Why X-rays? The importance of radiographs in spine surgery

  • Matthew L. Goodwin
    Corresponding author. Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110 USA.
    Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110 USA
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  • Jacob M. Buchowski
    Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110 USA
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  • Daniel M. Sciubba
    Department of Neurosurgery, Northwell Health Chair of Neurosurgery at North Shore University Hospital and Long Island Jewish Medical Center, NY, USA

    Institute for Neurology and Neurosurgery, Northwell Health and Chair of Neurosciences, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
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      • Spine x-rays/radiographs provide critical information not obtained in other advanced imaging.
      • Radiographs allow visualization of everything at once, including hardware and foreign bodies.
      • Upright radiographs are critical in analyzing alignment and dynamic pathology.
      • Radiographs are critical to both intraoperative localization and post-operative follow-up


      Despite the advances made in high-resolution spinal imaging, plain films (radiographs or x-rays) remain a cornerstone of evaluating and caring for spine patients in the preoperative, intraoperative, and postoperative settings. Although often undervalued when compared with more advanced imaging such as MRIs or CT scans, plain films provide surgeons invaluable information that other imaging modalities oftentimes cannot. In addition to their use during surgery for localization or evaluation of hardware placement, x-rays provide an overall image of a patient's spine, are useful in evaluating hardware complications, allow detailed assessment of alignment and stability and allow for repeated images in clinic during follow-up. Plain films continue to provide critical information that cannot be obtained with other imaging modalities, and they remain central to providing optimal care for spine patients.


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