Cervical Disc Injuries Workup

Updated: Apr 03, 2022
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD  more...
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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. [18] 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 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. [19]


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.