CTA Neck The literature search did not identify any studies regarding the use of CT angiography (CTA) in the evaluation of this clinical presentation. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. MRA Neck The literature search did not identify any studies regarding the use of MR angiography (MRA) in the evaluation of this clinical presentation. MRI Cervical Spine MRI is the most sensitive test for detecting soft abnormalities associated with neck pain; however, this is characterized by a high rate of abnormalities in asymptomatic individuals [22,23]. As such, MRI is not considered a first-line imaging modality in the setting of acute or worsening uncomplicated neck pain. Cervical Neck Pain or Cervical Radiculopathy Bone Scan Whole Body with SPECT or SPECT/CT Neck There is no current role for nuclear medicine studies as the initial examination in this scenario. Tc-99m bone scan lacks both resolution and specificity in detecting pathology related to acute or worsening neck pain in the absence of red flag symptoms; most commonly, these will be associated with degenerative spondylosis. A recent retrospective study of patients with nonconclusive MRI or CT findings demonstrated that hybrid single-photon emission computed tomography (SPECT)/CT imaging identified potential pain generators in 92% of cervical spine scans [26]; however, this is not a first-line examination. Radiography Cervical Spine Radiographs are widely accessible and useful to diagnose spondylosis, degenerative disc disease, malalignment, or spinal canal stenosis. Flexion/extension radiographs have limited value in degenerative disease [27]. In the absence of red flag symptoms, therapy is rarely altered by radiographic findings [27-29].
Cervical Neck Pain or Cervical Radiculopathy PCAs. CTA Neck The literature search did not identify any studies regarding the use of CT angiography (CTA) in the evaluation of this clinical presentation. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. MRA Neck The literature search did not identify any studies regarding the use of MR angiography (MRA) in the evaluation of this clinical presentation. MRI Cervical Spine MRI is the most sensitive test for detecting soft abnormalities associated with neck pain; however, this is characterized by a high rate of abnormalities in asymptomatic individuals [22,23]. As such, MRI is not considered a first-line imaging modality in the setting of acute or worsening uncomplicated neck pain. Cervical Neck Pain or Cervical Radiculopathy Bone Scan Whole Body with SPECT or SPECT/CT Neck There is no current role for nuclear medicine studies as the initial examination in this scenario. Tc-99m bone scan lacks both resolution and specificity in detecting pathology related to acute or worsening neck pain in the absence of red flag symptoms; most commonly, these will be associated with degenerative spondylosis. A recent retrospective study of patients with nonconclusive MRI or CT findings demonstrated that hybrid single-photon emission computed tomography (SPECT)/CT imaging identified potential pain generators in 92% of cervical spine scans [26]; however, this is not a first-line examination. Radiography Cervical Spine Radiographs are widely accessible and useful to diagnose spondylosis, degenerative disc disease, malalignment, or spinal canal stenosis. Flexion/extension radiographs have limited value in degenerative disease [27]. In the absence of red flag symptoms, therapy is rarely altered by radiographic findings [27-29].