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Plain X Rays

In the past, X rays were often used in the investigation of pain, particularly in the back.  However, in most cases, plain Xrays of the lumbar spine and pelvis have only a limited role in diagnosing the source of back or leg pain.  

Xrays will often show minor abnormalities that are of little or no consequence.  In fact,  a large proportion of people with no back pain will have changes on their Xray, such as early degenerative changes.  Almost all people over 50 have abnormalities due to wear and tear on their neck or low back Xrays, and often patients with severe pain can have a normal Xray.

Certainly, within the first few weeks of an episode of low back pain, Xrays are not routinely indicated and both the National Institute of Clinical Excellence (NICE) and the Royal College of Radiologists recommend that plain Xrays should not be used in the investigation of low back pain.  This is particularly because spinal Xrays expose people to substantial radiation doses.

Xrays, however, may have a role in certain situations:

1. When there is a suspicion of a more significant spinal injury or disease such as a fracture.

2. When there is a suspicion of a spondylolisthesis or spondylolysis.

3. At a more specialist level, when considering targeted spinal injections/interventions.

In short; although your Xrays may show degenerative changes, these are common in people without pain, and are therefore not necessarily the cause.











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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]

Page updated 19/02/2016