Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Imaging for diagnosing spinal cord injuries is not typically recommended in primary care settings. Instead, suspected spinal cord injuries require urgent assessment and imaging in an emergency department or trauma unit, with images interpreted immediately by a trained healthcare professional NICE NG41.
The recommended imaging modalities depend on the patient's age and the suspected injury location:
- For children (under 16s) with suspected cervical spinal cord or column injury: Magnetic Resonance Imaging (MRI) is performed if there is a strong suspicion based on clinical assessment or abnormal neurological signs or symptoms NICE NG41. Plain X-rays may be considered if MRI criteria are not met but clinical suspicion remains after repeated assessment NICE NG41. Findings from plain X-rays should be discussed with a consultant radiologist, and further imaging performed if needed NICE NG41.
- For adults (16 or over) with suspected cervical spine injury: Computed Tomography (CT) is performed if imaging is indicated by the Canadian C-spine rule NICE NG41.
- For adults (16 or over) with strong suspicion of thoracic or lumbosacral spine injury associated with abnormal neurological signs or symptoms: CT is performed NICE NG41. If there is a neurological abnormality attributable to spinal cord injury, MRI should be performed after CT, regardless of whether the abnormality is evident on CT NICE NG41.
- For people (children and adults) with suspected spinal column injury without abnormal neurological signs or symptoms in the thoracic or lumbosacral regions (T1–L3): An X-ray is the first-line investigation NICE NG41. CT is performed if the X-ray is abnormal or if there are clinical signs or symptoms of a spinal column injury NICE NG41. If a new spinal column fracture is confirmed, the rest of the spinal column should be imaged NICE NG41.
It is important to note that for suspected spinal metastases or metastatic spinal cord compression (MSCC), MRI is the primary imaging modality, performed at a local hospital or appropriate centre, and plain X-rays are not recommended for diagnosis in this context NICE NG234. If MRI is contraindicated, a CT scan is carried out NICE NG234.