[Radiological imaging of spinal trauma in special situations]

Spinal trauma is rare but associated with considerable morbidity and mortality. Its diagnostic evaluation poses significant challenges for radiologists, particularly in specific patient groups and clinical scenarios. This review article highlights the role of computed tomography and magnetic resonance imaging in acute and specialized imaging of spinal trauma under particular circumstances. Special attention is given to pediatric injuries, normal variants (e.g., pseudosubluxation, os odontoideum), discoligamentous injuries, age- and medication-related osteoporotic fractures, imaging in pregnant patients with strict radiation protection requirements, as well as complex situations such as polytrauma, traumatic brain injury, or coagulopathies. In addition, pathological fractures caused by tumors or infections and imaging in postoperative patients are discussed. Classification systems such as Thoracolumbar Injury Classification and Severity Score (TLICS), AO Spine score, Osteoporotic Fracture (OF) score, and Spinal Instability Neoplastic Score (SINS) provide a structured basis for therapeutic decision-making. Radiologists play a key role, as imaging not only makes the diagnosis, but also directly influences classification and treatment planning. Future developments such as AI-supported fracture detection, dual-energy CT and artefact-reduced MRI sequences will further improve diagnostics.