Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
Study Results
Study Quality
Study Quality
1. Aprill C, Bogduk N. The prevalence of cervical zygapophyseal joint pain. A first approximation. Spine (Phila Pa 1976). 1992;17(7):744-747. Review/Other-Dx 318 patients To determine if zygapophyseal pain was common using provocative discography and facet block. Symptomatic zygapophyseal joints were encountered in 25% of the sample with a possibility that a further 38% suffered zygapophyseal pain but were not appropriately investigated. The null hypothesis was rejected. 4
2. Deans GT, Magalliard JN, Kerr M, Rutherford WH. Neck sprain--a major cause of disability following car accidents. Injury. 1987;18(1):10-12. Review/Other-Dx 137 patients Follow-up study (1-2 years) after car accident to determine incidence of neck pain. 85 (62%) had pain in the neck at some time following their accident compared with 42 (30.6%) who were noted to have pain in the neck when examined soon after the accident. 31 patients (22.6%) still felt occasional pain 1 year after the accident and 5 had continuous pain at 1 year. Pain in the neck occurred irrespective of the direction of impact but was disproportionately common in rear impact accidents. Patients wearing seat belts experienced pain more frequently than unbelted patients. 4
3. Gore DR, Sepic SB, Gardner GM, Murray MP. Neck pain: a long-term follow-up of 205 patients. Spine (Phila Pa 1976). 1987;12(1):1-5. Review/Other-Dx 205 patients 10 year follow-up of patients with neck pain to determine degenerative changes, spinal stenosis or cervical lordosis. 79% had a decrease in pain, and 43% were free of pain; however, 32% had moderate or severe residual pain. Patients who had been injured and initially had severe pain were the most likely to have an unsatisfactory outcome; however, no other clinical features were of value in predicting the final result. The presence or severity of pain was not related to the presence of degenerative changes, the sagittal diameter of the spinal canal, the degree of cervical lordosis, or to any changes in these measurements over the evaluation period. 4
4. Makela M, Heliovaara M, Sievers K, Impivaara O, Knekt P, Aromaa A. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol. 1991;134(11):1356-1367. Review/Other-Dx 7,216 patients To describe the distribution, determinants and consequences of chronic neck pain in a representative sample of Finnish adults. Chronic neck syndrome was diagnosed in 9.5% of the men and 13.5% of the women. When adjusted for age and sex, the prevalence of the neck syndrome was associated with a history of injury to the back, neck, or shoulder and with mental and physical stress at work. There was some independent association between neck syndrome and disabilities, use of physician services, and use of pain killers. 4
5. Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334(7592):527-531. Review/Other-Dx N/A Review diagnosis of cervical spondylosis and the evidence available for the different treatments. The diagnosis of cervical spondylosis is usually based on clinical symptoms. The best treatments are exercise, manipulation, and mobilization, or combinations thereof. 4
6. Kaale BR, Krakenes J, Albrektsen G, Wester K. Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma. 2005;22(4):466-475. Observational-Dx 87 persons with a WAD2 diagnosis and 29 control individuals To determine whether reported pain and functional disability in WAD patients is associated with specific soft tissue abnormalities in the upper cervical spine, as assessed by MRI. Symptoms and complaints among WAD patients is linked with structure abnormalities in ligaments and membranes in the upper cervical spine, in particular the alar ligaments. 2
7. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976). 1995;20(8 Suppl):1S-73S. Review/Other-Dx N/A To evaluate the Quebec experience in “whiplash”, redefine it and make recommendations regarding management. Excellent cooperative study that developed a flow sheet defining WAD and recommends diagnosis and management. 4
8. Vetti N, Krakenes J, Eide GE, Rorvik J, Gilhus NE, Espeland A. MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2: high-signal changes by age, gender, event and time since trauma. Neuroradiology. 2009;51(4):227-235. Observational-Dx 1,226 patients To describe the prevalence of high signal changes on MRI studies of the alar and transverse ligaments in WAD grade 1-2, in relation to age, gender, spinal degeneration, type of trauma, and time since trauma. MRI showed grades 2-3 alar ligament changes in 449 (35.5%; 95% CI, 32.8% to 38.1%) and grades 2-3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2-3 changes were more common in men than women, OR 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided. 4
9. Chen Y, Guo Y, Chen D, et al. Diagnosis and surgery of ossification of posterior longitudinal ligament associated with dural ossification in the cervical spine. Eur Spine J. 2009; 18(10):1541-1547. Observational-Dx 62 patients To determine if there are any neutral-position imaging criteria that can help predict functional cord impingement at flexion-extension cervical MRI. MRIs in 19 (31%) of 62 patients showed functional cord impingement at extension MRI compared with images in 2 (3%) patients at flexion MRI. Statistically significant differences were found for the criteria cervical degeneration stage (P<.001) and spinal canal space (P=.037) for predicting functional cord impingement at extension MRI. In contrast, no significant differences were found among selection criteria for flexion MRI. Probabilities of functional cord impingement at extension MRI were calculated with different combinations of degenerative stages and canal spaces. Probability could increase to 79% if the patient had both stabilization degeneration (disk protrusion or osteophytic formation with hypertrophy of the ligamentum flavum) and C7 canal space of =10 mm. 3
10. Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine J. 2011;5(4):267-276. Review/Other-Dx N/A To review current development, natural history, clinical symptoms, classification, radiologic diagnosis, and treatments regarding OPLL. Radiological analysis of plain radiograph, CT and MRI is essential, and preoperative meticulous evaluation on maximum compression area of the spinal cord, dural ossification, and presence of signal changes in the spinal cord is important for establishing treatment plans and prognoses of the patients. 4
11. van der Donk J, Schouten JS, Passchier J, van Romunde LK, Valkenburg HA. The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. J Rheumatol. 1991;18(12):1884-1889. Review/Other-Dx 5,440 men and women To examine the association of neck pain with personality traits, disc degeneration and osteoarthritis on radiographs. Disc disease causes neck pain in men but not women. Facet osteoarthritis not related to pain but to personality traits, neuroticism and injury. 4
12. Goode AP, Freburger J, Carey T. Prevalence, practice patterns, and evidence for chronic neck pain. Arthritis Care Res (Hoboken). 2010;62(11):1594-1601. Review/Other-Dx 141 noninstitutionalized adults To estimate the prevalence of chronic neck pain in North Carolina, to describe health care use (providers, treatments, and diagnostic testing) for chronic neck pain, and to correlate health care use with the current best evidence. The estimated prevalence of chronic neck pain in 2006 among noninstitutionalized individuals for the state of North Carolina was 2.2% (95% CI, 1.7-2.6). Individuals with chronic neck pain were middle-aged (mean age 48.9 years) and the majority of subjects were women (56%) and non-Hispanic white (81%). The subjects saw a mean of 5.21 (95% CI, 4.8-5.6) provider types and had a mean of 21 visits. The types of treatments subjects reported varied, with treatments such as electrotherapy stimulation (30.3%), corsets or braces (20.9%), massage (28.1%), ultrasound (27.3%), heat (57.0%), and cold (47.4%) having unclear or little benefit based on the current best available reviews. 4
13. Kaaria S, Laaksonen M, Rahkonen O, Lahelma E, Leino-Arjas P. Risk factors of chronic neck pain: a prospective study among middle-aged employees. Eur J Pain. 2012;16(6):911-920. Review/Other-Dx 5,277 participants To study the associations of sociodemographic factors, working conditions, lifestyle and previous pain in the spine with new onset chronic neck pain. The incidence of chronic neck pain was 15% in women and 9% in men. In multivariable analysis among women, acute neck pain [OR 3.8, 95% CI, 2.9-5.1], chronic low back pain (1.6, 1.2-2.2), reporting current workplace bullying (OR 1.6, 95% CI, 1.1-2.4), earlier bullying at the present workplace (1.6, 1.2-2.0), and earlier bullying in another workplace (1.8, 1.3-2.4), frequent sleep problems (1.5, 1.2-2.0), overweight (1.2, 1.0-1.5), and obesity (1.4, 1.1-1.8) predicted chronic neck pain at follow-up. Men with acute NP (2.3, 1.4-3.8), chronic low back pain (2.3, 1.2-4.3), manual occupational class (1.8, 1.1-3.1) and high work-related emotional exhaustion (1.9, 1.1-3.3) at baseline had an increased risk of new onset chronic neck pain. 4
14. Nolet PS, Cote P, Cassidy JD, Carroll LJ. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. Eur Spine J. 2010;19(6):972-981. Observational-Dx 919 Saskatchewan adults To investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The authors found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index (adjusted HRR = 2.14; 95% CI, 1.12-4.10). 4
15. Ichihara D, Okada E, Chiba K, et al. Longitudinal magnetic resonance imaging study on whiplash injury patients: minimum 10-year follow-up. J Orthop Sci. 14(5):602-10, 2009 Sep. Observational-Dx 133 patients Prospective, long-term follow-up study to assess associations between MRI findings and changes in clinical symptoms in patients with whiplash injury. Progression of some degenerative changes was recognized on MRI in 98.5% of the 133 whiplash injury patients, and clinical symptoms diminished in more than a half of the 133 patients. There were no statistically significant associations between MRI findings and changes in clinical symptoms. The prognosis for neck pain tended to be poor after accidents with double collisions (rear-end collision followed by frontend collision) [adjusted OR 5.83, 95% CI, 1.15-29.71] and accidents with serious car damage (2.87, 1.03-7.99). The prognosis for stiff shoulders tended to be poor in women (2.83, 1.23-6.51); and the prognosis for numbness in the upper extremities tended to be poor after accidents with serious car damage (3.39, 1.14-10.06). 3
16. Daffner RH. Radiologic evaluation of chronic neck pain. Am Fam Physician. 2010;82(8):959-964. Review/Other-Dx N/A To summarize the American College of Radiology Appropriateness Criteria for chronic neck pain. Imaging plays an important role in evaluating patients with chronic neck pain. Five radiographic views (anteroposterior, lateral, open-mouth, and both oblique views) are recommended for all patients with chronic neck pain with or without a history of trauma. MRI should be performed in patients with chronic neurologic signs or symptoms, regardless of radiographic findings. The role of MRI in evaluating ligamentous and membranous abnormalities in persons with WAD is controversial. If there is a contraindication to MRI, CT myelography is recommended. Patients with normal radiographic findings and no neurologic signs or symptoms, or patients with radiographic evidence of spondylosis and no neurologic findings, need no further imaging studies. 4
