The previous chapter discussed the indications for imaging patients with suspected vertebral injuries. This chapter discusses the three imaging modalities that use ionizing radiation: radiography, CT, and myelography. These techniques are frequently used in combination to arrive at the correct diagnosis. This chapter reviews each of these imaging formats and illustrates their uses in the diagnosis of vertebral injury. Chapter 6 will discuss MR imaging. Chapters 7 and 8 describe the integrated use of multiple imaging techniques.

Radiography

Radiography was the foundation on which the diagnosis of vertebral injury was made [1,2]. As Chapter 4 illustrated, in an era when specialized imaging techniques such as CT and MR are commonplace, radiography has taken a “back seat.” In the past, radiography was used extensively and relied upon to screen the patient and to make an initial diagnosis. Special imaging techniques were then used to confirm the initial impression and to outline the extent of damage. However, despite the advantages of CT, in many instances it is still necessary to refer to radiographs for guidance, particularly for operative planning. Furthermore, there are still many places in the world where CT is not readily available on an emergency basis and trauma physicians still must utilize radiography. For this reason we include radiography in this discussion.

Techniques

What is the “routine” series of radiographs for examining an adult with an acute vertebral injury? This question is frequently asked of radiologists by their surgical colleagues.