However, the presence of degenerative changes should be interpreted with caution. In a small series, Fryer et al [113] found little correlation between the presence of facet arthropathy and the side or level of symptoms in patients with acute, unilateral neck pain. Spondylotic changes on radiographs and MRI are common in patients over 30 years of age and have been shown to correlate poorly with the presence of neck pain [20-23,114,115]. Okada et al [112], in a 10-year longitudinal MRI study, showed that cervical disc degeneration progressed in 85% of patients, though symptoms developed in only 34% of patients. Most significantly, patients developing symptoms showed more frequent progression of disc degeneration on MRI, including anterior compression of the dura and spinal cord, posterior disc protrusion, disc space narrowing, and foraminal stenosis. Bone Scan Whole Body with SPECT or SPECT/CT Neck The role of Tc-99m bone scan in the setting of chronic neck pain is limited, though SPECT likely offers benefit over conventional planar imaging. Some authors have advocated the use of SPECT imaging in identifying the pain source (ie, facet disease) [106]. A recent retrospective study of 25 patients with chronic cervical spine pain demonstrated that hybrid SPECT/CT imaging identified potential pain generators in 92% of patients [26], and as such may have a role in secondary workup. Myelography Cervical Spine Myelography is not an appropriate test for chronic neck pain in the absence of radicular or myelopathic symptoms. Similar to more recent literature on MRI, asymptomatic degenerative changes have been described on myelograms [116]. Cervical Neck Pain or Cervical Radiculopathy Variant 9: Chronic cervical or neck pain without or with radiculopathy. Radiographs show ossification in the posterior longitudinal ligament (OPLL). Next imaging study.
Cervical Neck Pain or Cervical Radiculopathy PCAs. However, the presence of degenerative changes should be interpreted with caution. In a small series, Fryer et al [113] found little correlation between the presence of facet arthropathy and the side or level of symptoms in patients with acute, unilateral neck pain. Spondylotic changes on radiographs and MRI are common in patients over 30 years of age and have been shown to correlate poorly with the presence of neck pain [20-23,114,115]. Okada et al [112], in a 10-year longitudinal MRI study, showed that cervical disc degeneration progressed in 85% of patients, though symptoms developed in only 34% of patients. Most significantly, patients developing symptoms showed more frequent progression of disc degeneration on MRI, including anterior compression of the dura and spinal cord, posterior disc protrusion, disc space narrowing, and foraminal stenosis. Bone Scan Whole Body with SPECT or SPECT/CT Neck The role of Tc-99m bone scan in the setting of chronic neck pain is limited, though SPECT likely offers benefit over conventional planar imaging. Some authors have advocated the use of SPECT imaging in identifying the pain source (ie, facet disease) [106]. A recent retrospective study of 25 patients with chronic cervical spine pain demonstrated that hybrid SPECT/CT imaging identified potential pain generators in 92% of patients [26], and as such may have a role in secondary workup. Myelography Cervical Spine Myelography is not an appropriate test for chronic neck pain in the absence of radicular or myelopathic symptoms. Similar to more recent literature on MRI, asymptomatic degenerative changes have been described on myelograms [116]. Cervical Neck Pain or Cervical Radiculopathy Variant 9: Chronic cervical or neck pain without or with radiculopathy. Radiographs show ossification in the posterior longitudinal ligament (OPLL). Next imaging study.