17. Matsunaga S, Nakamura K, Seichi A, et al. Radiographic predictors for the development of myelopathy in patients with ossification of the posterior longitudinal ligament: a multicenter cohort study. Spine (Phila Pa 1976). 2008;33(24):2648-2650. Observational-Dx 156 patients To identify radiographic predictors for the development of myelopathy in patients with OPLL. All 39 patients with greater than 60% spinal canal stenosis on the plain roentgenogram exhibited myelopathy. Of 117 patients with less than 60% spinal canal stenosis, 57 (49%) patients exhibited myelopathy. The range of motion of the cervical spine was significantly larger in patients with myelopathy than in those without it. The axial ossified pattern could be classified into 2 types: a central type and a lateral deviated type. The incidence of myelopathy in patients with <60% spinal canal stenosis was significantly higher in the lateral deviated-type group than in the central-type group. 15 patients of 156 subjects developed trauma-induced myelopathy. Of the 15 patients, 13 had mixed-type OPLL and 2 had segmental-type OPLL. 3
18. Laker SR, Concannon LG. Radiologic evaluation of the neck: a review of radiography, ultrasonography, computed tomography, magnetic resonance imaging, and other imaging modalities for neck pain. Phys Med Rehabil Clin N Am. 2011;22(3):411-428, vii-viii. Review/Other-Dx N/A To review the current literature on imaging for the patient with neck pain, illustrate several imaging abnormalities, and discuss the workup of commonly seen patient populations. As imaging progresses, isolated radiographs continue to move toward multimodality evaluation of patients with neck pain. Effective use of the full gamut of imaging modalities allows the physician to reliably diagnose and treat the patient with neck pain. Future trends suggest the use of functional imaging to help guide both surgical and nonsurgical treatments. 4
19. Mathers KS, Schneider M, Timko M. Occult hypermobility of the craniocervical junction: a case report and review. J Orthop Sports Phys Ther. 2011;41(6):444-457. Review/Other-Dx 1 patient To review history, physical exam, and diagnostic imaging findings of a patient with neck pain, occipital headache, and dizziness associated with a past history of cervical spine injury. Stress cervical radiographs, obtained using open-mouth projections in neutral, left, and right cervical lateral flexion, revealed a 3-mm lateral offset of the right lateral mass of C1 on C2. MRI evaluation of the lower cervical spine did not reveal any significant disc derangement; however, images of the soft tissues of the craniocervical junction were not obtained. Based on the examination and imaging studies, the patient was determined to have a previously undiagnosed hypermobility of the atlantoaxial joint. 4
20. Richards JS, Kerr GS, Nashel DJ. Odontoid erosions in rheumatoid arthritis: utility of the open mouth view. J Clin Rheumatol. 2000;6(6):309-312. Review/Other-Dx 25 patients To determine if odontoid erosions are a marker for more severe cervical spine disease in rheumatoid arthritis. Lateral cervical spine views were available for 19 patients, 11 of whom demonstrated odontoid erosions. 7/22 patients who had open mouth odontoid views available demonstrated odontoid erosions. In only 3/15 patients could odontoid erosions be seen on both views. Anterior atlantoaxial subluxation was present in 6/25 patients, 5 of whom had odontoid erosions. Anterior atlantoaxial subluxation was seen more commonly in patients with odontoid erosions. 4
21. Taniguchi D, Tokunaga D, Hase H, et al. Evaluation of lateral instability of the atlanto-axial joint in rheumatoid arthritis using dynamic open-mouth view radiographs. Clin Rheumatol. 27(7):851-7, 2008 Jul. Observational-Dx 30 rheumatoid arthritis patients and a control group of 22 non- rheumatoid arthritis outpatients The authors hypothesized that not only antero-posterior sagittal instability, but also lateral coronal instability may occur with atlanto-axial involvement in rheumatoid arthritis. To prove this hypothesis, the authors evaluated the lateral instability of the atlanto-axial joint in rheumatoid arthritis, using dynamic open-mouth view radiographs. In the rheumatoid arthritis group, anterior atlanto-dental interval averaged 3.2 mm in flexion, and in 8 patients, it exceeded 3 mm in flexion anterior atlanto-axial subluxation. In the control group, the anterior atlanto-dental interval averaged 1.0 mm in flexion. The atlanto-dental lateral shift in the RA group averaged 14.8%, and this was significantly greater than in the control group, in which it averaged 6.1%. The atlanto-dental lateral shift averaged 20.6% in the rheumatoid arthritis subgroup with anterior atlanto-axial subluxation, and 12.7% in the rheumatoid arthritis subgroup without anterior atlanto-axial subluxation. In both subgroups, the atlanto-dental lateral shift was significantly greater than that of the control group. 3
22. Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases. Clin Rheumatol. 1998;17(6):511-514. Observational-Dx 65 patients To assess the value of lateral view cervical spine radiography in various positions of the neck in patients with rheumatoid atlantoaxial subluxation. The authors wanted to find out how much information is lost if only neutral position radiographs are used. Lateral view cervical spine radiographs were taken in the neutral position and during flexion and extension. Neutral position radiographs would have failed to confirm the diagnosis of atlantoaxial subluxation in 31 cases (48%) and would have failed to record its true severity in 43 cases (66%); their diagnostic sensitivity was 52%. The sensitivity of the neutral radiographs in showing the reversibility of atlantoaxial subluxation was 48%. Routine cervical spine radiography of rheumatoid patients should include lateral view radiographs taken during flexion and extension. The result may be applied to MRI, which is usually performed in the neutral position. 3
23. Rosenbaum DM, Blumhagen JD, King HA. Atlantooccipital instability in Down syndrome. AJR Am J Roentgenol. 1986;146(6):1269-1272. Review/Other-Dx 2 patients To report the findings in two children with Down syndrome who have striking atlantooccipital subluxation demonstrated on flexion and extension radiographs. Since there is increasing radiologic evaluation of cervical spine stability in patients with Down syndrome who wish to participate in athletic activities, the status of the atlantooccipital joint needs careful assessment, especially after cervical fusion for C1-C2 instability. 4
