Introduction

Radiography remains an important investigation for the assessment of spinal anatomy, with all areas adequately assessed by a combination of anteroposterior (AP) and lateral views. These can be supplemented by:

• AP open mouth view of the odontoid peg and atlanto-axial articulation (Fig. 5.1)

• AP view of the lumbosacral junction with ~25° cranial angulation (Ferguson view) demonstrating the L5/S1 disc space tangentially and the L5 pars en face (Fig. 5.2).

A major advantage of radiography is that it can be obtained in the erect position, allowing accurate assessment of spinal alignment and overall spinal balance in the coronal and sagittal planes.

A major limitation is the inability to assess the soft tissues of the spinal column, which include the intervertebral discs, spinal ligaments, spinal cord and paraspinal musculature:

• these require the additional techniques of CT and MRI.

Therefore, the radiographic anatomy of the spinal column is essentially limited to assessment of the vertebrae, the joints and spinal alignment.