Diagnosis of Neck Pain

Cervical spine x-rays are often used to detect small fractures or misalignment of the vertebrae. These x-rays generally include 3 standard views: AP (anteroposterior), or frontal view; lateral (side view); and a third view that allows the radiologist to see the structure (odontoid or dens) that comes from the second vertebra and fits into the socket formed by the back of the first vertebra. To see this important structure, the mouth is open to eliminate shadows from the teeth and the x-ray is directed to the back of the throat. This is called an "open mouthed" view and it is key in detecting fractures of the dens, which are very serious.

Man Neck Pain - Masterfile Image

To diagnose arthritis, 2 additional views (called oblique views) are necessary. In a lateral x-ray, the appearance of the disc space is fairly evident and the radiologist can diagnose arthritis, if it is present, but many structures of the neck appear superimposed on each other. Turning the head a bit during this view "opens up" the view of the foramen through which the nerves exit the spinal column.

In patients below the age of 20, there usually is no degeneration. In patients in their 30s and 40s, spurs often start to develop, especially in the lower cervical spine. Cervical x-rays may indicate the degree of degeneration, but they do not provide very much information about the discs themselves. X-rays are unable to diagnose other conditions of the cervical spinal cord or its linings. In some cases, MRI scan or a special type of CT scan is necessary.

MRI scan is noninvasive and does not involve radiation, but it does require the patient to remain very still. The MRI shows the spinal cord, the nerves, and the discs, in many different planes.

CT scan by itself is not used to diagnose neck pain. In some cases, a contrast dye is injected into the spinal canal, which encompasses the spinal cord. This test, which is called a CT myelogram, provides a much better picture of what is causing the problem. CT myelogram is often considered the "gold standard" in cervical imaging. This test involves substantial radiation, however, and is invasive.

Neck Pain Treatment

In many cases, neck pain can be treated effectively using conservative measures, such as medication and heat. A cervical collar and physical therapy may be used to gently pull the spaces between the vertebrae slightly apart. During the day, a cervical collar also supports the neck and prevents excess movement, but overuse may lead to diminished muscle strength in the neck. Wearing a collar when sleeping can also be helpful. Depending on how the patient sleeps, movement during the night can cause spur damage.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Apr 2000

Last Modified: 28 Sep 2015