Cervical Disc Injuries Workup

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jan 6, 2010
 

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.[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.[16] 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.
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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.
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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, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

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: 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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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.

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