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Cervical Disc Injuries Workup

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Jan 22, 2015

Imaging Studies

See the list below:

  • 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.[6]
    • 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.[17] 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. A cross-sectional study designed to determine the prevalence and distribution of abnormal findings on cervical spine MRI concluded that disc bulging was frequently observed in asymptomatic subjects, even including those in their 20s.[18]

Other Tests

See the list below:

  • 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.
Contributor Information and Disclosures

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, Texas Medical Association

Disclosure: Nothing to disclose.


Ricardo A Nieves, MD, FAAPMR President, Colorado Spine, Pain and Sports Medicine, PC

Ricardo A Nieves, MD, FAAPMR is a member of the following medical societies: North American Spine Society, American Society of Interventional Pain Physicians, American Academy of Physical Medicine and Rehabilitation, 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, North American Spine Society, International Spine Intervention 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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Samuel Punnamoottil Thampi, MD Attending Pain Management, Anesthesiology, North Shore Pain Service

Samuel Punnamoottil Thampi, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Erik D Hiester, DO Fellow in Interventional Pain Management, Georgia Pain Physicians, Emory University School of Medicine

Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American Pain Society

Disclosure: Nothing to disclose.

R Blake Windsor, MD Resident Physician, Department of Pediatrics, Boston Children's Hospital and Boston Medical Center

R Blake Windsor, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

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, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Dr Dennis P White to the development and writing of this article.

  1. 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. 1990 Sep. 72(8):1178-84. [Medline].

  2. 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. 2005 Sep. 55(3):409-14. [Medline].

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

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

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

  6. 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. 1997 Dec. 87(6):843-50. [Medline].

  7. Mall NA, Buchowski J, Zebala L, Wright RW, Matava MJ. Spine and axial skeleton injuries in the national football league. Am J Sports Med. 2012 Aug. 40(8):1755-61. [Medline].

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

  9. American Academy of Pediatrics. Trampoline. Pediatrics. 1981. 67:438.

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

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

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

  13. 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.

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

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

  16. 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].

  17. 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. 1993 Sep-Oct. 21(5):640-9. [Medline].

  18. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1,211 Asymptomatic Subjects. Spine (Phila Pa 1976). 2015 Jan 12. [Medline].

  19. Tomasino A, Gebhard H, Parikh K, Wess C, Härtl R. Bioabsorbable instrumentation for single-level cervical degenerative disc disease: a radiological and clinical outcome study. J Neurosurg Spine. 2009 Nov. 11(5):529-37. [Medline].

  20. Phillips FM, Tzermiadianos MN, Voronov LI, Havey RM, Carandang G, Dooris A, et al. Effect of two-level total disc replacement on cervical spine kinematics. Spine (Phila Pa 1976). 2009 Oct 15. 34(22):E794-9. [Medline].

  21. Peng CW, Quirnoa M, Bendo JA, Spivak JM, Goldstein JA. Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement. Spine J. 2009 Jul. 9(7):551-5. [Medline].

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

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

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

  25. Tu TH, Wu JC, Fay LY, Ko CC, Huang WC, Cheng H. Vertebral body split fracture after a single-level cervical total disc replacement. J Neurosurg Spine. 2012 Mar. 16(3):231-5. [Medline].

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

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

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

  29. 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. 2005 Mar. 63(3):210-8; discussion 218-9. [Medline].

  30. Whang PG, Simpson AK, Rechtine G, Grauer JN. Current trends in spinal arthroplasty: an assessment of surgeon practices and attitudes regarding cervical and lumbar disk replacement. J Spinal Disord Tech. 2009 Feb. 22(1):26-33. [Medline].

  31. Buchowski JM, Anderson PA, Sekhon L, Riew KD. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am. 2009 Oct 1. 91 Suppl 2:223-32. [Medline].

  32. Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL. Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976). 2009 Jul 1. 34(15):1554-60. [Medline].

  33. 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.

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

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

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

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

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

  39. 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. 2005 Apr. 18(2):171-7. [Medline].

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