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Chronic Neck Pain

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Chronic Neck Pain, Neck Pain

  • Types
  • Chronic Neck Pain
  1. Post-Traumatic conditions
    1. Whiplash
    2. Other Cervical Spine injuries
  2. Degenerative conditions
    1. Degenerative disc disease
    2. Cervical Disc Herniation
    3. Spondylosis
  • Imaging
  • Evaluation of Chronic Neck Pain
  1. Step 1: All Patients with Chronic Neck Pain
    1. Cervical Spine XRay with 5 views (AP, Lateral, odontoid, obliques)
  2. Step 2: MRI Cervical Spine indications (CXT myelography where MRI is contraindicated)
    1. No further imaging needed in Spondylosis without neurologic changes
    2. Neurologic findings
    3. Persistent Whiplash Symptoms (to evaluate differential diagnosis including discs, spurs and ligament injury)
      1. Controversial as to benefit
    4. Signs of bony destruction on XRay (suggestive of Spinal Infection, requires IV contrast)
    5. Suspected Cervical Disc Herniation
    6. Suspected Spinal Neoplasm (e.g. metastasis)
    7. Degenerative osteophytes
    8. Vertebral Fractures (e.g. compression Fractures)
  • Imaging
  • Studies NOT helpful in diagnosis
  1. Chronic Neck Pain
    1. Provocative diagnostic discography is not reliable