It is important to detect neck pain caused by significant causes (e.g., primary or metastatic cancer) and neck pain associated with neurologic compromise. The diagnostic approach to neck pain has not been as well studied as back pain, but a similar approach is recommended.
Summary
Definitions
Neck pain can be considered in 4 categories as follows:[1]
- Grade 1: No signs of major pathology and little interference with daily activities
- Grade 2: No signs of major pathology but may impact daily activities
- Grade 3: Neck pain with neurologic signs or symptoms (radiculopathy)
- Grade 4: Neck pain with major pathology (e.g., fracture, myelopathy, neoplasm, spinal infection).
Epidemiology
Neck pain is a common condition that causes significant disability. The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%, and the global point prevalence of neck pain is 4.9%.[2] [3] Between 33% and 65% of people recover from an episode of neck pain within one year, but relapses are common.[4] Up to 20% of acute neck pain will go on to become chronic neck pain.[5]
In the 2010 Global Burden of Disease Study, neck pain ranked fourth highest for the number of years lived with disability.[6]
Neck pain increases from 18 to 30 years through to middle age (50-55 years).[7] In some studies, there is a decrease after 50 to 55 years, whereas other studies report no change or a slight increase.[8] [9] [10] [11] All epidemiologic studies show women having higher rates of neck pain than men.[4] [6]
Injury is a strong predictor of chronic neck pain.[12] This has mainly been described for whiplash; 20% to 40% of whiplash injury patients will go on to have chronic neck pain.[13]
High body mass index, frequent neck extension during the working day, high initial pain intensity, and high psychological job demands are all predictors of chronic neck pain development in office workers.[5]
Cervical radicular pain has an annual incidence of 63 to 107 cases per 100,000, and incidence peaks in the fourth and fifth decades.[14]
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Patient with severe left torticollis (note hypertrophy of right sternocleidomastoid muscle)
MRI cervical spine. Sagittal T1, SE with a central disc at C5/C6 indenting the thecal sac
MRI cervical spine. Axial three-dimensional cosmic at C5/C6 with anterior indentation of the thecal sac
Zostiform vesicular eruption within the D8 dermatome on the left
Normal lateral cervical spine x-ray
C3-4 diskitis with endplate destruction
Bilateral facet dislocation
Citations
Expert Panel on Neurological Imaging and Musculoskeletal Imaging, Beckmann NM, West OC, et al. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol. 2019 May;16(5s):S264-S285.[Abstract]
Expert Panel on Neurological Imaging, Ortiz AO, Levitt A, et al. ACR Appropriateness Criteria® Suspected Spine Infection. J Am Coll Radiol. 2021 Nov;18(11S):S488-S501.[Abstract]
Bono CM, Ghiselli G, Gilbert TJ, et al; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011 Jan;11(1):64-72.[Abstract]
Expert Panel on Neurological Imaging, McDonald MA, Kirsch CFE, et al. ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy. J Am Coll Radiol. 2019 May;16(5s):S57-S76.[Abstract]
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