Case Vignette – May 2022

Do X-rays Lie?

With traumatic lesions, there is an old saying that the situation can “never be better than the worst x-ray”. There is much truth in this axiom. It means that if you can see a displaced fracture, then a displaced fracture exists.

What might be hidden however is an additional fracture (or even multiple fractures with comminution) and even more displacement. It cannot be better than what you are witnessing, but it could possibly be worse. That is the reason we engage in more sophisticated scans or multiple views of an afflicted region.

At a degenerative level, x-ray or radiographic changes take place over an extended period. Spurs, disc space narrowing, end plate sclerosis and facet joint narrowing in the lumbar spine take many years, possibly decades, to develop. Some patients will categorically deny any form of symptoms despite quite remarkably severe changes on their films. Whilst the correlation between these degenerative features and recognised symptomatology is not necessarily a direct line, or watertight, a relationship still does exist.

I don’t that think I have ever seen a patient with a severely diseased spine who does not have some discomfort, some stiffness and some disability.