Medscape is available in 5 Language Editions – Choose your Edition here.


Cervical Discogenic Pain Syndrome Workup

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
Updated: Jul 24, 2014

Laboratory Studies

See the list below:

  • Laboratory studies typically are not indicated in the diagnosis of cervical discogenic pain syndrome.

Imaging Studies

See the list below:

  • Radiographs of the cervical spine primarily are indicated in cases in which significant trauma is involved (eg, motor vehicle accident, sport injuries) and in cases in which the history and physical examination suggest the possibility of a fracture or instability. See the images below.
    Lateral cervical spine plain radiograph illustratiLateral cervical spine plain radiograph illustrating the Torg/Pavlov ratio.
    Lateral view of a C2 fracture dislocation. Lateral view of a C2 fracture dislocation.
    See the list below:
    • An oblique view is necessary to evaluate for fracture of the pars interarticularis and facet joint arthropathy. If spondylolisthesis is found and is believed to be symptomatic, flexion/extension lateral views are helpful to evaluate for instability.
    • In cervical discogenic pain syndrome (CDPS), radiographic findings can be normal or can show decreased intervertebral space and associated facet joint and/or vertebral body degenerative changes. Radiographic findings commonly show degenerative changes in persons older than 55 years. Little correlation exists between symptomatic and asymptomatic individuals and structural changes on roentgenographic examinations.[2, 17, 36]
    • In 1987, Deyo recommended radiographic studies be obtained in the following circumstances[37] :
      • Patients older than 50 years
      • History of significant trauma (fracture risk)
      • Neuromotor deficits (to rule out spondylolisthesis or tumor)
      • Unexplained weight loss (to rule out malignancy)
      • Drug or alcohol abuse (risk factors for osteomyelitis, osteoporosis, and trauma)
      • History of cancer (to rule out metastasis)
      • Use of corticosteroids (increased risk of infections and osteoporosis)
      • Fever (potential sign of osteomyelitis or epidural abscess)
      • Failure to improve with conservative therapy
      • Medicolegal cases involved in litigation
  • CT scanning provides high-quality osseous detail and spatial resolution.
    • CT scanning is a valuable adjunct in evaluating patients with extensive bony degenerative changes and suspected stenosis or bony pathology not identified by plain radiographic films.
    • CT scan also is an alternative to evaluate for disc herniations in patients in which MRI is contraindicated. See the image below.
      Axial computed tomography scan of cervical herniatAxial computed tomography scan of cervical herniated nucleus pulposus.
    • When combined with discography, axial CT scanning surpasses MRI in detecting annular fissures.[38]
    • CT scanning with myelography is helpful in evaluating patients with extradural compression of the neural elements from bone or disc material.[39, 40]
  • MRI is the study of choice in patients with suspected degenerative discogenic disease. See the images below.
    T1-weighted magnetic resonance image of a cervicalT1-weighted magnetic resonance image of a cervical disk herniation.
    T2-weighted magnetic resonance image of a cervicalT2-weighted magnetic resonance image of a cervical disk herniation.
    See the list below:
    • MRI is a sensitive diagnostic modality that offers multiplanar imaging capability and excellent soft-tissue and spatial resolution without ionic radiation. MRI also provides physiologic information regarding the water content of the disc.[41]
    • Schellhas et al studied subjects who were asymptomatic and those who experienced pain.[42] The investigators concluded that significant disc annular tears often escape MRI detection and that MRI cannot reliably identify the source or sources of cervical discogenic pain syndrome (CDPS).
    • MRI abnormalities are common in patients who are asymptomatic and must therefore be corroborated with physical examination findings in making the diagnosis of cervical discogenic pain syndrome (CDPS).
    • Matsumoto et al completed a study of 497 patients who were asymptomatic.[43] In this study, cervical MRI revealed that the frequency of degenerative changes increases as age increases. Disc degeneration was the most common observation. In men and women in their 20s, 17% of men and 12% of women showed disc degeneration; in individuals than 60 years, 86% of men and 89% of women showed disc degeneration.[43] Posterior disc protrusion with demonstrable compression of the spinal cord was found in 7.6% of subjects, mostly those older than 50 years.[43]

