Neurologic abnormalities. Next imaging study. CT Myelography Thoracic and Lumbar Spine CT myelography can be performed to assess for traumatic spinal canal narrowing that is due to disc herniation or epidural hematoma and to assess for preganglionic nerve root avulsions. However, as with conventional CT, CT myelography is inferior to MRI in assessing cord contusion, cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57]. Performance of thoracolumbar CT myelogram can also be technically challenging, particularly in patients with suspected unstable thoracolumbar spine injury. CT Thoracic and Lumbar Spine CT does play a role in the initial assessment of thoracic and lumbar spine injury. However, CT is significantly inferior to MRI in identifying many soft-tissue pathologies, such as cord contusion, epidural hematoma, and nerve root avulsions that can cause neurologic deficits requiring surgical intervention [40,41,43,57]. Therefore, CT should not be considered adequate for excluding significant soft-tissue pathology in patients presenting with thoracolumbar spine trauma and neurologic deficit. MRI Thoracic and Lumbar Spine MRI should be performed in patients who have possible spinal cord injury, in whom there is clinical concern for cord compression that is due to disc protrusion or hematoma, and in those suspected of ligamentous instability. Although numerous research studies have reported a potential value of diffusion MRI for characterizing spinal cord injury [111], technical problems have prevented widespread application of this technique to human studies. The current utility of diffusion MRI for assessing cord trauma remains unknown. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
Suspected Spine Trauma PCAs. Neurologic abnormalities. Next imaging study. CT Myelography Thoracic and Lumbar Spine CT myelography can be performed to assess for traumatic spinal canal narrowing that is due to disc herniation or epidural hematoma and to assess for preganglionic nerve root avulsions. However, as with conventional CT, CT myelography is inferior to MRI in assessing cord contusion, cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57]. Performance of thoracolumbar CT myelogram can also be technically challenging, particularly in patients with suspected unstable thoracolumbar spine injury. CT Thoracic and Lumbar Spine CT does play a role in the initial assessment of thoracic and lumbar spine injury. However, CT is significantly inferior to MRI in identifying many soft-tissue pathologies, such as cord contusion, epidural hematoma, and nerve root avulsions that can cause neurologic deficits requiring surgical intervention [40,41,43,57]. Therefore, CT should not be considered adequate for excluding significant soft-tissue pathology in patients presenting with thoracolumbar spine trauma and neurologic deficit. MRI Thoracic and Lumbar Spine MRI should be performed in patients who have possible spinal cord injury, in whom there is clinical concern for cord compression that is due to disc protrusion or hematoma, and in those suspected of ligamentous instability. Although numerous research studies have reported a potential value of diffusion MRI for characterizing spinal cord injury [111], technical problems have prevented widespread application of this technique to human studies. The current utility of diffusion MRI for assessing cord trauma remains unknown. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.