Investigations

1st investigations to order

Test
Result
Test

Ordered if neck pain persists for 4 to 6 weeks, radicular pain does not subside with treatments, or more severe deficit suggestive of myelopathy is present. This would normally be the primary study ordered from the clinic setting once these criteria are met.[5][33]

MRI is also indicated for patients with neck pain and a history of malignancy, prior cervical spine surgery, or if there is suspicion for infection.[5]

Result

bone destruction, spinal cord or nerve compression, intradural or epidural pathology

Test
Result
Test

Indicated for patients with severe neck pain, chronic neck pain, or pain with a history of trauma or neck surgery (recent or previous).[5] Flexion/extension radiographs have limited value in degenerative disease.[34]

Result

presence of degenerative joint disease or degenerative disc disease, malalignment, spinal canal stenosis, fracture, or instability

Investigations to consider

Test
Result
Test

An extension to cervical radiographs to obtain more detail about bone structure, such as in ossified posterior longitudinal ligament calcification, trauma setting, or instability.

Also indicated if an MRI is not possible (e.g., implanted metal).[5]

Result

bone destruction, spinal cord or nerve compression; intradural or epidural pathology

Test
Result
Test

If a cervical CT scan with no contrast suggests spinal cord abnormalities and an MRI is not possible, then the next step is a CT cervical spine scan with intrathecal contrast (CT myelography) to obtain more detail about spinal cord and nerve changes.[5]

Primarily indicated only if an MRI is not possible (e.g., implanted metal).[5]

Result

presence of disc herniation or nerve root compression

Test
Result
Test

Ordered if brachial plexopathy, peripheral neuropathy, or peripheral nerve compression suspected, or mimicking radiculopathy or myelopathy.

Electromyography or nerve conduction velocity is a negative diagnostic test in cervical myelopathy, as nerve studies primarily demonstrate lower motor neuron changes. In degenerative cervical myelopathy, the neurological abnormalities arise from spinal cord compression and upper motor neuron dysfunction.

Result

may show changes of muscle denervation; localises the problem to the root or reveals changes in keeping with peripheral nerve entrapment

Test
Result
Test

Ordered when specific nerve root involved with radiculopathy cannot be clinically or radiologically determined.[29]

Result

positive test if nerve block relieves patient's radicular pain temporarily; localises single nerve root

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