Other Tests

See the list below:

  • Cervical discography
    • Cervical discography is an important adjunct in the evaluation of the patient with cervical discogenic pain syndrome (CDPS), particularly when other diagnostic studies fail to detect any abnormalities in a patient with subjective symptoms of cervical discogenic pain.[42, 44]
    • Manchikanti et al performed a systematic review of the cervical discography literature.[45] The investigators found that cervical discography plays a significant role in selecting surgical candidates and improving outcomes, despite concerns regarding the false-positive rate, lack of standardization, and assorted potential confounding factors. Manchikanti et al concluded that cervical discography performed according to the International Association for the Study of Pain (IASP) criteria may be a useful tool for evaluating chronic cervical pain, without disc herniation or radiculitis. "Based on a modified Agency for Healthcare Research and Quality (AHRQ) accuracy evaluation and US Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence as level II-2 for diagnostic accuracy of cervical discography."[45]
    • Cervical discography is also useful in the evaluation of patients with multiple degenerative disc findings or various levels of disc herniations in which surgery is contemplated.[46]
    • The most important part of the cervical discography evaluation is the provocation/analgesia response, because it will differentiate symptomatic from nonsymptomatic discs. In a study published by Osler, a series of patients with positive cervical analgesic discography followed by anterior cervical fusion with or without discectomy resulted in 81% excellent or good results.[47] Osler concluded that analgesic discography is the most effective test for location of the lesion in the painful disc syndrome.[47, 48]
  • Electromyography (EMG)
    • EMG is performed primarily by specialists in neurology or physical medicine and rehabilitation as an extension of the history and physical examination of patients with suspected cervical radiculopathy.
    • Prevalence studies of cervical radiculopathies demonstrate that 2 age peaks exist, one in the 60s and 70s and one in the 20s. Cervical radiculopathy in the older age group almost always is caused by a combination of osteophytic spurs and disc protrusion compressing an exiting nerve root, and cervical radiculopathy in the younger age group tends to be caused by a typical type of disc herniation.
    • EMG is a physiologic test not necessary in the initial evaluation of patients with new symptoms unless it is being utilized as a baseline for worker's compensation or to assess personal injuries to rule out a preexisting injury.
    • Wait approximately 3 weeks after the onset of symptoms to perform an EMG. Delaying the study for 3 weeks ensures accurate detection of positive waves and fibrillation potentials.[17, 49]
    • EMG can also be useful by assisting in the determination of the approach to epidural injections, selective nerve root blocks, and/or surgery. EMG is valuable in identifying other possible concomitant neurologic conditions, such as entrapment neuropathies, peripheral neuropathies, brachial plexopathies, myopathies, and motor neuron diseases.
  • Sensory-evoked potentials are useful in evaluating patients with cervical myelopathy.[50]
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.

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.

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.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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.

  1. Hult L. Cervical, dorsal and lumbar spinal syndromes; a field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. Acta Orthop Scand Suppl. 1954. 17:1-102. [Medline].

  2. McKenzie RA. The Cervical and Thoracic Spine. Mechanical Diagnosis and Therapy. Wakainae, New Zealand: Spinal Publications; 1990.

  3. Kramer J. Intervertebral Disk Diseases. Causes, Diagnosis, Treatment and Prophylaxis. George Thieme Verlag, Stuttgart Year Book, Medical Publishers Inc; 1981.

  4. Bailes JE, Maroon JC. Management of cervical spine injuries in athletes. Clin Sports Med. 1989 Jan. 8(1):43-58. [Medline].

  5. Maroon JC, Steele PB, Berlin R. Football head and neck injuries--an update. Clin Neurosurg. 1980. 27:414-29. [Medline].

  6. Cantu RC. The cervical spinal stenosis controversy. Clin Sports Med. 1998 Jan. 17(1):121-6. [Medline].

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

  8. Bagduk N, Twomey LT. Clinical Anatomy of the Lumbar Spine. 2nd ed. New York, NY: Churchill Livingston; 1991.

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

  10. Bogduk N, Windsor M, Inglis A. The innervation of the cervical intervertebral discs. Spine. 1988 Jan. 13(1):2-8. [Medline].

