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Clinical condition: myelopathy
CT spine without contrast CT spine with contrast CT myelography MRI spine without contrast MRI spine without and with contrast X-ray spine X-ray myelography CTA spine MRA spine Traumatic 9a 2 5b 8cd 2 7ef 3g 3h 3h Painful* 7i 3j 5k 8 7l 3f 2g 2c 2 Sudden onset† 5k 3 6k 9 8 3f 6g 5m 4m Stepwise progressive‡ 5k 3 6k 9 8 3 6gm 5 4 Slowly progressive§ 6i 3j 5k 8 7 3f 5gn 2 2 Infectious disease patient‖ 6k 5 5k 8 9 3f 5gk 2 2 Oncology patient¶ 6k 4 5k 9 8 3o 5gk 2c 2 Note:—Rating Scale: 1, least appropriate; 9, most appropriate.
a First test for acute management.
b MRI preferable.
c Problem solving or operative planning.
d Most useful when injury not explained by bony fracture.
e May be first test in multi-symptom trauma, especially when CT is delayed.
f To assess stability.
g Usually performed in conjunction with CT.
h For suspected vascular trauma.
i Most useful for spondylosis.
j Consider for infection, neoplasm or if MRI unavailable or contraindicated.
k Problem solving or if MRI unavailable or contraindicated.
l If infection or neoplastic disorder suspected.
m If AVM is suspected.
n If MRI is not possible or for preoperative planning and problem solving.
o Assess stability or for treatment planning.
* Bone scan, rating of 4 to search for associated extra spinal disease.
† Arteriography spine, rating of 4 if AVM suspected.
‡ Arteriography spine, rating of 6 if AVM suspected.
§ Bone scan, rating of 4 and arteriography spine, rating of 4.
‖ WBC scan rating of 4 may be combined with bone scan to diagnose osteomyelitis.
¶ Bone scan, rating of 6 to search for associated extra spinal disease.
