Radiological protocol in spinal trauma: literature review and Spinal Cord Society position statement

  • P. K. Karthik Yelamarthy
  • H. S. ChhabraEmail author
  • Vedant Vaksha
  • Yatish Agarwal
  • Anita Agarwal
  • Kalidutta Das
  • Hans Joseph Erli
  • Mihir Bapat
  • Roop Singh
  • Darshan Gautam
  • Rushama Tandon
  • G. Balamurali
  • Sriram Rajan
Review Article



The Spinal Cord Society constituted a panel tasked with reviewing the literature on the radiological evaluation of spinal trauma with or without spinal cord injury and recommend a protocol. This position statement provides recommendations for the use of each modality, i.e., radiographs (X-rays), computed tomography (CT), magnetic resonance imaging (MRI), as well as vascular imaging, and makes suggestions on identifying or clearing spinal injury in trauma patients.


PubMed was searched for the corresponding keywords from January 1, 1980, to August 1, 2017. A MEDLINE search was subsequently undertaken after applying MeSH filters. Appropriate cross-references were retrieved. Out of the 545 articles retrieved, 105 relevant papers that address the present topic were studied and the extracted content was circulated for further discussions. A draft position statement was compiled and circulated among the panel members via e-mail. The draft was modified by incorporating relevant suggestions to reach a consensus.

Results and conclusion

For imaging cervical and thoracolumbar spine trauma patients, CT without contrast is generally considered to be the initial line of imaging and radiographs are required if CT is unavailable or unaffordable. CT screening in polytrauma cases is best done with a multidetector CT by utilizing the reformatted images obtained when scanning the chest, abdomen, and pelvis (CT-CAP). MRI is indicated in cases with neurological involvement and advanced cervical degenerative changes and to determine the extent of soft tissue injury, i.e., disco-ligamentous injuries as well as epidural space compromise. MRI is also usually performed when X-rays and CT are unable to correlate with patient symptomatology.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Cervical spine trauma Thoracolumbar spine trauma Spinal cord injury X-rays Computed tomography Magnetic resonance imaging Protocol Position statement 



There are no financial grants received for conducting this study.

Compliance with ethical standards

Conflict of interest

There are no potential conflicts of interest.

Supplementary material

586_2019_6112_MOESM1_ESM.pptx (159 kb)
Supplementary material 1 (PPTX 158 kb)
586_2019_6112_MOESM2_ESM.doc (120 kb)
Supplementary material 2 (DOC 214 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • P. K. Karthik Yelamarthy
    • 1
  • H. S. Chhabra
    • 1
    Email author
  • Vedant Vaksha
    • 1
  • Yatish Agarwal
    • 2
  • Anita Agarwal
    • 1
  • Kalidutta Das
    • 1
  • Hans Joseph Erli
    • 3
  • Mihir Bapat
    • 4
  • Roop Singh
    • 5
  • Darshan Gautam
    • 6
  • Rushama Tandon
    • 7
  • G. Balamurali
    • 8
  • Sriram Rajan
    • 9
  1. 1.Indian Spinal Injuries CentreNew DelhiIndia
  2. 2.Department of Diagnostic Radiology and ImagingSafdarjung Hospital and VM Medical CollegeNew DelhiIndia
  3. 3.Centre for Musculoskeletal SurgeryVivantes Humboldt HospitalBerlinGermany
  4. 4.Kokilaben Dhirubhai Ambani Hospital and Medical Research InstituteMumbaiIndia
  5. 5.PGIMSRohtakIndia
  6. 6.Indian Spine and Bone HospitalKotaIndia
  7. 7.Northern Railway Central HospitalNew DelhiIndia
  8. 8.Kauvery Spine InstituteChennaiIndia
  9. 9.Diwan Chand Satyapal Aggarwal Imaging Research CentreNew DelhiIndia

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