  11. Malinsky J. The ontogenetic development of nerve terminations in the intervertebral discs of man. (Histology of intervertebral discs, 11th communication). Acta Anat (Basel). 1959. 38:96-113. [Medline].

  12. Mendel T, Wink CS, Zimny ML. Neural elements in human cervical intervertebral discs. Spine. 1992 Feb. 17(2):132-5. [Medline].

  13. Panjabi MM, Vasavada A, White AA III. Cervical spine biomechanics. Semin Spine Surg. 1993. 5:10-6.

  14. Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine. 1992 Jun. 17(6 suppl):S129-32. [Medline].

  15. Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. 1990 Jul. 15(7):674-8. [Medline].

  16. Ordway NR, Seymour RJ, Donelson RG, Hojnowski LS, Edwards WT. Cervical flexion, extension, protrusion, and retraction. A radiographic segmental analysis. Spine. 1999 Feb 1. 24(3):240-7. [Medline].

  17. Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994 Mar. 75(3):342-52. [Medline].

  18. White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, Pa: JB Lippincott; 1991. 85-125.

  19. Maroon JC. Burning hands' in football spinal cord injuries. JAMA. 1977 Nov 7. 238(19):2049-51. [Medline].

  20. Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: a comparison of three pillows. Arch Phys Med Rehabil. 1997 Feb. 78(2):193-8. [Medline].

  21. CLOWARD RB. Cervical diskography. A contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959 Dec. 150:1052-64. [Medline]. [Full Text].

  22. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988 May-Jun. 3(3):230-8. [Medline].

  23. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain?. JAMA. 1992 Aug 12. 268(6):760-5. [Medline].

  24. Yoss RE, Corbin KB, MacCarty CS, Love JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. 1957 Oct. 7(10):673-83. [Medline].

  25. Beatty RM, Fowler FD, Hanson EJ Jr. The abducted arm as a sign of ruptured cervical disc. Neurosurgery. 1987 Nov. 21(5):731-2. [Medline].

  26. Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989 Mar. 14(3):253-7. [Medline].

  27. Gumina S, Carbone S, Albino P, Gurzi M, Postacchini F. Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain. Eur Spine J. 2013 Jul. 22(7):1558-63. [Medline]. [Full Text].

  28. Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column. Spine. 1982 Mar-Apr. 7(2):116-22. [Medline].

  29. Handa T, Ishihara H, Ohshima H, et al. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine. 1997 May 15. 22(10):1085-91. [Medline].

  30. Hickey DS, Hukins DW. Relation between the structure of the annulus fibrosus and the function and failure of the intervertebral disc. Spine. 1980 Mar-Apr. 5(2):106-16. [Medline].

  31. Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc. Its microscopic anatomy and pathology. Part III. Pathological changes in the intervertebral disc. J Bone Joint Surg. 1945. 27:460-74. [Full Text].

  32. 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]. [Full Text].

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

  34. 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].

  35. Harms-Ringdahl K. On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position. Scand J Rehabil Med Suppl. 1986. 14:1-40. [Medline].

  36. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986 Jul-Aug. 11(6):521-4. [Medline].

  37. Deyo RA, ed. Occupational Back Pain. Spine: State of the Art Reviews. Philadelphia, Pa: Hanley and Belfus; 1987. Vol 2:

  38. Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol. 1988 Mar-Apr. 9(2):367-70. [Medline].

  39. Karnaze MG, Gado MH, Sartor KJ, Hodges FJ 3rd. Comparison of MR and CT myelography in imaging the cervical and thoracic spine. AJR Am J Roentgenol. 1988 Feb. 150(2):397-403. [Medline]. [Full Text].

  40. Modic MT, Masaryk TJ, Mulopulos GP, et al. Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology. 1986 Dec. 161(3):753-9. [Medline]. [Full Text].

  41. Kramer J, Rivera CA, Kleefield J. Degenerative disorders of the cervical spine. Rheum Dis Clin North Am. 1991 Aug. 17(3):741-55. [Medline].

