Cervical pain / radiculopathy

Question 1

Variant 1
New or increasing nontraumatic cervical p! or neck pain.
No red flags
Initial imaging

Answer 1

1. MRI without IV contrast (may be appropriate)

2. CT without IV contrast (may be appropriate)

Question 2

Variant 2:

New or increasing nontraumatic cervical radiculopathy. No “red flags.” Initial imaging.

Answer 2

1. MRI without IV contrast (green)
2. CT without IV contrast (yellow)
3. radiographs (yellow)

Question 3

Variant 3
Prior cervical spine surgery. New or increasing nontraumatic cervical or neck pain or radiculopathy.
Initial imaging.

Answer 3

1. Radiographs (green)
2. CT without IV contrast (green)
3. MRI with and without IV contrast (yellow)
4. MRI without IV contrast (yellow)
5. CT myelography (yellow)

Question 4

Variant 4
Suspicion for infection with new or increasing nontraumatic cervical or neck pain or radiculopathy.
Initial imaging.

Answer 4

1. MRI with and without IV contrast (green)

yellow:

2. CT WITH contrast
3. MRI without conrast
4. CT without contrast
5. MRI with contrast
6. radiographs

Question 5

Variant 5
Known malignancy. New or increasing nontraumatic cervical or neck pain or radiculopathy.
Initial imaging.

Answer 5

1. MRI with and without contrast (green)
2. MRI without IV contrast (green)

yellow:

3. radiographs
4. CT with contrast
5. CT without contrast
6. MRI with contrast
7. Bone scan + SPECT or SPECT/CT

Question 6

Variant 6:
Cervicogenic headache and new or increasing nontraumatic cervical or neck pain.
No neurologic deficit.
Initial imaging.

Answer 6

yellow:

1. MRI without contrast
2. radiographs
3. CT without contrast
4. facet injection / MBB

Question 7

Variant 7
Chronic cervical or neck pain.
Initial imaging.

Answer 7

1. radiographs (green)

2. MRI without contrast (yellow)

Question 8

Variant 8
Chronic cervical or neck pain. No neurologic findings. Radiographs show degenerative
changes.
Next imaging study

Answer 8

1. MRI without contrast (green)

yellow:

2. CT without contrast
3. CT myelography

Question 9

Variant 9
Chronic cervical or neck pain without or with radiculopathy. Radiographs show ossification
in the posterior longitudinal ligament (OPLL).
Next imaging study

Answer 9

1. CT without contrast (green)
2. CT myelogram (yellow)
3. MRI without contrast (yellow)