common imaging and testing modalities for neck pain
Depending on presentation of pain, evaluation with imaging can be useful. Plain films or x-ray seems to be most useful when evaluating a patient who is 50 years of age or older. Lateral views can help evaluate facet arthritis and foraminal narrowing, related to arthritic change. Oblique views can also show a better view of the foraminal spaces. Also flattening of the normal lordotic curvature may be present in those with arthritis or muscle spasm. AP views will assess for abnormal rotational changes such as torticollis. Odontoid view will determine if there is any major proximal fracture or vertebral displacement. Flexion-extension views will determine if there is any instability of the spine or dynamic spondylolisthesis. X-ray can grossly assess bony integrity, as an initial evaluation for fractures.
MRI or CT imaging is recommended to be performed in those neck pain sufferers with a history of infection and/or malignancy. Those with clinical findings of cervical radiculopathy should also be imaged if these findings persist for 6 weeks or more. Those with signs and symptoms of cervical myelopathy should receive this imaging modality immediately. MRI imaging better views soft tissue structures that may contribute to pain and nerve injury such as disc herniation, ligament hypertrophy, tumor, and infection. MRI also can show nerve root compression and myelopathic changes to the spinal cord. It can also show capsular changes of the facet joints. CT scan and CT myelogram can show bony changes such as fracture. It can show stenosis, degenerative change, nerve compression, tumors, and disc herniation.
EMG and nerve conduction testing is another good confirmatory tool to determine the timing (acute or chronic) and location of radiculopathy. The needle EMG becomes most useful for diagnosis. If motor axonal injury is present, there will be abnormal findings in the muscles predominantly innervated by a particular nerve root. Nonetheless, radiculopathy can be present in some cases without abnormal findings. For example, if the sensory afferent fibers are injured at the dorsal root ganglia and no motor innervations are lost, EMG will be normal. Electrodiagnostic testing should be performed 2 to 3 weeks after initial presentation of radicular signs and/or symptoms.