Purpose: To determine if multidetector-row CT (MDCT) can replace conventional radiographs and be performed alone in severe trauma patients for the depiction of thoracolumbar spine fractures. Materials and Methods: One hundred consecutive severe trauma patients who underwent conventional radiographs of the thoracolumbar spine as well as thoraco-abdominal MDCT were prospectively identiþed. Conventional radiographs were reviewed independently by 3 radiologists and 2 orthopedic surgeons, and MDCT by 3 radiologists. Reviewers were blinded both to each other and to the results of the initial evaluation of these examinations. Presence, location and stability of fractures, as well as quality of reviewed imaging methods were assessed. Statistical analysis was performed to determine sensitivity and inter-observer agreement of each procedure, with clinical and radiological follow-up chosen as the reference standard. Time to perform each examination as well as involved radiation doses were also evaluated. Finally, a resource cost analysis was performed. Results: Sixty-seven fractured vertebrae in 26 of the patients were diagnosed. Twelve patients showed unstable spine fractures. Sensitivity and inter-observer agreement for unstable fractures amounted to 97.2% and 95.1% with MDCT, and 33.3% and 36.8% with conventional radiology. Average times in the performance of conventional radiographs and MDCT examinations amounted to 33 minutes and 40 minutes, respectively. Effective radiation doses involved in conventional radiographs of the spine and thoraco-abdominal MDCT amounted to 6.36 mSv and 19.42 mSv, respectively. MDCT afforded identiþcation of 145 associated traumatic lesions. Finally, costs of conventional radiographs and of MDCT amounted to 145 US$ and 880 US$ per patient, respectively. Conclusion: MDCT is a better test for depicting spine fractures than conventional radiographs. It can replace conventional radiographs and be performed alone in severe trauma patients.