A recent review of 690 patients who underwent ACDF concluded that CT altered the treatment plan in 39% of patients who had persistent symptoms and altered the treatment plan for 60% of patients with persistent symptoms and abnormal radiographs or MRI. Furthermore, recent advances in dual-energy CT has shown promise to reduce beam- hardening metal artifact, which may improve the evaluation of hardware complications and adjacent segment degeneration in postoperative patients with new or worsening neck pain [52]. Whether imaging is informative for changes to improve outcome remains to be established. In one study, half of the symptomatic cohort did not have postoperative CT, and the majority recovered with 2 years of conservative therapy [53]. CT Myelography Cervical Spine CT myelography is not the first-line test of choice for complex cervical radiculopathy [37]. However, it can be considered in patients with radiculopathy, particularly if MRI is nondiagnostic related to hardware artifact. Cervical Neck Pain or Cervical Radiculopathy CTA Neck The literature search did not identify any studies regarding the use of 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 MRA in the evaluation of this clinical presentation. MRI Cervical Spine Metal artifact may limit assessment of the cervical hardware and complications related to position or integrity. There continues to be emerging techniques for metal artifact reduction, which is beyond the scope of this document [54]. MRI is the most sensitive imaging test for detecting soft-tissue abnormalities associated with neck pain but is characterized by a high rate of abnormalities in asymptomatic individuals [22,23].
Cervical Neck Pain or Cervical Radiculopathy PCAs. A recent review of 690 patients who underwent ACDF concluded that CT altered the treatment plan in 39% of patients who had persistent symptoms and altered the treatment plan for 60% of patients with persistent symptoms and abnormal radiographs or MRI. Furthermore, recent advances in dual-energy CT has shown promise to reduce beam- hardening metal artifact, which may improve the evaluation of hardware complications and adjacent segment degeneration in postoperative patients with new or worsening neck pain [52]. Whether imaging is informative for changes to improve outcome remains to be established. In one study, half of the symptomatic cohort did not have postoperative CT, and the majority recovered with 2 years of conservative therapy [53]. CT Myelography Cervical Spine CT myelography is not the first-line test of choice for complex cervical radiculopathy [37]. However, it can be considered in patients with radiculopathy, particularly if MRI is nondiagnostic related to hardware artifact. Cervical Neck Pain or Cervical Radiculopathy CTA Neck The literature search did not identify any studies regarding the use of 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 MRA in the evaluation of this clinical presentation. MRI Cervical Spine Metal artifact may limit assessment of the cervical hardware and complications related to position or integrity. There continues to be emerging techniques for metal artifact reduction, which is beyond the scope of this document [54]. MRI is the most sensitive imaging test for detecting soft-tissue abnormalities associated with neck pain but is characterized by a high rate of abnormalities in asymptomatic individuals [22,23].