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Cervical Neck Pain or Cervical Radiculopathy

Appropriate cervical spine (c-spine) imaging and use of intravenous contrast (venous dye) for neck pain varies depending on clinical scenario.

In individuals with new or increasing nontraumatic neck pain (no high-risk factors), x-rays are usually appropriate as first imaging test; MRI or CT without contrast may be appropriate.

In cases with spinal nerve irritation (pinched nerve), MRI without contrast is usually appropriate, and x-rays or CT without contrast may be appropriate.

If there is history of prior c-spine surgery, x-rays or CT without contrast is usually appropriate; MRI with or without contrast (or both) or CT myelography (contrast injection in space around spinal cord) may be appropriate.

If infection is suspected, MRI without and with contrast is usually appropriate; x-rays, CT, or MRI with or without contrast may be appropriate.

In individuals with cancerous tumors, MRI without and with or only without contrast is usually appropriate; x-rays, CT with or without contrast, MRI with contrast, or bone scan or CT may also be appropriate.

With headaches originating in the c-spine without weakened nerve function, MRI or CT without contrast may be appropriate, as well as x-rays or nerve block injection.

In chronic neck pain, x-rays are usually appropriate as initial imaging. MRI without contrast may be appropriate.

If x-rays show degenerative changes, MRI without contrast is usually appropriate. CT without contrast or CT myelography may be appropriate.

If x-rays show hardening of the connecting fibers of the neck vertebrae, CT without contrast is usually appropriate; CT myelography or MRI without contrast may be appropriate.

— By Susan Anemone and Bruno Policeni, MD, MBA. This information originally appeared in the Journal of the American College of Radiology.

This page was reviewed on December 15, 2021

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