  42. Schellhas KP, Smith MD, Gundry CR, Pollei SR. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine. 1996 Feb 1. 21(3):300-11; discussion 311-2. [Medline].

  43. Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br. 1998 Jan. 80(1):19-24. [Medline]. [Full Text].

  44. Parfenchuck TA, Janssen ME. A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms. Spine. 1994 Dec 15. 19(24):2819-25. [Medline].

  45. Manchikanti L, Dunbar EE, Wargo BW, et al. Systematic review of cervical discography as a diagnostic test for chronic spinal pain. Pain Physician. 2009 Mar-Apr. 12(2):305-21. [Medline]. [Full Text].

  46. Siebenrock KA, Aebi M. [The value of diskography in disk-related pain syndrome of the cervical spine for evaluation of indications for spondylodesis] [German]. Z Orthop Ihre Grenzgeb. 1993 May Jun. 131(3):220-4. [Medline].

  47. Osler GE. Cervical analgesic discography. A test for diagnosis of the painful disc syndrome. S Afr Med J. 1987 Mar 21. 71(6):363. [Medline].

  48. Roth DA. Cervical analgesic discography. A new test for the definitive diagnosis of the painful-disk syndrome. JAMA. 1976 Apr 19. 235(16):1713-4. [Medline].

  49. Wilbourn AJ, Aminoff MJ. AAEE minimonograph #32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve. 1988 Nov. 11(11):1099-114. [Medline].

  50. Dvorak J. Epidemiology, physical examination, and neurodiagnostics. Spine. 1998 Dec 15. 23(24):2663-73. [Medline].

  51. Gangi A, Tsoumakidou G, Buy X, Cabral JF, Garnon J. Percutaneous techniques for cervical pain of discal origin. Semin Musculoskelet Radiol. 2011 Apr. 15(2):172-80. [Medline].

  52. [Guideline] Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations. Pain Physician. 2013 Apr. 16(2 Suppl):S49-S283. [Medline].

  53. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine. 1997 May 15. 22(10):1115-22. [Medline].

  54. Donelson R, McKenzie R. Mechanical assessment and treatment of spinal pain. Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York, NY: Lippincott-Raven Publishers; 1997. 1821-35.

  55. Donelson R, Silva G, Murphy K. Centralization phenomenon. Its usefulness in evaluating and treating referred pain. Spine. 1990 Mar. 15(3):211-3. [Medline].

  56. Benini A, Krayenbuhl H, Bruderl R. Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien). 1982. 61(1-3):105-10. [Medline].

  57. Martins AN. Anterior cervical discectomy with and without interbody bone graft. J Neurosurg. 1976 Mar. 44(3):290-5. [Medline].

  58. Palit M, Schofferman J, Goldthwaite N, et al. Anterior discectomy and fusion for the management of neck pain. Spine. 1999 Nov 1. 24(21):2224-8. [Medline].

  59. Yamamoto I, Ikeda A, Shibuya N, Tsugane R, Sato O. Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine. 1991 Mar. 16(3):272-9. [Medline].

  60. Green PW. Anterior cervical fusion. A review of thirty-three patients with cervical disc degeneration. J Bone Joint Surg Br. 1977 May. 59(2):236-40. [Medline]. [Full Text].

  61. Heller JG, Schimandle JH. Operative treatment of degenerative cervical disk disease. J South Orthop Assoc. 1996 Fall. 5(3):188-206. [Medline].

  62. Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J. 1996. 5(5):319-25. [Medline].

  63. Honet JC, Puri K. Cervical radiculitis: treatment and results in 82 patients. Arch Phys Med Rehabil. 1976 Jan. 57(1):12-6. [Medline].

  64. Rubin D. Cervical radiculitis: diagnosis and treatment. Arch Phys Med Rehabil. 1960 Dec. 41:580-6. [Medline].

  65. Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine. 1996 Aug 15. 21(16):1877-83. [Medline].

  66. Bush K, Chaudhuri R, Hillier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine. 1997 Jan 15. 22(2):183-6; discussion 187. [Medline].

