Diagnostic Considerations

Mechanical etiologies include the following:

Cervical stenosis
Cervical zygapophyseal (facet) arthropathy

Infectious etiologies include the following:

Discitis
Epidural, subdural, or intradural abscess

Metabolic etiologies include the following:

Osteomalacia
Parathyroid disease

Rheumatologic etiologies include the following:

Polymyalgia rheumatica
Ankylosing spondylitis
Reiter syndrome
Enteropathic arthritis
Diffuse idiopathic skeletal hyperostosis

Differential Diagnoses

Workup

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Media Gallery

Disc herniation classification. A: Normal disc anatomy demonstrating nucleus pulposus (NP) and annular margin (AM). B: Disc protrusion, with NP penetrating asymmetrically through annular fibers but confined within the AM. C: Disc extrusion with NP extending beyond the AM. D: Disc sequestration, with nuclear fragment separated from extruded disc.
Axial magnetic resonance imaging (MRI) scan (C3-C4) demonstrating left-sided posterolateral protrusion of the nucleus pulposus with compression of the cerebrospinal fluid.
Sagittal magnetic resonance imaging (MRI) scan demonstrating cervical intervertebral disc protrusions at C3-C4 and C7-T1.
Right C7 cervical transforaminal epidural steroid injection demonstrating epidural and radicular spread of radiologic contrast dye.
Cervical epidural steroid injection at the C7-T1 interlaminar space.
Cervical discography. Anteroposterior fluoroscopic image.
Cervical discography. Lateral fluoroscopic image.
Postdiscography axial computed tomography (CT) scan demonstrating right posterolateral subligamentous protrusion.

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Author

Michael B Furman, MD, MS Physiatrist, Interventional Spine Care Specialist, Electrodiagnostics, Pain Medicine, Director, Spine and Sports Fellowship, OSS Health

Michael B Furman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, North American Spine Society, Pennsylvania Medical Society, Spine Intervention Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: OSS Health<br/>Serve(d) as a speaker or a member of a speakers bureau for: Spine Intervention Society; North American Spine Society<br/>Received research grant from: Mesoblast/ Cascade<br/>Received income in an amount equal to or greater than $250 from: Elsevier (Royalties).

Coauthor(s)

Gene Tekmyster, DO Assistant Professor, Department of Orthopedic Surgery, Physician in Interventional Spine Care, Regenerative and Sports Medicine, Keck School of Medicine of the University of Southern California

Gene Tekmyster, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, Association of Academic Physiatrists, International Spine Intervention Society, North American Spine Society

Disclosure: Nothing to disclose.

Jeremy Simon, MD Attending Physician, Department of Physical Medicine, The Rothman Institute

Jeremy Simon, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation, International Spine Intervention Society

Disclosure: Nothing to disclose.

Kirk M Puttlitz, MD Consulting Staff, Pain Management and Physical Medicine, Arizona Neurological Institute

Kirk M Puttlitz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Phi Beta Kappa

Disclosure: Nothing to disclose.

Frank John English Falco, MD Clinical Assistant Professor, Director of the Pain Management Fellowship Program, Temple University Hospital

Frank John English Falco, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, Association of Academic Physiatrists, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Received consulting fee from St. Jude's Medical for speaking and teaching; Received consulting fee from Joimax for speaking and teaching.

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.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief Medical Officer, Corpus Christi Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, Texas Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Everett C Hills, MD, MS Principal Consultant, Function Focused PMR Care+, LLC

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Pennsylvania Medical Society

Disclosure: Nothing to disclose.