Spinal Level Identification
The spine global region of interest is not correct in this analysis. The iliac crests should be used to designate the L4-L5 interpace
In this analysis, the iliac crest is used to designate the L4-L5 interspace. This patient may have 6 lumbar vertebral bodies or T12 may not have ribs. What is designated as L5 is the first level above the sacrum.
Case Description:
Two spinal analyses are presented. The analysis on the right is recommended. The top of the iliac crest is used to designate the L4-L5 interspace. In DXA scanning, the vertebral bodies are numbered from the bottom up. The first vertebral body above the sacrum is labelled as L5.
Credit:
Sarah L Morgan, MD, RD, CCD, The University of Alabama at Birmingham
References:
• Peel, N.F., et al., Impact of anomalous vertebral segmentation on measurements of bone mineral density. J Bone Miner Res, 1993. 8(6): p. 719-23.
• Choplin, R.H., L. Lenchik, and S. Wuertzer, A practical approach to interpretation of Dual-Energy X-ray Absorptiometry (DXA) for assessment of bone density. . Curr Radiol Rep 2014. 2(48).
• Lewiecki, E.M. and N.E. Lane, Common mistakes in the clinical use of bone mineral density testing. Nat Clin Pract Rheumatol, 2008. 4(12): p. 667-74.
• Guan, W., et al., Lumbar Vertebrae Morphological Analysis and an Additional Approach for Vertebrae Identification in Lumbar Spine DXA Images. J Clin Densitom, 2018.
• Sarathi, V., C.V. Rakesh, and S. Tirupati, Effect of T12 Mislabeling as L1 on the Diagnosis of Low BMD at Lumbar Spine. J Clin Densitom, 2020.