The abnormal spine

A plain film examination of the spine is an integral part of the investigation of patients with neurological symptoms and signs suggestive of a lesion of the spinal cord or spinal nerves. Should this be omitted, evidence of value in both diagnosis and management may be overlooked. Close scrutiny of the plain films is important before deciding to carry out special investigations as they may reveal changes in the spine which explain the clinical findings. The demonstration of atlanto-axial subluxation due to rheumatoid arthritis or the presence of multiple spinal metastases, for example, will prevent inappropriate radiological investigation or injudicious surgical intervention. The inability to detect by clinical examination lesions at more than one level in the spine or to determine the cause of abnormal radionuclide emission, emphasises the need for a plain film examination