Spinal computed tomography: limitations and applications

A comprehensive review of 188 spinal computed tomography (CT) scans done over a 9-month period was performed to establish both the shortcomings and applications of the technique. The value of intrathecal enhancement was reviewed in an attempt to establish indications for its use. The data base comprised 51 abnormal scans including cases of spinal trauma, dysraphism, intra- and extraspinal neoplasm, and spinal stenosis. Results indicate that: (1) the introduction of intrathecal contrast media greatly extends the morphologic capabilities of spinal CT in practically all cases where altered anatomy of the spinal canal and its contents is suspected; (2) conventional screening procedures such as plain films of the spine and myelography should be obtained prior to spinal CT in most cases because of their value in defining the location and longitudinal extent of the pathologic process; (3) spinal CT examinations tailored to specific areas of interest result in better characterization of traumatic, dysraphic, and stenotic conditions conceivably leading to better surgical management and more accurate prognosis. At present, spinal CT has its greatest diagnostic usefulness in the evaluation of trauma and its sequela.