24. Ghiselli G, Wharton N, Hipp JA, Wong DA, Jatana S. Prospective analysis of imaging prediction of pseudarthrosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation. Spine (Phila Pa 1976). 2011;36(6):463-468. Observational-Dx 22 patients To prospectively compare motion analyzed flexion/extension radiographs to CT to predict pseudarthroses. Define motion thresholds on flexion/extension radiographs to define pseudarthroses. Using greater than 4 degrees of measured motion on flexion/extension radiographs resulted in a Spearman correlation P-value of 0.096 (95% CI, -0.06 to 0.66). Using greater than 1 degrees of motion, the Spearman correlation P<0.0001 (95% CI, 0.54-0.90). The PPV using 4 degrees of motion as the criterion was 100%, indicating a high specificity. The NPV was 52%, indicating a low sensitivity. Using greater than 1 degrees of motion, the PPV was 100% and the NPV was 73%. Findings from CT showed an identical PPV and NPV to assessments made using greater than 1 degrees of rotation. Specificity and PPV were 100% for all criteria. Using a lack of bridging on CT or more than 1 degrees of intervertebral motion during flexion/extension increased the sensitivity to 85% and the NPV to 85%. 3
25. Hong JT, Sung JH, Son BC, Lee SW, Park CK. Significance of laminar screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976). 2008;33(16):1739-1743. Review/Other-Tx 11 patients To describe the technique and surgical results of translaminar screw placement in the subaxial cervical spine. The mean follow-up period was 5.7 months, at which time there was no significant complications from laminar screw placement, except for 2 asymptomatic breaches of the dorsal lamina cortex. Sound bone fusion was identified in cases where arthrodesis was the goal. No screw pullout or avulsion was identified in the laminoplasty cases. 4
26. Hwang IC, Kang DH, Han JW, Park IS, Lee CH, Park SY. Clinical experiences and usefulness of cervical posterior stabilization with polyaxial screw-rod system. J Korean Neurosurg. Soc 2007;42(4):311-316. Review/Other-Tx 32 patients To investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segments (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and CT scans in all cases. Revision surgery was required in 2 cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. 4
27. Ryu WH, Kowalczyk I, Duggal N. Long-term kinematic analysis of cervical spine after single-level implantation of Bryan cervical disc prosthesis. Spine J. 2013;13(6):628-634. Observational-Dx 20 patients To characterize the long-term segmental kinematic outcomes after cervical arthroplasty. Biomechanics of the implanted artificial cervical disc was maintained up to 5 years with no significant changes in range of motion, functional spinal unit angle, disc height, sagittal translation, and center of rotation values when compared with early postoperative performance. Artificial discs were able to adequately restore and maintain preoperative kinematics. Early differences seen in disc height and functional spinal unit angle did not change during the duration of follow-up. No significant kyphotic changes or decrease in range of motion were seen at the adjacent spinal levels. 3
28. White AP, Biswas D, Smart LR, Haims A, Grauer JN. Utility of flexion-extension radiographs in evaluating the degenerative cervical spine. Spine (Phila Pa 1976). 2007;32(9):975-979. Review/Other-Dx 258 patients To determine the: (1) percentage of flexion-extension radiographs that revealed pathology not appreciated on neutral radiographs in the nontrauma population, and (2) frequency that these views led to a change in the management of these patients. Listhesis was observed on 23 of the neutral lateral images; 6 of these were found to have changes between flexion and extension (2-4 mm). 2 patients (1%) had spondylolisthesis on flexion-extension radiographs not visualized on neutral lateral radiographs. A subsequent review of these patients' charts revealed no change in management based on these findings. 4
29. Okada E, Matsumoto M, Ichihara D, et al. Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study. Spine (Phila Pa 1976). 2009;34(7):706-712. Observational-Dx 223 subjects To clarify normal aging process of cervical spine and correlation between progression of disc degeneration and development of clinical symptoms. Progression of degenerative findings was observed in 189 subjects (81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%, anterior compression of dura and spinal cord in 61.4%, posterior disc protrusion in 70.0%, disc space narrowing in 26.9%, and foraminal stenosis in 9.0%. Logistic regression analysis revealed that incidence of progression of posterior disc protrusion; foraminal stenosis was higher in elderly subjects. There were no correlations between any degenerative MRI findings and sex, smoking, alcohol, sport, or body mass index. Neck pain, shoulder stiffness, and numbness in upper extremities were recognized in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have developed in 34.1% during 10 years. 3
30. Song KJ, Choi BW, Kim GH, Kim JR. Clinical usefulness of CT-myelogram comparing with the MRI in degenerative cervical spinal disorders: is CTM still useful for primary diagnostic tool? J Spinal Disord Tech. 2009;22(5):353-357. Observational-Dx 50 patients (29 radiculopathy and 21 myelopathy) To compare the accuracy between MRI and CTM in degenerative cervical spine disease by assessing the degree of interobserver and intraobserver agreement. Intraclass correlation coefficiency statistical analysis showed moderate intraobserver agreement (Cronbach's alpha=0.63) and interobserver agreement (0.52). There was no significant difference in intraobserver, interobserver agreement between MRI (0.58) and CTM (0.57). Compared between MRI and CTM, disc abnormality and nerve root compression on MRI and foraminal stenosis and bony lesion on CTM showed better agreement. 3
