Imaging recommendation · Neuro · Head & Neck

Acute spinal cord injury after trauma

Q: What's the alternative imaging for acute spinal cord injury after trauma when mri contraindicated?

CT — CT Myelogram (iv contrast).

Q: What's the alternative imaging for acute spinal cord injury after trauma when vascular injury concern (cervical penetrating)?

CT — Add CTA Neck (iv contrast).

Recommended: CT Cervical/Thoracic/Lumbar Spine + MRI Spine within 24-48 hours is the preferred imaging study for acute spinal cord injury after trauma. CT for bony injury; MRI for cord, ligaments, hematoma, herniation.

Recommended study

CT Cervical/Thoracic/Lumbar Spine + MRI Spine within 24-48 hours

MRI No contrast Preferred Neuro · Head & Neck Emergency Reviewed 2026-05

CT for bony injury; MRI for cord, ligaments, hematoma, herniation. Steroid use (high-dose methylprednisolone) is controversial and not standard of care per recent AANS guidance.

If the default doesn't apply

MRI contraindicated

CT CT Myelogram IV contrast

Vascular injury concern (cervical penetrating)

CT Add CTA Neck IV contrast

Watch-outs

Neurogenic shock

Hypotension + bradycardia after high cord injury — fluids + vasopressors; differentiate from hemorrhagic shock.

Unstable cervical fracture in obtunded patient

Maintain spinal immobilization; do not clear cervical spine clinically — MRI within 48h to exclude ligamentous injury.

Pearls

ASIA impairment scale (A-E) at admission and follow-up drives prognosis.
SCIWORA (spinal cord injury without radiographic abnormality) more common in children — MRI is the diagnostic test.
Spinal shock can mask deficit severity for 24-48 hours; bulbocavernosus reflex return signals end of shock.