Investigations

1st investigations to order

cervical MRI

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] [26]

Result

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

cervical x-ray

Test
Result
Test

Primarily indicated when trauma suspected or the patient has pain on motion of the neck, and not in the routine, outpatient setting.

Result

presence of degenerative joint disease or degenerative disc disease, fracture, or instability

Investigations to consider

cervical CT scan

Test
Result
Test

An extension to cervical radiographs to obtain more detail about bone structure, such as in 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 process

cervical CT myelogram

Test
Result
Test

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

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

Result

presence of disc herniation or nerve root compression

cervical/upper extremity EMG or nerve conduction velocity

Test
Result
Test

Ordered if brachial plexopathy, peripheral neuropathy, or peripheral nerve compression suspected, or mimicking radiculopathy or myelopathy. Rarely used to confirm myelopathy, but if negative, it can help to confirm cervical myelopathy.

Result

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

cervical nerve root block

Test
Result
Test

Ordered when specific nerve root involved with radiculopathy cannot be clinically or radiologically determined. [24]

Result

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

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