31. Arana E, Marti-Bonmati L, Molla E, Costa S. Upper thoracic-spine disc degeneration in patients with cervical pain. Skeletal Radiol. 2004;33(1):29-33. Observational-Dx 156 patients To study the relationship of upper thoracic spine degenerative disc changes on MRI in patients with neck pain. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together (P<.001), but not with any thoracic disc. 4
32. Boutin RD, Steinbach LS, Finnesey K. MR imaging of degenerative diseases in the cervical spine. Magn Reson Imaging Clin N Am. 2000;8(3):471-490. Review/Other-Dx N/A Review the role of MRI in evaluating patients with chronic neck pain. MRI is single best test to detect and distinguish between the various clinical diagnostic possibilities that may cause neck pain. 4
33. Kongsted A, Sorensen JS, Andersen H, Keseler B, Jensen TS, Bendix T. Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. Eur Spine J. 2008;17(8):996-1005. Review/Other-Dx 178 participants Prospective, multicenter study to evaluate the predictive value of cervical MRI after whiplash injuries as well as the value of repeating MRI examinations after 3 months. Traumatic findings were observed in 7 participants. Signs of disc degeneration were common and most frequent at the C5-6 and C6-7 levels. Findings were not associated with outcome after 3 or 12 months. The population had no considerable neck trouble prior to the whiplash injury and the nontraumatic findings represent findings to be expected in the background population. Trauma-related MRI findings are rare in a whiplash population screened for serious injuries in the emergency unit and not related to a specific symptomatology. Also, pre-existing degeneration is not associated with prognosis. 4
34. Krakenes J, Kaale BR. Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine (Phila Pa 1976). 2006;31(24):2820-2826. Review/Other-Dx N/A To determine the role of MRI for soft tissue abnormalities in patients with a history of whiplash trauma. MRI shows structural changes in ligaments and membranes after whiplash injury, and such lesions can be assessed with reasonable reliability. Lesions to specific structures can be linked with specific trauma mechanisms. There is a correlation between clinical impairment and morphologic findings. 4
35. Ozawa H, Sato T, Hyodo H, et al. Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy. Spinal Cord. 2010;48(5):415-422. Observational-Dx 683 patients To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated. Intramedullary enhancement was observed in 50 cases (7.3%). The enhancements were observed between the most severely compressed disc and the cranial half of the lower vertebral body. On axial images, they were observed at the posterior or posterolateral periphery of the spinal cord. Enhancement areas were observed within T2 high-intensity areas and smaller than them. The preoperative Japanese Orthopedic Association (JOA) score was 9.8+/-2.8 points in the enhancement group and 9.8+/-3.3 points in the non-enhancement group (NS). The postoperative JOA score was 12.7+/-2.9 points in the enhancement group and 14.2+/-2.4 in the non-enhancement group (P=0.006). Intramedullary enhancement disappeared in 60% of the patients 1 year after surgery. 3
36. Myran R, Kvistad KA, Nygaard OP, Andresen H, Folvik M, Zwart JA. Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: a case-control study. Spine (Phila Pa 1976). 2008;33(18):2012-2016. Observational-Dx 173 patients; 2 reviewers Blinded, case-control study to assess signal intensity changes in MRI of the alar ligaments. 3 groups of patients: 59 involved in motor vehicle collision with WAD; 57 with chronic neck pain and no history of trauma; 57 controls with no history of trauma and no pain. Alar ligament changes Grade 0 to 3 were seen in all 3 diagnostic groups. Areas of high signal intensity (Grade 2-3) were found in at least one alar ligament in 49% of the patients in the whiplash associated disorder Grade I-II group, in 33% of the chronic neck pain group and in 40% of the control group (chi, P=0.22). 3
37. Avadhani A, Rajasekaran S, Shetty AP. Comparison of prognostic value of different MRI classifications of signal intensity change in cervical spondylotic myelopathy. Spine J. 2010;10(6):475-485. Observational-Dx 35 patients To determine the MRI classification of signal intensity changes in patients with cervical spondylotic myelopathy that is useful for prognostication of surgical outcome. Preoperative MRI studies demonstrated the following: Grade 0=1, Grade 1=13, Grade 2=13; focal=18, multisegmental=16; Group A=1; Group B=29; and Group C=5. Resolution of signal changes in T2-weighted images was seen in most patients; however, 4 patients developed low signal intensity in T1-weighted images in the postoperative MRI. There was no significant difference in the recovery rates of patients with different grades in the T2-weighted images or with focal or multisegmental signal intensity changes (P=.47 and .28, respectively). In contrast, patients with low signal intensity changes in T1-weighted images were associated with a poor surgical outcome (P<.001). The linear regression model performed using low-intensity signal changes as a dependent variable and the recovery rate as an independent variable confirmed the significance (P<.001) of low signal intensity changes on T1-weighted images as a predictor for surgical outcome. 3
38. Chen CJ, Hsu HL, Niu CC, et al. Cervical degenerative disease at flexion-extension MR imaging: prediction criteria. Radiology. 2003;227(1):136-142. Observational-Dx 62 patients To determine if there were any neutral-positioning criteria that can help predict functional cord impingement at flexion-extension cervical MRI. MRIs in 19 (31%) of 62 patients showed functional cord impingement at extension MRI compared with images in 2 (3%) patients at flexion MRI. Statistically significant differences were found for the criteria cervical degeneration stage (P<.001) and spinal canal space (P=.037) for predicting functional cord impingement at extension MRI. In contrast, no significant differences were found among selection criteria for flexion MRI. Probabilities of functional cord impingement at extension MRI were calculated with different combinations of degenerative stages and canal spaces. Probability could increase to 79% if the patient had both stabilization degeneration (disk protrusion or osteophytic formation with hypertrophy of the ligamentum flavum) and C7 canal space of 10 mm or less. 2
