Spine Imaging 101: MRI vs CT (and When Each Is Best)
A Fort Wayne Guide to Understanding Spine Imaging Options
Dr. Marc Greenberg
Fellowship-Trained Spine Surgeon
Dr. Greenberg completed advanced fellowship training at Mayo Clinic, Johns Hopkins, and Brown University. He specializes in minimally invasive and motion-preserving spine surgery, with a focus on evidence-based care and shared decision-making.
MRI: First-line for Nerves & Discs
When MRI is Your Best Choice
For radiculopathy or suspected disc herniation, MRI best shows soft tissues, nerves, and infection/tumor signals—typically the right first study if red flags or surgical planning are present.
- Excellent soft tissue contrast for disc herniations
- Superior nerve root visualization
- Detects infection, tumors, and inflammatory conditions
- No radiation exposure
Why Choose Greenberg Spine?
Dr. Marc Greenberg brings fellowship-trained expertise in minimally invasive and motion-preserving spine surgery to Fort Wayne. Our evidence-based approach combines the latest surgical techniques with personalized patient care.
CT: Best for Bone & Hardware
When CT Excels
CT is superior for fractures, postoperative hardware assessment, or when MRI is contraindicated. In trauma, CT is often the initial study.
- Excellent bone detail and fracture detection
- Superior hardware visualization
- Fast acquisition for trauma cases
- Safe for patients with implants/pacemakers
Special Cases & Clinical Guidelines
CT Myelography
CT myelography helps when MRI is not possible or equivocal. This combines the bone detail of CT with contrast enhancement to visualize nerve compression.
ACR Appropriateness Criteria
Most uncomplicated acute low-back pain doesn't need imaging initially. Escalate based on red flags and response to care—per ACR Appropriateness Criteria.
Red Flags Requiring Immediate Imaging
- Suspected cauda equina syndrome
- Progressive neurological deficits
- Suspected infection or malignancy
- History of cancer with new back pain
Quick Decision Matrix
| Clinical Scenario | First Choice | Alternative |
|---|---|---|
| Radiculopathy/Sciatica | MRI | CT myelography if MRI contraindicated |
| Trauma/Fracture | CT | MRI for ligamentous injury |
| Post-surgical Hardware | CT | MRI with metal artifact reduction |
| Infection Suspected | MRI | CT if MRI unavailable |
Need Help Interpreting Your Imaging?
Schedule a consultation to review your MRI or CT results and discuss treatment options.
Related Information
Disclaimer: Information is educational, not medical advice. Outcomes vary. Individual results depend on many factors including age, health status, anatomy, and adherence to post-operative instructions. Always consult with a qualified spine surgeon for personalized medical advice.
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