Lumbar X-rays are commonly done for low back pain. Degenerative changes are one of the most common findings and becomes more advanced with age. Degenerative changes encompasses findings that involve degeneration of the disks, arthritis, bone spurring and other changes of the bones such as sclerosis or whitening of the tops and bottoms of the vertebra.
Degenerative changes of varying degrees are seen in the majority of X-rays as people age. These are often graded from mild to severe based on the assessment of the radiologist. The degenerative findings are often not the reason why the back pain has suddenly become bad enough for someone to come into their doctor. Degenerative findings of the lumbar spine are likely responsible for more chronic pain in some patients.
Most common degenerative changes I see on lumbar X-rays are of the disks. The disks are between the bony vertebra and lose height and degenerate. You can’t see the disks on X-ray but you can see the loss of its height on X-ray by a reduced space between the vertebra. Arthritis of the facets or joints between the vertebra is also commonly seen. Many patients have arthritic spurs arising from the vertebra. The end plates of the vertebra, or tops and bottoms also begin looking more white or sclerotic from degenerative change.
Lumbar X-rays are also not very good at looking at the tissues around the bones. Lumbar X-rays will not identify abnormalities like disk herniations, infections, injuries to the ligaments or cancer. Some of these other diagnosis will need to be ruled out before assuming back pain is because of degenerative changes of the spine seen on lumbar X-ray.
Lumbar X-rays are therefore a good start to get an overview of the bones of the lumbar spine for major abnormalities like a compression fracture. They will almost always show degenerative type changes with advancing age. Other more serious causes need to be excluded. Your doctors will take a detailed history and physical exam to make sure there are no red flags like fever, cancer or loss of neurologic function. MRI may be needed to take a more detailed look.