Many patients do not require X-rays, some chiropractors take them as a standard procedure to rule out pathology such as cancer, arthritis, fracture, infection or scoliosis and to determine the type and frequency of treatment to proceed with. It is also important to rule out an congenital anomaly of the spine before proceeding with some chiropractic treatments.

After certain traumas such as a car accident, whiplash , fall or sports injury ruling out serious injury through chiropractic X-rays is important.

Some common conditions your doctor of chiropractic may be examining through X-ray studies include:

Osteoarthritis (OA), or degenerative joint disease (DJD), is the most common of the arthritics.


It is believed to be caused by trauma, either overt or as an accumulation of micro-trauma over years, although there is also a hereditary form called primary osteoarthritis that occurs primarily in middle-aged women.

Radiographic Features

The hallmarks of DJD are joint space narrowing, sclerosis, and osteophytosis. If all three of these findings are not present on a radiograph, another diagnosis should be considered. Joint space narrowing is the least specific finding of the three, yet it is virtually always present in DJD. Unfortunately, it is also seen in almost every other joint abnormality.

Osteoarthritis on X-ray

  • asymmetric loss of joint space
  • Enthesopathy- A disease process occurring at the site of insertion of muscle tendons and ligaments into bones or joint capsules
  • subchondral sclerosis
  • subchondral cysts- decreased density
  • intra-articular loose bodies- usually attract calcium
  • ankylosis (very, very rare)
  • subluxation

Osteopenia or weakening of the bones
Radiographic presentation:

  • Osteopenia
  • Cortical thinning- “pencil-thin”
  • Resorption of non-stress-bearing trabeculae
  • Altered shape
  • will not see bowing with osteoporosis

Age groups and gender

  • females > 45
  • males>60
  • Caucasian and Asian races


  • 4 most common areas of osteoporosis = hip, ribs, vertebra, radius

Signs and symptoms

  • Pain (due to microfractures)
  • Loss of height, accentuated kyphosis.
  • Classification


  • hormonal factors
  • Decreased bone quantity
  • ward’s triangle = osteoporosis; between the tensile trabeculae and primary/secondary trabeculae in the femur
  • risk factors of low body weight b/c estrogen is a fat driven hormone
  • pneumonia, depression, thrombi, embolism are mortality reason for hip fractures – these people get fractures due to osteoporosis
  • Etiology:
  • bone resorption exceeds bone production due to multiple factors including cellular, hormonal, and nutritional factors
  • Imaging and positive tests
  • Bone scan
  • Bone densitometry
  • Prior films


  • Compression Fx
  • Compression Fx
  • Bursting Fx
  • Scheuermann’s
  • Schmoral’s Node or Biconcave Codfish vertebra
  • Schmoral’s Node or Biconcave/Codfish vertebra
  • Chance Fx
  • Complete compression Fx
  • Osteoblastic lesion
  • Osteoblastic lesions
  • Erosion
  • Erosion
  • Limbus, Chip or avulsion, tear drop Fx
  • Arch Fx

Possible Congenital Problems That May Cause Spinal Pain:

  • Dorsal Hemivertebra
  • Hemivertebra
  • Butterfly vertebra
  • Scramble Spine
  • Persistent Notochord
  • Cupid’s Bow
  • Persistent vascular groove
  • Pancake Vertebra
  • Bone Island
  • Multiple Bone Islands
  • Posterior Scalloping
  • Anterior Scalloping
  • Un-united Secondary Center
  • Spina Bifida

Doctors of chiropractic are highly trained in examination through X-ray studies. Discuss the benefits and necessity of X-ray before proceeding with treatment with your chiropractic physician.

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