eMedicine Specialties > Sports Medicine > Spine

Cervical Disc Injuries: Differential Diagnoses & Workup

Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Coauthor(s): Ricardo A Nieves, MD, President, Colorado Spine, Pain and Sports Medicine, PC; Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group; Samuel Punnamoottil Thampi, MD, Consulting Staff, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Franklin Hospital Medical Center, North Shore-Long Island Jewish Health System; Frank J King, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Georgia Pain Physicians/Emory School of Medicine; Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Contributor Information and Disclosures

Updated: Apr 6, 2006

Differential Diagnoses

Cervical Discogenic Pain Syndrome
Cervical Facet Syndrome
Cervical Radiculopathy
Cervical Spine Sprain/Strain Injuries

Workup

Imaging Studies

  • Plain radiography
    • Plain radiography is a useful screening tool to demonstrate associated osseous injury. Although disc space reduction is seen in chronic disc degeneration, plain films may not necessarily demonstrate reduced disc space secondary to acute disc injury.
    • Plain films have a role for assessment of cervical spinal stenosis, as this is associated with a higher incidence of cervical cord injury. The Torg ratio is used to assess cervical spinal stenosis. The Torg ratio is the sagittal canal/vertebral body ratios measured on cervical spine lateral radiographs. The normal value is 1.0. A ratio of 0.8 and below has been considered indicative of cervical spinal stenosis (Torg and Corcoran, 1997).
    • Plain radiography helps diagnose spear tackler spine, which is an entity seen in a subset of football players. Permanent neurologic injury is higher in this population due to axial loading of a relatively straight spine (Torg, 1993). Spear tackler spine is characterized by the following:

      • Developmental narrowing (stenosis) of the cervical canal
      • Persistent straightening or reversal of the normal cervical lordotic curve on erect lateral radiographs obtained in the neutral position
      • Concomitant preexisting posttraumatic radiographic abnormalities of the cervical spine
      • Documentation of having employed spear tackling techniques
  • MRI
    • MRI may demonstrate decreased disc height and reduced signal intensity as well as spondylotic spurs. MRI is more important to evaluate spinal cord or nerve root compression secondary to the disc herniation.
    • Interpretation of MRIs is important, as many abnormal MRI findings are noted in individuals who are asymptomatic.

Other Tests

  • Electrodiagnostic studies may be necessary to correlate clinical and radiological findings.
  • Discography is indicated in intractable axial neck pain not responding to conservative measures. Discography is a provocative procedure and is performed by injecting the lower cervical discs with normal saline to reproduce the patient's pain complex.

More on Cervical Disc Injuries

Overview: Cervical Disc Injuries
Differential Diagnoses & Workup: Cervical Disc Injuries
Treatment & Medication: Cervical Disc Injuries
Follow-up: Cervical Disc Injuries
References
[ CLOSE WINDOW ]

References

  1. American Academy of Pediatrics. Trampoline. Pediatrics. 1981;67:438.

  2. Aydin Y, Kaya RA, Can SM, Türkmenoglu O, Cavusoglu H, Ziyal IM. Minimally invasive anterior contralateral approach for the treatment of cervicaldisc herniation. Surg Neurol. Mar 2005;63(3):210-8; discussion 218-9. [Medline].

  3. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. Sep 1990;72(8):1178-84. [Medline].

  4. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat. Jan 1981;132(Pt 1):39-56. [Medline].

  5. Cantu RC. Functional cervical spinal stenosis: a contraindication to participation in contact sports. Med Sci Sports Exerc. Mar 1993;25(3):316-7. [Medline].

  6. Cantu RC, Bailes JE, Wilberger JE Jr. Guidelines for return to contact or collision sport after a cervical spine injury. Clin Sports Med. Jan 1998;17(1):137-46. [Medline].

  7. Coventry MB, Ghormley RK, Kernahan JW. The intervertebral disc: Its microscopic anatomy and pathology. Part III: Pathologic changes in the intervertebral disc. J Bone and Joint Surg. 1945;27:460-474.

  8. Duggal N, Pickett GE, Mitsis DK, Keller JL. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus. Sep 15 2004;17(3):E9. [Medline].