39. Zhang L, Zeitoun D, Rangel A, Lazennec JY, Catonne Y, Pascal-Moussellard H. Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging: about a prospective study of fifty patients. Spine (Phila Pa 1976). 2011;36(17):E1134-1139. Observational-Dx 50 patients To evaluate the usefulness of preoperative flexion-extension MRI for patients with cervical spondylotic myelopathy. On both the anterior and posterior edges of the cord, mean length of the cervical cord in flexion was longer than in extension or the neutral position and longer in the neutral position than in extension (P<0.05). In all three positions, the average length of the anterior edge of the cervical cord was longer than the posterior edge (P<0.05). The mean value of cervical cord sagittal diameter at each level in extension was greater than in flexion or the neutral position (P<0.05). In the neutral position, cervical cord sagittal diameter were greater than in flexion from C4 to C7 (P<0.05), but this difference failed to reach significance at levels C3 and T1. In the neutral position, cervical cord available space was greater than in either extension or flexion (P<0.05), and cervical cord available space was greater in flexion than in extension (P<0.05) at all levels except C6, at which cervical cord available space was greater in flexion than in either extension or the neutral position (P<0.05). MRI demonstrated functional cord impingement (grade 3 of Muhle) in 6/50 (12%) patients in flexion, in 17 patients (34%) in the neutral position, and in 37 patients (74%) in extension. Intramedullary high-intensity signal was observed in flexion in 20 patients (40%), in the neutral position in 13 patients (26%), and in extension in 7 patients (14%). 3
40. Hung SC, Wu HM, Guo WY. Revisiting anterior atlantoaxial subluxation with overlooked information on MR images. AJNR Am J Neuroradiol. 2010;31(5):838-843. Observational-Dx 40 patients and 20 controls To systematically investigate imaging findings of supine neutral positioning cervical spine MRIs and focus on these anchoring points in both normal and abnormal atlantodental interval cases to improve accuracy in diagnosing anterior atlantoaxial subluxation. 38% (15/40) of patients with anterior atlantoaxial subluxation showed anterior atlantoaxial subluxation with normal atlantodental interval. There was no significant difference between the groups of anterior atlantoaxial with normal and abnormal atlantodental interval except that more peridental pannus was seen in the latter group. More dens erosion (P=.022), tilting of anterior atlantoaxial joint (P=.022), peridental effusion (P<.001), lateral facet arthropathy (P<.001), abnormal spinolaminar line (P=.001), and focal myelopathy (P=.001) were observed in anterior atlantoaxial subluxation with normal atlantodental interval patients compared with the controls. The combination of peridental effusion, lateral facet arthropathy, abnormal intramedullary signals, and abnormal spinolaminar line showed a sensitivity of 100% and a specificity of 90% in diagnosing anterior atlantoaxial subluxation. 3
41. Bykowski JL, Wong WH. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol. 2012;33(8):1419-1426. Review/Other-Dx N/A The authors discuss patient evaluation, the role of imaging, current and emerging image-guided therapies for facet-related pain, and the increasing importance of outcome-related research in this arena. Neuroradiologists interested in treating patients with chronic facet degenerative pain should be aware of the options and the role of physical examination and history in addition to imaging, as well as the need to closely track and report outcomes. 4
42. Fryer G, Adams JH. Magnetic resonance imaging of subjects with acute unilateral neck pain and restricted motion: a prospective case series. Spine J. 2011;11(3):171-176. Review/Other-Dx 5 subjects To investigate the presence of periarticular tissue inflammation and zygapophysial joint synovitis in the cervical region using MRI in subjects with acute unilateral cervical pain and limited motion (acute "crick in the neck" <48 hours from onset), as well as the feasibility of recruiting these subjects. Subjects presented with mean current pain of 4.8 (SD, 1.6; visual analog scale, 0-10), worst pain since onset of 7.0 (SD, 0.7), and duration of symptoms of 12.4 hours (SD, 14.1). The plane of active motion most commonly limited was rotation to the painful side, followed by side bending to the painful side and extension. No MRI findings demonstrated clear evidence of synovial effusion or inflammation around the joints of the cervical spine. In some individuals, signs of muscle edema, altered alignment, disc and facet arthrosis, and spinal stenosis were noted, but these did not appear to be related to the side of pain or symptomatic level. 4
43. Baker JC, Demertzis JL, Rhodes NG, Wessell DE, Rubin DA. Diabetic musculoskeletal complications and their imaging mimics. Radiographics. 2012;32(7):1959-1974. Review/Other-Dx 5 subjects To review diabetic musculoskeletal complications and their imaging mimics. Contrast material-enhanced MRI is important when planning the treatment of foot infections in diabetic patients because it allows the differentiation of viable tissue from necrotic regions that require surgical debridement in addition to antibiotic therapy. 4
