is that radiology group in network?
• If these films are taken in a chiropractic or specialist office rather than a hospital, how is the charge structured, and does my plan cover imaging ordered there?