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THORACOLUMBAR SPINE X-RAYS

Tessa Davis
Written on 07/01/2019 ​
Last updated 05/04/2023 , ​
:CITE THIS ARTICLE AS
 Tessa Davis . Thoracolumbar spine x-rays, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.17581
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Read our step-by-step guide to interpreting thoracic and lumbar spine x-rays.
Imaging the thoracolumbar spine x-ray involves two views – anteroposterior (AP)
.and lateral

Check it’s an adequate view

For a lumbar spine view

You should be able to see L1-L5 but also the full T12 vertebral body, ●
T11/12, and the sacrum on the AP view
The vertebral bodies, facet joints, and pedicles should be clearly visible on ●
the lateral view
The transverse processes should also be visible (and are often obscured ●
)by gas
 For the thoracic spine view

Make sure the whole thoracic spine is visible ●

Mou should be able to see the pedicles, spinous processes, and vertebral ●
bodies
The ribs can cause difficulty seeing the thoracic spine on a lateral view ●
 Know your anatomy .2

Clavicle is at T3 ●
Tracheal bifurcation is T4/5 ●
12th rib is at T12 ●
In the lumbar spine, the disc spaces also increase in size, although note ●
that the L5/sacral space is narrower than the L4/L5 space

/From https://www.wikiradiography.net

Check the alignment .3

On the AP check that the vertebral bodies and spinous processes are aligned. On
.the lateral, check the alignment of the vertebral bodies

Lumbar AP

Lumbar lateral
 Thoracic AP

Thoracic lateral
 Look for loss of vertebral height .4

In the thoracic spine, the vertebral bodies (and the disc spaces) should gradually
.increase in size as you get further down the spine

Check all the vertebral bodies looking specifically for loss of height. This indicates a
.compression fracture
 Look for widened inter-spinous or inter-pedicle .5
distance and check the processes

In the lumbar spine check that all the pedicles, spinal, and transverse processes are
.intact

See below (under burst fracture) for an example of widened inter-pedicle distance
.and (under Chance fracture) widened spinous process process distance
 Transverse process fracture From
https://www.imageinterpretation.co.uk/thoracolumbar.php

Check for translation/rotation or distraction .6

Translation or rotation is displacement in horizontal plane; and distraction is

.displacement in the vertical plane

Translation/rotation is due to a side-to-side motion (can be left-to-right or

front-to-back). It is a serious injury and always involves the posterior ligamentous
.complex

Distraction is where the vertebrae are pulled apart and carries a high risk of cord
.)injury. Often there is compression at the other side (see Chance fracture below
 Know the common fracture patterns .7

Compression fracture

This is the most common type of fracture and is identified through loss of vertebral
.height (see number 4 above). It involves one column only and is a stable fracture

Burst fracture

of burst fractures are misdiagnosed as vertebral compression fractures on 25%

x-ray. A burst fracture is where there is a compression, but part of the vertebral body
.has been projected out anteriorly

On AP view there will be an increased interpedicular distance in 80% of burst

.fractures
On lateral view there will be reduced vertebral height and disrupted anterior
.alignment

AP

AP
Lateral

Lateral
 .A burst fracture involves two columns and is usually considered to be unstable

Chance fracture

Usually from a seatbelt injury and is commonly at L2/L3

This is a flexion-distraction injury where there is horizontal splitting of the vertebral

body with ligament rupture. This is an unstable fracture and involves all three
columns

Sometimes there is increased distance between the spinous processed on the lateral
.)view (but not always

On the AP view, there can be increased distance between the spinous processes at
.the level of the Chance fracture
 AP

AP

Lateral
 Lateral

Jumper’s/lover’s fracture

So-called because it’s usually from people jumping out of windows to escape the
police or angry partners. This is severe axial loading leading to compression/burst
.fractures alongside a calcaneus fracture

https://radiopaedia.org/articles/lovers-fracture-2?lang=us
 References

Radiopaedia

Radiology Assistant

Norwich Image Interpretation Course

Radiology Masterclass

AUTHOR
 TESSA DAVIS ●
Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal
London Hospital and a Senior Lecturer at Queen Mary University of London.
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 ”thoughts on “Thoracolumbar spine x-rays 6

.1
Syllable counterSeptember 30, 2023 at 8:51 am .2

I always forget to get my bubbly x-rays done. Thanks for .3

!reminding me
Reply .4

.5
teleradiology Gold CoastDecember 22, 2021 at 12:03 pm .6

If the clinical information is inadequate, the radiologist should be .7

able to contact the referring doctor with ease by a phone call or
.electronic communication
Reply .8

.9
KarlaJanuary 6, 2021 at 5:58 am .10

Probably not the name of the condition, just the X-ray views… .11
Anterior-Posterior (from front to back), and Lateral (from the side)
views of the thoracolumbar spine (does not include cervical spine
.)which is the neck
Reply .12
 .13
UMJuly 29, 2020 at 5:35 pm .14

?.Thank you ! It has increased my knowledge,explained very well .15

Reply .16

.17
MarieFebruary 19, 2020 at 6:00 pm .18

Thoracolumbar APL.. .19

Please help me my daughter have a Thoracolumbar APL . I hope
this is not serious. She’s not fit to work? Why it cause. Pls
explain I’m worried. Thanks
Reply .20

.21
Dr Fiona MairFebruary 7, 2019 at 1:33 am .22

thank you, great overview, I have shared this with our FY1’s. We .23
often review Thoracic (and other spinal) x rays each day on our
ED Ward round
Reply .24
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