Which imaging modalities are recommended for diagnosing spinal cord injuries in primary care?

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 ¹.

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 ¹. Plain X-rays may be considered if MRI criteria are not met but clinical suspicion remains after repeated assessment ¹. Findings from plain X-rays should be discussed with a consultant radiologist, and further imaging performed if needed ¹.
• 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 ¹.
• For adults (16 or over) with strong suspicion of thoracic or lumbosacral spine injury associated with abnormal neurological signs or symptoms: CT is performed ¹. 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 ¹.
• 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 ¹. CT is performed if the X-ray is abnormal or if there are clinical signs or symptoms of a spinal column injury ¹. If a new spinal column fracture is confirmed, the rest of the spinal column should be imaged ¹.

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 ². If MRI is contraindicated, a CT scan is carried out ².