Diagnostic contribution of the standard lateral compared to the coned lateral L5/S1 projection for specific lumbar pathologies in the digital era

Introduction: The aim of this study was to compare the diagnostic contribution of the standard lateral and coned lumbar vertebra five and sacral vertebra one (L5/S1) projection in diagnostic radiology for specific pathologies in the digital era.

Methods: The study used a retrospective qualitative design through a systematic stepwise process. The steps included a retrospective analysis of lumbar spine radiology reports over 20 months. The objective of this step was to identify the most common lumbar spine pathologies observed among the source population records (N=354). A radiologist identified five different pathologies on standard lateral and coned lateral L5/S1 projections (n=96). Fischer's exact test was performed to examine the significance of the association between the standard lateral and coned lateral L5/S1 projection classifications for each of the top five lumbar spine pathologies separately.

Results: The five most prevalent lumbar spine pathologies indicated were degenerative disc disease (n=235; 66.4%), disc space narrowing (n=175; 49.4%), osteophytes (n=92; 26.0%), endplate sclerosis 19.21% (n=68; =9.2%) and malalignment (n=61; 17.2%). The Fisher's exact test executed to compare the top five lumbar spine pathologies visible on the standard lateral and coned lateral L5/S1 indicated that except for endplate sclerosis (p=0.0023), no significant difference in additional diagnostic information was observed between the standard lateral and coned lateral L5/S1 projections at α=0.05.

Conclusion: Compared to the standard lateral projection, the coned lateral L5/S1 projection did not contribute statistically significant additional diagnostic information for specific lumbar spine pathologies in the digital era.