This book constitutes the refereed proceedings of the 5th International Workshop and Challenge on Computational Methods and Clinical Applications for Spine Imaging, CSI 2018, held in conjunction with MICCAI 2018, in Granada, Spain, in September 2018. The 8 full papers presented together with 8 short papers and 1 keynote were carefully reviewed and selected for inclusion in this volume. Papers on novel methodology and clinical research, and also papers which demonstrate the performance of methods on the provided challenges, the aim is to cover both theoretical and very practical aspects of computerized spinal imaging.