Computed tomography (CT) is recommended for routine use in the evaluation of patients with spinal trauma. An evaluation of the CT scans and complementary radiographic studies of 117 patients with spinal trauma was performed. CT provides critical information often not afforded by conventional radiographs concerning fractures, bullet fragments, surgical devices, and paraspinal pathology. Furthermore, in contrast to myelography, it can demonstrate directly certain soft-tissue abnormalities within the spinal canal, such as intramedullary hematomas, herniated discs, and posttraumatic syrinxes. CT can also determine the etiology of myelographic defects, including those causing total myelographic blocks. Further, aided by intrathecal metrizamide, it can differentiate cord swelling from extrinsic cord pressure and thereby demonstrate the need for medical or surgical therapy.