From the Guidelines
Your X-ray from March 4,2025, showed some changes in your lower back that help explain your pain, and based on the latest guidelines from the American College of Radiology, the next step would be to consider an MRI of the lumbar spine to further evaluate the degenerative changes and potential actionable pain generators 1. The X-ray revealed a slightly unusual spine structure with only 4 lumbar vertebrae instead of the typical 5, with your lowest vertebra partially fused to your sacrum (the bone at the bottom of your spine). The X-ray also revealed degenerative changes in multiple areas of your lower back, similar to arthritis, with the most significant narrowing of space between your vertebrae at the L2-L3 level, where there is also a slight backward slippage of one vertebra on another (called retrolisthesis). These findings are consistent with normal aging of the spine and can explain your back pain. Some key points to consider about your condition and the imaging results include:
- The presence of lumbosacral transitional anatomy, which is a common variation in spine structure 1
- The degenerative changes observed, which are similar to those seen in many people with back pain, and can be effectively managed with conservative therapy 1
- The potential benefits of further imaging, such as an MRI, to better understand the cause of your pain and guide treatment decisions 1 Treatment typically includes pain management with over-the-counter medications like acetaminophen or ibuprofen, physical therapy to strengthen core muscles, and possibly heat or ice therapy. If your pain persists or worsens, we may need to consider additional treatments such as prescription medications, injections, or referral to a spine specialist, and the latest guidelines suggest that MRI of the lumbar spine is the initial imaging modality of choice for patients with subacute or chronic low back pain who have failed conservative therapy 1.
From the Research
Explanation of Lumbar Spine X-ray Results
The patient underwent a lumbar spine X-ray on March 4,2025, due to back pain, which was performed and interpreted by Dr. Kevin McGill, MD, MPH. The X-ray revealed several key findings:
- Lumbosacral transitional anatomy with 4 lumbar-type vertebral bodies and partial sacralization of L5
- Multilevel degenerative changes, particularly in the lower lumbar spine
- Significant intervertebral disc space narrowing at L2-L3
- Mild retrolisthesis at L2-L3
Implications of X-ray Findings
According to studies, lumbar spine radiography has limited use in diagnosing the cause of acute low back pain 2. The findings of degenerative changes and disc space narrowing are common in patients with low back pain, but may not necessarily be the cause of the pain. A study published in the Southern Medical Journal found that making a diagnosis of spinal degenerative joint disease based on X-ray findings has little effect on patient management 3.
Use of Imaging in Low Back Pain Diagnosis
The use of imaging in diagnosing low back pain is a topic of ongoing debate. A systematic review and meta-analysis published in the American Journal of Neuroradiology found that extraspinal incidental findings are common on MR imaging of the lumbar spine, but may not be clinically significant 4. Another study published in the European Spine Journal found that computed tomography (CT) has limited diagnostic accuracy in identifying lumbar disc herniation, with a sensitivity of 77.4% and specificity of 73.7% 5.
Next Steps
The patient's X-ray results will be taken into consideration, along with their medical history and physical examination, to determine the best course of treatment for their back pain. Further testing or imaging may be ordered if necessary to confirm a diagnosis or rule out other potential causes of the pain.