44. Kiss E, Keusch G, Zanetti M, et al. Dialysis-related amyloidosis revisited. AJR Am J Roentgenol. 2005;185(6):1460-1467. Review/Other-Dx N/A To illustrate the radiographic, sonographic, CT, and MRI findings of dialysis-related amyloid arthropathies. Dialysis-related amyloidosis is characterized by various imaging appearances. In evaluating amyloidosis, MRI provides considerably more information than that obtained from conventional radiographic, CT, and sonographic studies. 4
45. Carragee EJ. Continuing debate: validity and utility of magnetic resonance imaging of the upper cervical spine after whiplash exposure. Spine J. 2009;9(9):778-779. Review/Other-Dx N/A A commentary on the validity and utility of MRI of the upper cervical spine after whiplash exposure. No results stated. 4
46. Johansson BH. Whiplash injuries can be visible by functional magnetic resonance imaging. Pain Res Manag. 2006;11(3):197-199. Review/Other-Dx 3 patients To show that functional MRI (with flexion and extension) is useful in delineating injuries at the craniocervical junction that standard MRI may fail to do. Functional MRI is an appropriate diagnostic tool. Adding flexion/extension sequences improves the diagnostic acumen. 4
47. Dullerud R, Gjertsen O, Server A. Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects. Acta Radiol. 2010;51(2):207-212. Observational-Dx 28 patients; 27 healthy controls To assess the ligaments and membranes in the craniocervical junction with MRI in patients with WAD and to compare them with healthy control subjects. High signal intensity of the alar and transverse ligaments was quite common and was reported at an average of about 50% both among patients and control subjects. The incidence of abnormalities of the tectorial and posterior atlantooccipital membranes was low in both groups. No statistically significant difference between control subjects and patients with WAD was revealed for any of the structures assessed. Additional fat-suppressed images seemed to reduce the number of reported anomalies. 4
48. Matsumoto M, Okada E, Ichihara D, et al. Prospective ten-year follow-up study comparing patients with whiplash-associated disorders and asymptomatic subjects using magnetic resonance imaging. Spine. 35(18):1684-90, 2010 Aug 15. Observational-Dx 133 WAD patients and 223 control subjects To clarify long-term impact of whiplash injury on patient's symptoms and on MRI findings of the cervical spine. Progression of decrease in signal intensity was observed in 109 WAD patients (82.0%), and 132 control subjects (59.2%), (age, sex adjusted OR: 3.06), posterior disc protrusion in 101 (75.9%) and in 155 (69.5%) (OR = 1.46), disc space narrowing in 33 (24.8%) and in 59 (26.5%) (OR = 0.98), and foraminal stenosis in 6 (4.5%), and in 20 (9.0%) (OR = 0.52), respectively. Neck pain was observed in 34 WAD patients (25.6%) and 22 control subjects (9.9%) (P<0.0001). There was no statistically significant correlation between neck pain and progression in each MR finding in either group. 3
49. Myran R, Zwart JA, Kvistad KA, et al. Clinical characteristics, pain, and disability in relation to alar ligament MRI findings. Spine. 36(13):E862-7, 2011 Jun. Observational-Dx 173 subjects To evaluate the association between degree of signal changes in the alar ligaments on MRI with respect to pain and disability. With respect to Brief Pain Inventory and Hospital Anxiety and Depression Rating Scale, the scores were highest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and lowest among controls. European Quality of Life scores were lowest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and highest among controls (P<0.001). There was, however, no significant correlation between the alar ligament changes and measures for pain and disability. 2
50. Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. [Review] [125 refs][Erratum appears in Spine. 2009 Mar 15;34(6):640], [Erratum appears in Spine (Phila Pa 1976). 2009 Mar;18(3):435-6], [Reprint in J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S117-40; PMID: 19251060]. Spine. 33(4 Suppl):S101-22, 2008 Feb 15. Review/Other-Dx 95 articles To critically appraise and synthesize the literature on assessment of neck pain. CT scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high PPV. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. 4
51. Vetti N, Krakenes J, Ask T, et al. Follow-up MR imaging of the alar and transverse ligaments after whiplash injury: a prospective controlled study. AJNR Am J Neuroradiol. 2011;32(10):1836-1841. Review/Other-Dx 3 patients To review patients that had been extensively examined without any findings of structural lesions and was diagnosed by functional MRI to have injuries in the craniocervical joint region. Functional MRI is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement pattern. 4
52. Stachniak JB, Diebner JD, Brunk ES, Speed SM. Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein-2 in patients at risk for pseudarthrosis. J Neurosurg Spine. 2011;14(2):244-249. Review/Other-Dx 30 patients To demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions using polyetheretherketone spacers with recombinant human bone morphogenetic protein-2 impregnated in a Type I collagen sponge and titanium plates. Patients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. 24 patients underwent 2-level anterior cervical discectomies and fusions and 6 underwent 3-level anterior cervical discectomies and fusions were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index =30 [43%]). 17% of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing-Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia. 4
53. Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT. Eur Spine J. 2013;22(5):1078-1089. Observational-Dx 22 patients of arthroplasty group and 21 patients of fusion group To determine associative factors of ASD after anterior cervical spine surgery. The study compared anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT. The study groups were demographically similar, and substantial improvements in visual analog scales (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2 % in the fusion group and 4.5 % in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9% and 50%, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups. 2
