Review of Spinal Imaging

Review of Spinal Imaging

By: Dr. Jennifer Pedley, MS, DC, DACBR

Editor’s Note: Dr. Pedley is presenting at the 2023 ICS Chicagoland Fall Convention and Expo. For more information and to register click here.


I have seen a trend, pattern, or, perhaps, bad habits when performing X-rays on our patients. Some doctors have forgotten that there are standard X-ray views and tube positioning to adequately evaluate the osseous and soft tissue structures. Therefore, taking shortcuts increases the likelihood of missed pathology or misdiagnosis, which then leads to the wrong course of treatment and possibly liability concerns. Additional radiographs, such as technique-specific and stress views, are encouraged to obtain more information about the patient’s injuries, biomechanics, and the cause of their pain and discomfort.

When evaluating the X-rays, radiologists use a search pattern, and this search pattern is utilized not only on X-rays but also on MR and CT.  Chiropractic physicians should also evaluate their patients’ imaging with a search pattern to ensure accuracy and thoroughness.  The ‘ABCs’ is the search pattern to assess the Alignment, Bone, Cartilage (joints), and Soft tissues on the x-rays. The alignment is for detecting anterolisthesis, retrolisthesis, lateral listhesis, pelvic unleveling, malpositions, postural alterations, etc. The shape, size, and density of the bone, cortices, etc. are also assessed.  The cartilage or joints are checked for degenerative changes, dysplasia, and again for alignment, etc.  Lastly, soft tissues are commonly forgotten in the evaluation process. We must not forget to check the soft tissues anterior and posterior to the spine, lateral to the spine, and within the lung fields, abdomen, and pelvic basin.  Of course, we cannot see the actual soft tissues on x-ray, but we can see the shadows of the soft tissue structures, and if present, calcifications that would reside within soft tissues or organs.

The Saturday afternoon lecture at the 2023 ICS Chicagoland Convention & Expo contains various cases commonly seen in chiropractic practice, with examples of congenital anomalies, degenerative changes, and trauma. This will challenge the chiropractic physician in the audience to use their search pattern to locate the abnormality on the radiographs. A discussion on types of treatment, contraindications of chiropractic treatment, referral, and advanced imaging will further inform the clinician on what is the best treatment plan for their patients.

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