Computed tomography (CT) of the spine is becoming one of the most common studies in the modern ED. CT is the fastest, cost-effective method of imaging the spine and provides the most accurate information for diagnosis, with the exception of some soft tissue or spinal cord lesions. CT is exactly as its name implies, a mathematical approximation of the multiple densities seen as the X-ray beam rotates around the patient. The pediatric population presents a wide array of pitfalls for the clinician when evaluating the spine. Dislocations and ligamentous injury are more common in the pediatric population; they can be occult on CT and require MRI. They also present with multiple levels of injury, and complete imaging of the spine is indicated if injury is found at any level of the spine. Correct clinical judgment is required prior to sending a patient to the scanner.

Nontraumatic spinal emergencies can be caused by a wide spectrum of conditions including infection, hemorrhage, and neoplasm. The most common findings in patients with spinal emergencies are pain, motor deficits, sensory deficits, abnormal reflexes, and urinary dysfunction. Acute back pain is the only symptom of catastrophic spinal emergencies such as spinal hemorrhage or infection. Sudden paralysis can result from trauma, cord infarction, or hemorrhage. Even though a thorough sensory examination in the emergency department is often difficult and unreliable, complexes of sensory and motor abnormalities are helpful. As a result of the anatomical distribution of upper and lower motor neurons, acute spinal cord lesions almost always present with hyperreflexia. The mechanism of urinary incontinence depends on the type of lesion. Spinal cord emergencies frequently go unrecognized initially or are misdiagnosed even with such obvious symptoms as the inability to walk or bladder function failure.