  9. Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ. Prevalence of annular tears and disc herniations on MR images of the cervicalspine in symptom free volunteers. Eur J Radiol. Sep 2005;55(3):409-14. [Medline].

  10. Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine. Nov-Dec 1982;7(6):536-9. [Medline].

  11. Goffin J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery. Sep 2002;51(3):840-5; discussion 845-7. [Medline].

  12. Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine. Oct 1984;9(7):667-71. [Medline].

  13. Gower WE, Pedrini V. Age-related variations in proteinpolysaccharides from human nucleus pulposus, annulus fibrosus, and costal cartilage. J Bone Joint Surg Am. Sep 1969;51(6):1154-62. [Medline].

  14. Johnson JP, Filler AG, McBride DQ, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease. Spine. Apr 15 2000;25(8):905-9. [Medline].

  15. Lipson SJ, Muir H. Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum. Jan 1981;24(1):12-21. [Medline].

  16. Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. Apr 1 1999;24(7):619-26; discussion 627-8. [Medline].

  17. Miyazaski K, Hirohuji E, Ono S, et al. Extensive simultaneous multisegment laminectomy and posterior decompression with posterolateral fusion. Jpn Spine Res Soc. 5:167.

  18. Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine. May 1 1998;23(9):990-5; discussion 996-7. [Medline].

  19. Morganti C. Recommendations for return to sports following cervical spine injuries. Sports Med. 2003;33(8):563-73. [Medline].

  20. Nachemson, Alf L. The lumbar spine: An orthopedic challenge. Spine. 1976;1(1).

  21. National Collegiate Athletic Association. Article 2-1,2-N 1976; Rule 2, Section 24; Rule 9, Section 1. In: Football rule changes and modifications. 1976.

  22. North American Spine Society. Orthopaedic Knowledge Update: Spine. American Academy of Orthopaedic Surgeons; 1997:75, 97-101.

  23. Pearce RH, Grimmer BJ, Adams ME. Degeneration and the chemical composition of the human lumbar intervertebral disc. J Orthop Res. 1987;5(2):198-205. [Medline].

  24. Pointillart V. Cervical disc prosthesis in humans: first failure. Spine. Mar 1 2001;26(5):E90-2. [Medline].

  25. Sasai K, Saito T, Ohnari H, Yamamoto T, Kasuya T, Wakabayashi E, et al. Microsurgical posterior herniotomy with en bloc laminoplasty: alternative methodfor treating cervical disc herniation. J Spinal Disord Tech. Apr 2005;18(2):171-7. [Medline].

  26. Tator CH, Edmonds VE. National survey of spinal injuries in hockey players. Can Med Assoc J. Apr 1 1984;130(7):875-80. [Medline].

  27. Torg J. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. In: The Cervical Spine. 1989:442-463.

  28. Torg JS, Corcoran TA, Thibault LE, Pavlov H, Sennett BJ, Naranja RJ Jr, et al. Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg. Dec 1997;87(6):843-50. [Medline].

  29. Torg JS, Ramsey-Emrhein JA. Suggested management guidelines for participation in collision activities with congenital, developmental, or post-injury lesions involving the cervical spine. Med Sci Sports Exerc. 1997;29:256-272.

  30. Torg JS, Sennett B, Pavlov H, Leventhal MR, Glasgow SG. Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med. Sep-Oct 1993;21(5):640-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

acute cervical spine injury, annular tear with herniation of the nucleus pulposus, annular tear without herniation of the nucleus pulposus, cervical degenerative disease

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Ricardo A Nieves, MD, President, Colorado Spine, Pain and Sports Medicine, PC
Ricardo A Nieves, MD is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group
Kevin P Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, and North American Spine Society
Disclosure: BioAssets Development Corp Consulting fee Consulting

Samuel Punnamoottil Thampi, MD, Consulting Staff, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Franklin Hospital Medical Center, North Shore-Long Island Jewish Health System
Samuel Punnamoottil Thampi, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and North American Spine Society
Disclosure: Nothing to disclose.

Frank J King, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Georgia Pain Physicians/Emory School of Medicine
Frank J King, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, and American Pain Society
Disclosure: Nothing to disclose.

Medical Editor

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.