First, a lumbar spine x-ray is required, which should include both frontal and lateral images. If the condition allows, a lumbar extension and flexion x-ray should also be performed to determine how stable the lumbar spine is. For patients with slipped vertebrae, an oblique X-ray is required. (Image shows radiograph showing patient with occult spina bifida) Patients with radiating leg pain or nerve damage on examination should be scheduled for further lumbar spine MRI (plain scan). CT exams go a long way in helping the spine surgeon understand the patient’s bone structure, especially in detecting rare and preferably negligible conditions (such as unilateral isthmus bifida), and should therefore be performed on patients who require surgery.