Radiography Cervical Spine Radiographs may be helpful in clarifying the clinical diagnosis of cervical spondylosis from mechanical, inflammatory, or metabolic processes in patients who otherwise have no red flag symptoms [107]. Radiographically visible degenerative changes, such as disc space narrowing, osteophyte formation, facet, and uncovertebral hypertrophy, are common [108] and may not correlate with symptoms or impact treatment. CT Cervical Spine Multidetector CT scans with high-quality multiplanar reformatted images have enhanced the efficacy of CT, which offers superior depiction of cortical bone and is more sensitive than radiographs in the assessment of facet degenerative disease, osteophyte formation, vacuum phenomenon, and joint capsular calcification [24]. CT Myelography Cervical Spine CT myelography is not an appropriate test for chronic neck pain in the absence of radicular or myelopathic symptoms. 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 use of provocative injections in the cervical spine to identify a pain source is controversial. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders concluded there was no evidence to support using cervical provocative discography or anesthetic facet or nerve blocks [1]. The use of facet injection as a diagnostic maneuver is limited by frequent anesthetic leakage into adjacent spaces, resulting in false-positive results [109,110]. 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 In patients with neck pain without neurologic symptoms, the relevance of specific MRI findings in the cervical spine should be considered in light of expected changes associated with aging. MRI is more sensitive than CT in identifying degenerative cervical disorders [111,112].
Cervical Neck Pain or Cervical Radiculopathy PCAs. Radiography Cervical Spine Radiographs may be helpful in clarifying the clinical diagnosis of cervical spondylosis from mechanical, inflammatory, or metabolic processes in patients who otherwise have no red flag symptoms [107]. Radiographically visible degenerative changes, such as disc space narrowing, osteophyte formation, facet, and uncovertebral hypertrophy, are common [108] and may not correlate with symptoms or impact treatment. CT Cervical Spine Multidetector CT scans with high-quality multiplanar reformatted images have enhanced the efficacy of CT, which offers superior depiction of cortical bone and is more sensitive than radiographs in the assessment of facet degenerative disease, osteophyte formation, vacuum phenomenon, and joint capsular calcification [24]. CT Myelography Cervical Spine CT myelography is not an appropriate test for chronic neck pain in the absence of radicular or myelopathic symptoms. 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 use of provocative injections in the cervical spine to identify a pain source is controversial. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders concluded there was no evidence to support using cervical provocative discography or anesthetic facet or nerve blocks [1]. The use of facet injection as a diagnostic maneuver is limited by frequent anesthetic leakage into adjacent spaces, resulting in false-positive results [109,110]. 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 In patients with neck pain without neurologic symptoms, the relevance of specific MRI findings in the cervical spine should be considered in light of expected changes associated with aging. MRI is more sensitive than CT in identifying degenerative cervical disorders [111,112].