 Introduction/Background The physical, psychological, and socioeconomic impact of cervical or neck pain is extensive. In 2010, 16.3 million health care visits to hospitals and physician offices were related primarily to neck pain [1]. The Global Burden of Disease 2010 Study identified neck pain as the fourth leading cause of years lost to disability [2], with most epidemiological studies reporting an annual prevalence ranging between 15% and 50% [3-8]. Although most episodes resolve, nearly 50% of individuals continue to experience ongoing or recurrent pain [9]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Cervical Neck Pain or Cervical Radiculopathy vertebral body. Additional proposed red flags include congenital findings, concomitant vascular disease in patients >50 years of age, abnormal labs (erythrocyte sedimentation rate, C-reactive protein level, white blood cell), and neurological deficits [10]. CT Cervical Spine CT offers superior depiction of cortical bone and is more sensitive than radiographs in assessing facet degenerative disease, osteophyte formation, vacuum phenomenon, and joint capsular calcification [24]. Ultra-low- dose techniques are proposed for CT in other regions of the body [25]; however, currently this has not been directly compared to radiographs for evaluation of the neck and cervical spine. CT Myelography Cervical Spine In the absence of radiographic abnormalities or neurological symptoms, myelography is not an appropriate first- line imaging test.
Cervical Neck Pain or Cervical Radiculopathy PCAs.  Introduction/Background The physical, psychological, and socioeconomic impact of cervical or neck pain is extensive. In 2010, 16.3 million health care visits to hospitals and physician offices were related primarily to neck pain [1]. The Global Burden of Disease 2010 Study identified neck pain as the fourth leading cause of years lost to disability [2], with most epidemiological studies reporting an annual prevalence ranging between 15% and 50% [3-8]. Although most episodes resolve, nearly 50% of individuals continue to experience ongoing or recurrent pain [9]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Cervical Neck Pain or Cervical Radiculopathy vertebral body. Additional proposed red flags include congenital findings, concomitant vascular disease in patients >50 years of age, abnormal labs (erythrocyte sedimentation rate, C-reactive protein level, white blood cell), and neurological deficits [10]. CT Cervical Spine CT offers superior depiction of cortical bone and is more sensitive than radiographs in assessing facet degenerative disease, osteophyte formation, vacuum phenomenon, and joint capsular calcification [24]. Ultra-low- dose techniques are proposed for CT in other regions of the body [25]; however, currently this has not been directly compared to radiographs for evaluation of the neck and cervical spine. CT Myelography Cervical Spine In the absence of radiographic abnormalities or neurological symptoms, myelography is not an appropriate first- line imaging test.