54. Yi S, Lee DY, Ahn PG, Kim KN, Yoon do H, Shin HC. Radiologically documented adjacent-segment degeneration after cervical arthroplasty: characteristics and review of cases. Surg Neurol. 2009;72(4):325-329; discussion 329. Review/Other-Dx 72 patients To retrospectively study the incidence and characteristics of radiologically documented adjacent-segment degeneration after single-level diskectomy and subsequent cervical arthroplasty using the Bryan (Medtronic Sofamor Danek; Memphis, TN) disk prosthesis. Among the 72 patients, 9 patients (12.5%) showed radiological evidence of adjacent-segment degeneration. The mean age was 43.3 years old, with a male-female ratio 1:3. The mean follow-up period was 24.2 (12.1-35.9) months. The mean period of onset was 16.3 months. Upper-segment degeneration was documented in 4 cases (3 new osteophyte, 1 enlargement of osteophyte), whereas lower-segment degeneration was noted in 5 cases (1 new osteophyte, 3 enlargement of osteophyte, 1 decreased disk height). Among the degenerated cases, 4 cases (44.4%) also showed various degrees of HO. 4
55. Kudo H, Yokoyama T, Tsushima E, et al. Interobserver and intraobserver reliability of the classification and diagnosis for ossification of the posterior longitudinal ligament of the cervical spine. Eur Spine J. 2013;22(1):205-210. Review/Other-Dx 16 observers To investigate the interobserver and intraobserver reliability of the classification and diagnosis for OPLL by radiographs and CT images. Interobserver reliability of the classification with radiographs only showed moderate agreement, but interobserver reliability with both radiographs and CT images showed substantial agreement. Intraobserver of reliability the classification was also improved by additional CT images. Interobserver reliability of the diagnosis with both radiographs and CT images was almost similar to with radiographs only. Intraobserver reliability of the diagnosis was improved by additional CT images. 4
56. Haque S, Bilal Shafi BB, Kaleem M. Imaging of torticollis in children. Radiographics. 2012;32(2):557-571. Review/Other-Dx N/A To review the normal anatomy of the cervical spine and various imaging techniques for the evaluation of torticollis and discuss the possible causes of torticollis in infants and children. In newborns or infants with congenital torticollis, US is the modality of choice. In cases of acquired torticollis resulting from trauma, conventional radiography (lateral and anteroposterior views) should be the first-line imaging modality. In nontraumatic acquired torticollis, CT of the neck or cervical spine is the initial imaging study. If CT findings are negative, MRI of the brain and cervical spine should be performed. The use of multiple imaging modalities (conventional radiography, US, CT, and MRI) is common in the radiologic work-up of torticollis, and radiologists must understand the role of each imaging modality in patients of various ages. 4
57. Makki D, Khazim R, Zaidan AA, Ravi K, Toma T. Single photon emission computerized tomography (SPECT) scan-positive facet joints and other spinal structures in a hospital-wide population with spinal pain. Spine J. 2010;10(1):58-62. Review/Other-Dx 534 patients To evaluate the prevalence of SPECT scan-positive facet joints and other spinal areas in different age groups in a hospital-wide population with spinal pain. A total of 486 patients (91.1%) had at least one positive abnormality on SPECT scan; 81.3% had increased uptake in different structures and regions of the spine. This included 42.8% increased uptake in the facet joint 29.8% in the vertebral bodies/end plates, and 5.9% in sacroiliac joints. The prevalence of increased uptake in the lumbosacral and cervical spine was 44% and 37%, respectively. When patients were divided into five age groups (below 40, 40-49, 50-59, 60-69, and 70 years and older), there was a significantly higher increased prevalence in advancing age groups. 4
58. Cetinkal A, Kaya S, Kutlay M, et al. Can scintigraphy explain prolonged postoperative neck pain? Turk Neurosurg. 2011;21(4):539-544. Review/Other-Dx 9 cases To determine whether scintigraphy can explain prolonged postoperative neck pain. Results showed a correlation between severity of neck pain and fusion status. Increased and prolonged uptake of nuclear agent should cause a suspicion on so-called fusion, proven by radiology. 4
59. Freedman MK, Overton EA, Saulino MF, Holding MY, Kornbluth ID. Interventions in chronic pain management. 2. Diagnosis of cervical and thoracic pain syndromes. Arch Phys Med Rehabil. 2008;89(3 Suppl 1):S41-46. Review/Other-Dx N/A To discuss the differential diagnoses for investigation of common cervical and thoracic conditions and cervicogenic headache. Indications for diagnostic tests including MRI, CT, bone scan, discography, radiographs, diagnostic injections, and electrodiagnostic studies are discussed with the idea that testing should be performed and interpreted with the specific clinical presentation in mind. 4
60. Anderberg L, Annertz M, Brandt L, Saveland H. Selective diagnostic cervical nerve root block--correlation with clinical symptoms and MRI-pathology. Acta Neurochir (Wien). 2004;146(6):559-565; discussion 565. Review/Other-Dx 20 patients To assess the ability of cervical selective diagnostic nerve root block to correlate with clinical symptoms and MRI findings in patients with cervical radicular pain. For the whole group mean visual analog scales arm pain reductions were 86% and mean visual analog scales neck pain reductions were 65%. When the results from the provocation were added all patients had a positive block. 18 were operated on by an anterior procedure and all 18 were free from radicular pain at follow up. The block procedure seems relevant for revealing a relationship between radiological pathology and clinical symptoms and signs. 4