Spinal imaging is indicated in the alert traumatized patient only when there is pain or signs of neural injury. With spinal cord injury, imaging the entire spine should be considered because a significant number of such patients have fractures at more than one level. High-quality plain radiographs are the single most useful test ( Royal CoJ.lege... of. ...Rad.ioj.P9j.sts. ..Wo.rk,i.09.Pa.rty..19.9.5), although, once detected, fractures are more completely evaluated by CT. Flexion and extension views may be helpful in revealing instability after pain and muscle spasm have subsided.

Imaging the spinal cord is often indicated. MRI may demonstrate potentially treatable causes of traumatic cord compression ( Fig..6), and is of value in predicting recovery, showing areas of cord damage not contiguous with spinal fracture, and diagnosing the cause of delayed deterioration.

Fig. 6 MRI of the cervical spine in a pedestrian hit by a motor car, resulting in acute paraplegia. An acute disk protrusion at C5-6 results in a spinal cord compression. There is also diffuse increased signal in the spinal cord for one and a half segments above and below, indicating acute spinal cord damage and perhaps edema.

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