Radiologic evaluation of chronic neck pain

Area of Science:

• Radiology
• Orthopedics
• Neurology

Background:

• Historically, a lack of established guidelines complicated the evaluation of chronic neck pain.
• Recent advancements in research over the past 15 years have led to specific recommendations, particularly for whiplash-associated disorders.
• This article presents the American College of Radiology Appropriateness Criteria for chronic neck pain management.

Observation:

• Standard radiography, including anteroposterior, lateral, open-mouth, and oblique views, is recommended for all chronic neck pain patients, irrespective of trauma history.
• Magnetic resonance imaging (MRI) is indicated for patients exhibiting chronic neurological signs or symptoms, even with normal radiographic results.
• The utility of MRI for detecting ligamentous and membranous abnormalities in whiplash-associated disorders remains a subject of debate.

Findings:

• Computed tomography myelography is advised when MRI is contraindicated.
• Patients with normal radiographic findings and no neurological deficits require no additional imaging.
• Individuals with radiographic evidence of spondylosis but no neurological findings also do not necessitate further imaging studies.

Implications:

• These guidelines aim to standardize the diagnostic approach to chronic neck pain, optimizing imaging utilization.
• The criteria help clinicians determine the appropriate use of various imaging modalities, potentially reducing unnecessary procedures.
• This evidence-based approach supports accurate diagnosis and management of chronic neck pain and related conditions.