Most cervical discectomies are performed by an anterior approach without transgression of the epidural space; therefore, epidural scar or granulation tissue formation is minimal, and contrast-enhanced imaging is not routinely used after ACDF [55]. Gadolinium-enhanced MRI may have a role in the setting of neck pain and prior posterior-approach cervical fusion/decompressive procedures, although the majority of the literature to date evaluates the use of gadolinium-based contrast in the differentiation of recurrent disc herniations (a potentially actionable finding) from epidural scar in the setting of lumbar spine surgery [56,57]. Bone Scan Whole Body with SPECT or SPECT/CT Neck There is no current role for nuclear medicine studies as the initial examination in this scenario. The role of Tc- 99m bone scan in the setting of new or worsening neck pain in the postsurgical patient is limited, as radionuclide scans may remain positive for a year or more in the region of the operative bed [58]. SPECT/CT may offer diagnostic information in the setting of suspected pseudoarthrosis or equivocal CT or MRI findings [59]. Radiography Cervical Spine Initial radiographic evaluation, including anteroposterior and lateral views, is useful to assess hardware integrity and detect adjacent segment disease, which may contribute to symptoms [60,61]. The addition of flexion/extension radiographs may be considered to improve detection of vertebral body nonunion or pseudoarthrosis [62] and may supplement conventional views following ACDF [63], cervical disc implantation, or posterior cervical fixation [64-66]. 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.
Cervical Neck Pain or Cervical Radiculopathy PCAs. Most cervical discectomies are performed by an anterior approach without transgression of the epidural space; therefore, epidural scar or granulation tissue formation is minimal, and contrast-enhanced imaging is not routinely used after ACDF [55]. Gadolinium-enhanced MRI may have a role in the setting of neck pain and prior posterior-approach cervical fusion/decompressive procedures, although the majority of the literature to date evaluates the use of gadolinium-based contrast in the differentiation of recurrent disc herniations (a potentially actionable finding) from epidural scar in the setting of lumbar spine surgery [56,57]. Bone Scan Whole Body with SPECT or SPECT/CT Neck There is no current role for nuclear medicine studies as the initial examination in this scenario. The role of Tc- 99m bone scan in the setting of new or worsening neck pain in the postsurgical patient is limited, as radionuclide scans may remain positive for a year or more in the region of the operative bed [58]. SPECT/CT may offer diagnostic information in the setting of suspected pseudoarthrosis or equivocal CT or MRI findings [59]. Radiography Cervical Spine Initial radiographic evaluation, including anteroposterior and lateral views, is useful to assess hardware integrity and detect adjacent segment disease, which may contribute to symptoms [60,61]. The addition of flexion/extension radiographs may be considered to improve detection of vertebral body nonunion or pseudoarthrosis [62] and may supplement conventional views following ACDF [63], cervical disc implantation, or posterior cervical fixation [64-66]. 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.