CT Spine Without Contrast is the Preferred Initial Imaging for Suspected Spine Trauma

Initial Imaging for Suspected Spine Trauma

The American College of Radiology recommends CT cervical spine without IV contrast as the initial imaging for patients with suspected acute blunt trauma of the cervical spine when imaging is indicated by NEXUS or CCR clinical criteria 1, 2
Non-contrast CT provides detailed visualization of bony structures, alignment, and fractures, which are the primary concerns in acute trauma 3, 4
CT reconstructions can be performed in multiple planes, allowing for comprehensive assessment of the spine without additional radiation exposure 4

The American College of Radiology recommends CT thoracic and lumbar spine without IV contrast as the initial imaging for patients with suspected thoracolumbar trauma 5, 6
Thoracic and lumbar spine CT reconstructions can be performed from concurrently obtained CT imaging of the thorax, abdomen, and pelvis without additional radiation exposure 4, 6
This approach is both effective and radiation dose-sparing in trauma patients 4

The American College of Radiology states that CT with IV contrast does not provide additional information to CT without IV contrast for evaluation of spinal fractures and alignment 7
CT without and with IV contrast of the spine is not typically performed as there is no diagnostic advantage to performing a single study with or without IV contrast 7

MRI without contrast is the appropriate next step when there are suspected or confirmed spinal cord or nerve root injuries 8, 5
MRI without contrast is also indicated when there are clinical findings suggesting ligamentous injury 4, 2
MRI without contrast is recommended for patients with neurologic abnormalities with acute spine injury detected on CT 6
MRI without contrast may be considered for obtunded patients with suspected spine trauma and negative initial CT 9, 5

CTA head and neck with IV contrast is appropriate only when there are clinical or imaging findings suggesting arterial injury 3, 5
Contrast administration is routinely recommended in the acute spine trauma setting only when there are clinical or imaging findings suggesting arterial injury 2

Using contrast-enhanced CT when non-contrast CT would suffice, unnecessarily exposing patients to contrast media risks 7
Failing to recognize that isolated unstable ligamentous injury in the absence of fractures is extremely rare in the thoracolumbar spine, making MRI screening unnecessary when CT is normal and there are no neurological symptoms 8, 4
Overlooking the need for vascular imaging (CTA with contrast) in patients with risk factors for blunt cerebrovascular injury 3, 5