age 65 years or older and reported pain in the thoracic or lumbosacral spine

dangerous mechanism of injury (fall from a height of greater than 3 metres, axial load to the head or base of the spine – for example falls landing on feet or buttocks, high‑speed motor vehicle collision, rollover motor accident, lap belt restraint only, ejection from a motor vehicle, accident involving motorised recreational vehicles, bicycle collision, horse riding accidents)

pre-existing spinal pathology, or known or at risk of osteoporosis – for example steroid use

suspected spinal fracture in another region of the spine

abnormal neurological symptoms (paraesthesia or weakness or numbness)

on examination:

• abnormal neurological signs (motor or sensory deficit)
• new deformity or bony midline tenderness (on palpation)
• bony midline tenderness (on percussion)
• midline or spinal pain (on coughing)

on mobilisation (sit, stand, step, assess walking): pain or abnormal neurological symptoms (stop if this occurs).

A CT scan should be obtained if you suspect a thoracic or lumbar spine injury associated with abnormal neurological signs or symptoms.

If, after CT imaging, there is a neurological abnormality which could be due to a spinal cord injury a MRI scan should be obtained.

X-rays can be performed if a spinal column injury in the thoracic or lumbosacral region is suspected without abnormal neurological signs or symptoms. If the x-ray is abnormal then a CT scan should be done.