Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- spontaneous onset of neck pain
- cervical muscle pain and spasm
- headaches or occipital pain
- weakness or numbness
- presence of radiating arm pain
- reflex changes
- proximal arm weakness
- distal hand weakness
- gait ataxia
Other diagnostic factors
- cervical muscle spasm
- decreased cervical range of motion
- sensory changes
Risk factors
- age >40 years
- head or neck trauma
- previous cervical spine surgery
- previous cervical myofascial strain
- genetic predisposition
Diagnostic investigations
1st investigations to order
- cervical MRI
- cervical x-ray
Investigations to consider
- cervical CT scan
- cervical CT myelogram
- cervical/upper extremity electromyography or nerve conduction velocity
- cervical nerve root block
Treatment algorithm
axial neck pain
cervical spondylotic radiculopathy (CSR)
degenerative cervical myelopathy (DCM)
Contributors
Authors
Dennis A. Turner, MA, MD

Professor
Neurosurgery and Neurobiology
Duke University Medical Center
Durham
NC
Disclosures
DAT is an author of a reference cited in this topic.
Peer reviewers
Ricardo Pietrobon, MD, PhD, MBA
Associate Professor of Surgery
Associate Professor in Anesthesiology
Associate Vice-Chair, Systems Integration
Department of Surgery
Duke University Medical Center
Durham
NC
Disclosures
RP is an author of a number of references cited in this topic.
Allan I. Binder, MD
Consultant Rheumatologist
Lister Hospital
East and North Hertfordshire NHS Trust
Stevenage
UK
Disclosures
AIB is an author of a number of references cited in this topic.
Differentials
- Whiplash injury (cervical myofascial strain)
- Acute disc herniation
- Metastatic malignancy
More DifferentialsGuidelines
- ACR appropriateness criteria: cervical neck pain or cervical radiculopathy
- A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression
More GuidelinesPatient leaflets
Back pain (lower back)
Back pain: questions to ask your doctor
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
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