  67. Maigne JY, Deligne L. Computed tomographic follow-up study of 21 cases of nonoperatively treated cervical intervertebral soft disc herniation. Spine. 1994 Jan 15. 19(2):189-91. [Medline].

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

  69. Schulman J. Treatment of neck pain with cervical epidural steroid injection. Reg Anesth. 1986. 11:92-94.

  70. Diwan S, Manchikanti L, Benyamin RM, Bryce DA, Geffert S, Hameed H, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012 Jul-Aug. 15(4):E405-34. [Medline].

  71. Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000 Jun. 81(6):741-6. [Medline].

  72. Boswell MV, Trescot AM, Datta S, et al, for the American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007 Jan. 10(1):7-111. [Medline]. [Full Text].

  73. Cantu RC, Mueller FO. Catastrophic spine injuries in football (1977-1989). J Spinal Disord. 1990 Sep. 3(3):227-31. [Medline].

  74. Cloward RB. Acute cervical spine injuries. Clin Symp. 1980. 32(1):1-32. [Medline].

  75. Delgado-Lo Pez PD, Rodri Guez-Salazar A, Castilla-Di Ez JM, et al. [Role of surgery in spinal degenerative disease. Analysis of systematic reviews on surgical and conservative treatments from an evidence-based approach] [Spanish]. Neurocirugia (Astur). 2005 Apr. 16(2):142-57. [Medline]. [Full Text].

  76. Haines T, Gross A, Goldsmith CH, Perry L. Patient education for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008 Oct 8. CD005106. [Medline].

  77. Heiskari M. Comparative retrospective study of patients operated for cervical disc herniation and spondylosis. Ann Clin Res. 1986. 18 suppl 47:57-63. [Medline].

  78. Kramer J. Intervertebral Disk Diseases: Causes, Diagnosis, Treatment and Prophylaxis. New York, NY: Thieme Medical Publishers; 1990.

  79. LaPrade RF, Burnett QM, Zarzour R, Moss R. The effect of the mandatory use of face masks on facial lacerations and head and neck injuries in ice hockey. A prospective study. Am J Sports Med. 1995 Nov-Dec. 23(6):773-5. [Medline].

  80. Levin JH. Prospective, double-blind, randomized placebo-controlled trials in interventional spine: what the highest quality literature tells us. Spine J. 2008 Sep 11. epub ahead of print. [Medline].

  81. Majors R. Degenerative and morphological changes of the cervical spine in professional soccer players. Presented at: Annual meeting of the American Orthopaedic Society for Sports Medicine. Sun Valley, Idaho: 1997.

  82. Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc. 1958 Jan 4. 166(1):23-8. [Medline].

  83. Schmidek HH. Cervical spondylosis. Am Fam Physician. 1986 May. 33(5):89-99. [Medline].

  84. Tator C. Injuries to the cervical spine and spinal cord resulting from ice hockey. Torg JS, ed. Athletic Injuries to the Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 124-32.

  85. Tator CH, Carson JD, Edmonds VE. New spinal injuries in hockey. Clin J Sport Med. 1997 Jan. 7(1):17-21. [Medline].

  86. Taylor KF, Coolican MR. Spinal cord injuries in football-rugby union, rugby league and Australian rules. Torg JS, ed. Athletic Injuries in Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 174-97.

  87. Torg JS, ed. Injuries to the cervical spine and spinal cord resulting from water sports. Athletic Injuries in Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 157-73.

  88. Wu WQ, Lewis RC. Injuries of the cervical spine in high school wrestling. Surg Neurol. 1985 Feb. 23(2):143-7. [Medline].

Appearance of torticollis as a result of sternomastoid fibrosis in a young child.
Lateral cervical spine plain radiograph illustrating the Torg/Pavlov ratio.
Axial computed tomography scan of cervical herniated nucleus pulposus.
T1-weighted magnetic resonance image of a cervical disk herniation.
T2-weighted magnetic resonance image of a cervical disk herniation.
Myelogram of cervical herniated disk. A filling defect is shown.
Three-dimensional computed tomography scan of C1.
Lateral view of a C2 fracture dislocation.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.