Brown et al [35] in a blinded, retrospective review studied 34 patients with clinically diagnosed cervical radiculopathy who underwent MRI prior to surgery and reported that MRI correctly predicted 88% of the lesions as opposed to 81% for CT myelography, 57% for plain myelography, and 50% for CT. However, as noted previously, degenerative findings on MRI are commonly observed in asymptomatic patients [21,23,40,41]. A prospective study evaluating MRI cervical spine in recent onset cervical radiculopathy found a high rate of both false-positive and false- negative findings [33]. Bone Scan Whole Body with SPECT or SPECT/CT Neck Tc-99m bone scan lacks both resolution and specificity to detect pathology related to suspected nerve root compression. Radiography Cervical Spine Approximately 65% of asymptomatic patients 50 to 59 years of age will have radiographic evidence of significant cervical spine degeneration, regardless of radiculopathy symptoms [42]. Myelography Cervical Spine CT myelography has supplanted fluoroscopic myelography in most circumstances; however, there may be times when fluoroscopic myelography is also performed prior to CT imaging. The ultimate judgment regarding the appropriateness of any specific procedure, lumbar versus cervical puncture route, amount of contrast, and the extent and modality of imaging coverage must be made by the radiologist, with appropriate documentation and coding [17]. CT Cervical Spine Multidetector CT scanning with high-quality multiplanar reformatted images have enhanced the efficacy of CT assessment and imaging findings, particularly around hardware. CT is the most sensitive and specific modality to assess spinal fusion [48-50] and can aid in detecting adjacent segment degeneration [51].
Cervical Neck Pain or Cervical Radiculopathy PCAs. Brown et al [35] in a blinded, retrospective review studied 34 patients with clinically diagnosed cervical radiculopathy who underwent MRI prior to surgery and reported that MRI correctly predicted 88% of the lesions as opposed to 81% for CT myelography, 57% for plain myelography, and 50% for CT. However, as noted previously, degenerative findings on MRI are commonly observed in asymptomatic patients [21,23,40,41]. A prospective study evaluating MRI cervical spine in recent onset cervical radiculopathy found a high rate of both false-positive and false- negative findings [33]. Bone Scan Whole Body with SPECT or SPECT/CT Neck Tc-99m bone scan lacks both resolution and specificity to detect pathology related to suspected nerve root compression. Radiography Cervical Spine Approximately 65% of asymptomatic patients 50 to 59 years of age will have radiographic evidence of significant cervical spine degeneration, regardless of radiculopathy symptoms [42]. Myelography Cervical Spine CT myelography has supplanted fluoroscopic myelography in most circumstances; however, there may be times when fluoroscopic myelography is also performed prior to CT imaging. The ultimate judgment regarding the appropriateness of any specific procedure, lumbar versus cervical puncture route, amount of contrast, and the extent and modality of imaging coverage must be made by the radiologist, with appropriate documentation and coding [17]. CT Cervical Spine Multidetector CT scanning with high-quality multiplanar reformatted images have enhanced the efficacy of CT assessment and imaging findings, particularly around hardware. CT is the most sensitive and specific modality to assess spinal fusion [48-50] and can aid in detecting adjacent segment degeneration [51].