Why are X-rays necessary? First, serious pathology needs to be ruled out. If there is a fracture, infection, tumor, or inflammatory disorder, spinal manipulation may not be indicated. Second, the condition of the patient’s spine needs to be determined. Some of the factors that affect a patient’s chiropractic treatment plan include:

• Spinal degeneration, such as osteoarthritis
• Disc degeneration
• Anatomical anomalies, such as an extra lumbar vertebra or a natural fusion in neck
• Spinal curvatures: normal, reduced, increased, or reversed
• Specific levels of spinal misalignments that may be interfering with nerve function and generating pain or other symptoms

By limiting the chiropractor’s examination tools to what they can see and feel, it limits the effectiveness of the treatment plan. It is accepted that dentists need to obtain X-ray images of the teeth before they can be treated, because they cannot see the roots of the teeth and refuse to guess as to the condition of the bones. The image below demonstrates the wide range of variations in spinal curvatures. By only looking from the outside, it is impossible to accurately determine the state of the spinal structures.

(Image taken from Oakley 2019)

Some patients, and even some healthcare providers, are hesitant to have spinal X-rays unless serious pathology is suspected. It is not an issue of minimizing health care costs. It typically costs under $80 to obtain a set of diagnostic X-rays for a single spinal region, such as neck or low back. In contrast, an MRI or CT scan costs $1000-2000. The amount of radiation exposure for a spinal X-ray is 5-10% of the exposure from a CT imaging exam of the head, chest, or abdomen. According to a 2019 journal article, “Concerns about the risk of cancer from chiropractic radiography are baseless because the dose of an X-ray normally … is more than 100 times lower than the dose threshold for radiogenic cancer.”

X-ray imaging is essential for an accurate diagnosis and treatment plan in a chiropractic office. The cost is minimal, and the radiation exposure is comparable to dental panoramic X-rays.

Source: Oakley et al, A. Vertebral Subluxation Res. July 29, 2019