Spinal Cord Injury, SCI, Traumatic — Plain Radiograph and Dedicated CT — Clinical Pathway: Emergency and Inpatient

Spinal Cord Injury (SCI) Clinical Pathway — Emergency Department and ICU

Obtain and/or Review Radiograph +/- Dedicated CT

Plain Radiographs

XR area of suspected injury (based on clinical exam, presence of neurological deficits, visible signs of trauma, etc.)

Tips for ordering:
  • AP and Lateral +/- Odontoid
  • Oblique View not necessary
 Consider need for vascular imaging when obtaining other studies
  • C-Spine MRA/CTA indications:
    • Penetrating trauma near carotid/vertebral vessels
    • Transverse process fracture of C6 and above
    • Severe cervical spine distraction injury
    • Jumped/perched facet injuries
Tips for ordering:

CTA is more sensitive than MRA for vascular injury and subtle fractures; however, final imaging choice determined following discussion by primary/consulting services
Dedicated CT
  • Based on clinical concern, significant mechanism of injury, abnormality/poor view on XR, or per discretion of operating spinal surgeon
  • Areas often requiring enhanced imaging include:
    • Infants: C1, C2
    • Teens: C7, T1
    • Inadequate odontoid view: skull base through C2-C3
  • Tips for ordering:
    • Specify area of interest
    • Cervical imaging listed as C-Spine CT (Not Neck)
MRI
  • Need for and timing of MRI to be determined following discussion with:
    • Trauma
    • Neurosurgery +/- Orthopedics
    • Critical Care
    • Neuroradiology
  • Tips for ordering:
    • Without IV contrast
  • Indications for EMERGENT spine MRI:
    • Progressive neurological deficit
    • Prior to OR to rule out herniated disk or hematoma (per discretion of operating spinal surgeon)