Lumbar spine (lateral view)

The lumbar spine lateral view images the lumbar spine which consists of five vertebrae. It is utilized in many imaging contexts including trauma, postoperatively, and for chronic conditions. 

  • the patient is positioned erect, supine or lateral recumbent, depending on clinical history
    • ideally, spinal imaging should be taken erect in the setting of non-trauma to give a functional overview of the lumbar spine
    • all imaging of patients with suspected spinal injury must occur in the supine position without moving the patient
  • in the lateral decubitus position, position the patient so that the humeri are extended 90 degrees to the thorax, with the elbows flexed so that the forearms are parallel to the thorax. Spinal curvature in the AP projection will determine if a right lateral or a left lateral is performed. 
  • when implementing horizontal beam technique, ensure the distal upper limbs are not overlying the region of interest. Ask the patient to cross their arms over their upper thorax, or to extend them in a similar position to that achieved in the lateral decubitus position
  • lateral projection
  • expiration (to minimize superimposition of the diaphragm over the upper lumbar spine) 
  • centering point
    • the level of the iliac crest 
    • coronal centering point is directly over the lumbar vertebra, which corresponds to the posterior third of the abdomen 
    • the central ray is perpendicular to the image receptor 
  • collimation
    • superiorly to include the T12/L1 
    • inferior to include the sacrum 
    • anterior to include the anterior border of the lumbar vertebral bodies 
    • posterior to include all elements of the posterior column, particularly the spinous processes 
  • orientation  
    • portrait
  • detector size
    • 35 cm x 43 cm 
  • exposure
    • 70-80 kVp
    • 60-80 mAs 
  • SID
    • 110 cm
  • grid
    • yes (ensure the correct grid is selected if using focused grids)
  • the entire lumbar spine should be visible from T12/ L1- L5/S1 
  • superimposition of the greater sciatic notches, the superior articulating facets and the superior and inferior endplates. This indicates a true lateral has been achieved 
  • adequate image penetration and image contrast is evident by clear visualization of lumbar vertebral bodies, with both trabecular and cortical bone demonstrated
  • the three column concept of thoracolumbar spinal fractures is of particular importance when assessing this image for pathology
  • utilize an erect bucky when performing horizontal beam laterals to utilize oscillating grids, automatic expose control, and CR/IR alignment  
  • if the patient demonstrates spinal scoliosis ensure that the side with the convexity is closest to the IR. This will utilize the diverging beam and aid in achieving superimposition of the upper and lower endplates
  • for particular patients, it is advisable to place a small radiolucent triangle sponge under the side in contact with the table at waist height to reduce spine convexity
  • a spot radiograph may be required to show a clearer visualization of the L4/L5/S1 articulation 
  • try to remove as many possible image artefacts, especially when performing horizontal beam technique in a trauma context 
  • using a breathing technique is a radiographical technique employed in some departments if imaging equipment permits. 
  • if using a CR system, a smaller cassette 30x35 can be used when the sacral region does not need to be demonstrated. When centering, place the height of the CR 2.5cms above the iliac crests 
Radiographic views

Article information

rID: 49523
Section: Radiography
Synonyms or Alternate Spellings:
  • Lateral view of lumbar spine

Cases and figures

  • Figure 1: Bones and ligaments of the vertebral column
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  • Case 1: Normal lateral lumbar spine radiograph
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  • Figure 2: Bones and ligaments of the vertebral column
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  • Case 2: Normal lateral lumbar spine radiograph
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