Controversy exists within the chiropractic profession, however, with some groups advocating for continued routine use of spinal X-rays within chiropractic clinical practice. Current evidence-based guidelines recommend that imaging be limited predominantly to cases of suspected underlying serious pathology or trauma. This transition, combined with the low diagnostic yield of clinically relevant radiographic findings, and increased awareness of associated risks has led to questioning of the routine use of imaging (including X-rays) to evaluate spinal pain. Over the last three decades the evidence-base for the diagnosis and management of spinal pain has transitioned from a static mechanical model, as visualised by X-ray, to a patient-centred model operating within a biopsychosocial context. Since that time chiropractors around the globe have gained licensure for X-ray machine ownership and use. Early X-ray technology was incorporated within chiropractic clinical examinations from 1910, with the stated purpose to visualise the alignment of spinal vertebrae and direct appropriate treatment. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.Ĭhiropractic has a long association with the use of spinal X-rays in clinical practice. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis.
Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis.
This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. The use of routine spinal X-rays within chiropractic has a contentious history.
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