Structured Reporting — Spine CT¶

Overview¶

Spine CT structured reporting focuses on bony anatomy, alignment, hardware (if present), and canal dimensions. CT provides superior bone detail compared to MRI but limited soft tissue evaluation.

Cervical Spine CT Template (Trauma)¶

Clinical Information: [Mechanism, neurological status]

Alignment: Lordosis. Listhesis. Widening of interspinous or interlaminar distance. Facet joint alignment.

Vertebral Bodies: Fractures (type, level, degree of compression, retropulsion). Vertebral body height. Endplate integrity.

Posterior Elements: Pedicle fractures. Lamina fractures. Spinous process fractures. Facet fractures or dislocations (unilateral/bilateral). Lateral mass fractures.

Disc Spaces: Height (normal/narrowed). Vacuum phenomenon.

Spinal Canal: AP diameter. Canal compromise from fracture fragments or disc material.

Neural Foramina: Patency. Bony foraminal stenosis.

Craniocervical Junction: Occipital condyles. Atlas (C1) integrity. Odontoid (C2). ADI. Atlantoaxial alignment.

Soft Tissues: Prevertebral soft tissue swelling (suggestive of ligamentous injury or hemorrhage in trauma). Paravertebral hematoma.

Post-Surgical Spine CT Template¶

Hardware: Type, position, integrity. Screw trajectory (medial/lateral breach). Lucency around screws. Rod integrity. Cage position.

Fusion Status: Bridging bone (present/absent). Graft incorporation. Pseudarthrosis.

Adjacent Levels: Degeneration at levels above and below the construct.

Clinical Pearl

In trauma CT, always report prevertebral soft tissue thickness — abnormal swelling (>7 mm at C2, >14 mm at C6 on lateral) may be the only clue to an occult ligamentous injury, even when the bones appear normal. This finding should prompt MRI for further evaluation.

Key Points¶

CT is the primary modality for trauma evaluation and hardware assessment
Report every posterior element individually in trauma (pedicles, laminae, facets, spinous processes)
Prevertebral soft tissue swelling in trauma suggests occult ligamentous injury
Post-surgical CT must evaluate hardware position, integrity, and fusion status
Sagittal and coronal reformats are essential — do not rely on axial images alone

References¶

Kahn CE Jr, Heilbrun ME, Applegate KE. From guidelines to practice: how reporting templates promote the use of radiology practice guidelines. J Am Coll Radiol. 2013;10(4):268-273. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3615027/
Larson DB. Strategies for implementing a standardized structured radiology reporting program. RadioGraphics. 2018;38(6):1705-1716. Available from: https://pubs.rsna.org/doi/abs/10.1148/rg.2018180040
Radiological Society of North America. RadReport reporting templates [Internet]. Oak Brook (IL): RSNA. Available from: https://www.rsna.org/practice-tools/data-tools-and-standards/radreport-reporting-templates
Khurana B, Sheehan SE, Sodickson A, Bono CM, Harris MB. Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. RadioGraphics. 2013;33(7):2031-2046. Available from: https://pubmed.ncbi.nlm.nih.gov/24224597/
Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, Vaccaro AR; Spine Trauma Study Group. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples. J Neurosurg Spine. 2009;10(3):201-206. Available from: https://pubmed.ncbi.nlm.nih.gov/19320578/
Nandolia K, Saran S, Varshney G, Shirodkar K, Iyengar KP, Botchu R. Spine trauma classifications: historical, current, and emerging perspectives for radiologists. Indian J Radiol Imaging. 2025;35(4):529-539. Available from: https://pubmed.ncbi.nlm.nih.gov/40963995/