From the Guidelines
To rule out osteoarthritis of the lower back, a standard lumbosacral spine X-ray series is typically ordered, as recommended by the most recent guidelines 1. This includes anteroposterior (AP) and lateral views of the lumbar spine, and sometimes oblique views and a spot view of the lumbosacral junction. These X-rays can reveal characteristic signs of osteoarthritis such as joint space narrowing, bone spurs (osteophytes), subchondral sclerosis (increased bone density), and facet joint changes. However, X-rays have limitations in fully evaluating osteoarthritis of the spine, as they cannot directly visualize soft tissues like cartilage, discs, or nerve structures. For this reason, additional imaging studies like MRI might be necessary for a comprehensive evaluation, especially if neurological symptoms are present or if the X-ray findings are inconclusive. Some key points to consider when evaluating osteoarthritis of the lower back include:
- The importance of initial evaluation with radiography of the SI joints and symptomatic areas of the spine 1
- The role of MRI in identifying early inflammatory disease when radiographic evidence of disease is absent 1
- The potential need for additional imaging studies, such as CT or MRI, to fully evaluate the spine and surrounding soft tissues 1
- The consideration of patient factors, such as age and medical history, when determining the appropriate imaging strategy 1
From the Research
X-Ray for Osteoarthritis of Lower Back
To rule out osteoarthritis of the lower back, the following x-rays can be ordered:
- Lateral bone density measurements: This can help assess the presence of osteoarthritis in the lumbar spine, as spinal osteoarthritis is a major cause of the difference between anteroposterior and lateral bone mineral density measurements 2.
- Lateral spine radiographs: These can be used to assess osteoarthritis, including disc space narrowing and osteophyte formation, which are common features of spinal osteoarthritis 2, 3.
- Anteroposterior and lateral radiographs: These can be used to assess the presence of osteoarthritis, including disc space narrowing and osteophyte formation, and to compare bone mineral density measurements in the anteroposterior and lateral planes 2.
Key Features to Look for on X-Ray
When assessing x-rays for osteoarthritis of the lower back, the following features should be looked for:
- Disc space narrowing: This is a common feature of spinal osteoarthritis, and can be assessed on lateral spine radiographs 4, 3.
- Osteophyte formation: This is also a common feature of spinal osteoarthritis, and can be assessed on lateral spine radiographs 4, 3.
- Vertebral body bone density: Lateral bone density measurements can provide a more accurate representation of true vertebral body bone density in patients with osteoarthritis of the lumbar spine 2.