• Daffner RH, Dalinka MK, Alazraki NP, DeSmet AA, El-Khoury GY, Kneeland JB, Manaster BJ, Pavlov H, Rubin DA, Steinbach LS, Weissman BN, Haralson RH III, Expert Panel on Musculoskeletal Imaging. Chronic neck pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 7 p. [21 references]

This is the current release of the guideline.

This guideline updates a previous version: Daffner RH, Dalinka MK, Alazraki N, Berquist TH, DeSmet AA, el-Khoury GY, Goergen TG, Keats TE, Manaster BJ, Newberg A, Pavlov H, Schweitzer ME, Haralson RH, McCabe JB. Chronic neck pain. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun;215(Suppl):345-56.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

ACR Appropriateness Criteria®

Clinical Condition: Chronic Neck Pain

Variant 1: Patient of any age, without or with a history of previous trauma, first study.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 2: Patients of any age. History of previous malignancy. First study.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 3: Patients of any age. History of previous neck surgery. First study.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 4: Radiographs normal. No neurologic findings.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 5: Radiographs normal. Neurologic signs or symptoms present.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 6: Radiographs show spondylosis. No neurologic findings.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 7: Radiographs show spondylosis. Neurologic signs or symptoms present.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 8: Radiographs show old trauma. No neurologic findings.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 9: Radiographs show old trauma. Neurologic signs or symptoms present.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 10: Radiographs show bone or disc margin destruction.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Recommendations

Patients of any age with chronic neck pain without or with a history of remote trauma should initially undergo a 3-view (AP, lateral, open mouth) radiographic examination. Oblique radiographs may be performed at the discretion of the attending physician.

Patients with a history of previous malignancy should initially undergo a 3-view radiographic examination. Radionuclide bone scanning should not be the initial procedure of choice.

Patients with a history of neck surgery in the remote past should initially undergo a three view radiographic examination.

Patients with normal radiographs and no neurologic signs or symptoms need no further imaging.

Patients with normal radiographs and neurologic signs or symptoms should undergo MR imaging. If there is a contraindication to the MR examination such as a cardiac pacemaker or severe claustrophobia, CT myelography, preferably using spiral technology and multiplanar reconstruction is recommended.

Patients with radiographic evidence of cervical spondylosis or of previous trauma without neurologic signs or symptoms need no further imaging.

Patients with radiographic evidence of cervical spondylosis or of previous trauma and neurologic signs or symptoms should undergo MR imaging. If there is a contraindication to MR, CT myelography is recommended.

Patients with radiographic evidence of bone or of disc margin destruction should undergo MR imaging. If an epidural abscess is suspected, the examination should be performed with intravenous contrast. CT is indicated only if MR cannot be performed.

Facet injection and arthrography are useful for patients with multilevel disease diagnosed by any imaging modality to identify the specific level(s) producing symptoms.

Discography is not recommended.

Summary

There are no existing guidelines for the evaluation of the patient with chronic neck pain.

All investigators generally agree that plain radiographs should be the initial study performed for evaluating these patients. However, there is no consensus on exactly which views should be obtained for the initial study. The guideline developers recommend a basic 3-view study, with oblique radiographs added at the discretion of the attending physician.

MR imaging should be performed on all patients who have chronic neck pain with neurologic signs, or symptoms, or both. If there is a contraindication to MR, CT myelography is recommended.

The use of additional imaging procedures should be determined by case manner, and the evaluation of patients with chronic neck pain should follow this "tailor-made" approach. Discography is not recommended.

Abbreviations

• AP, anteroposterior
• CT, computed tomography
• MRI, magnetic resonance imaging
• NUC, nuclear medicine

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

• Daffner RH, Dalinka MK, Alazraki NP, DeSmet AA, El-Khoury GY, Kneeland JB, Manaster BJ, Pavlov H, Rubin DA, Steinbach LS, Weissman BN, Haralson RH III, Expert Panel on Musculoskeletal Imaging. Chronic neck pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 7 p. [21 references]

Not applicable: The guideline was not adapted from another source.

1998 (revised 2005)

American College of Radiology - Medical Specialty Society

American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Musculoskeletal Imaging

Panel Members: Richard H. Daffner, MD; Murray K. Dalinka, MD; Naomi P. Alazraki, MD; Arthur A. DeSmet, MD; George Y. El-Khoury, MD; John B. Kneeland, MD; B.J. Manaster, MD, PhD; Helene Pavlov, MD; David A. Rubin, MD; Lynne S. Steinbach, MD; Barbara N. Weissman, MD; Robert H. Haralson III, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Daffner RH, Dalinka MK, Alazraki N, Berquist TH, DeSmet AA, el-Khoury GY, Goergen TG, Keats TE, Manaster BJ, Newberg A, Pavlov H, Schweitzer ME, Haralson RH, McCabe JB. Chronic neck pain. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun;215(Suppl):345-56.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

None available

This summary was completed by ECRI on May 6, 2001. The information was verified by the guideline developer as of June 29, 2001. This NGC summary was updated by ECRI on January 27, 2006.