Recently a patient from Rye, NH came in to talk about her low back pain. After a full work up we saw something somewhat unusual on x-ray. If you have back pain that seem to be very low and noticeably more on one side than the other, you may have a congenital variant called a spatulated transverse process (TP). This is a radiographic finding in which the bone that protrudes latterally from both sides of a lumbar vertebrae grow irregularly and instead of forming a normal TP the bone is flattened and shaped more like a pancake or a spatula. This is not a problem in itself but if the bone makes contact with the adjacent ilium this can cause significant pain. Chiropractic adjustments may be good for adding motion to the area but they may also intensify this pain. This is why its a good idea to have x-rays taken when back pain is otherwise unexplained.