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

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.

Treatment & Management

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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, 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: 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.

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.

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.

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 Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

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.

Acknowledgements

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.

Cervical Disc Injuries Workup

Imaging Studies

Plain radiography

MRI

Other Tests

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