How is cervical disc disease diagnosed?

Updated: Apr 16, 2020
  • Author: Michael B Furman, MD, MS; Chief Editor: Dean H Hommer, MD  more...
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Answer

Consider performing rheumatologic workup to evaluate for possible rheumatoid arthritis, ankylosing spondylitis, Reiter syndrome, and polymyalgia rheumatica. In addition, consider performing infection workup to evaluate for possible discitis, epidural abscess, and vertebral osteomyelitis.

Plain cervical spine radiographs are used to evaluate chronic degenerative changes, metastatic disease, infection, spinal deformity, and stability.

Computed tomography (CT) scans delineate cervical spine fracture and are used extensively in trauma cases.

A myelogram followed by a CT scan may be obtained prior to cervical decompressive spinal cord or nerve root surgery. This study evaluates the spinal canal, its relationship to the spinal cord, and nerve root impingement from disc, spur, or foraminal encroachment.

Magnetic resonance imaging (MRI) remains the imaging modality of choice to evaluate cervical HNP, due to its low morbidity. [5, 6] Advantages include soft-tissue definition (eg, cervical discs, spinal cord), cerebrospinal fluid visualization, noninvasiveness, and lack of patient radiation exposure.

Provocative discography is the only procedure that can determine whether a disc serves as the pain generator. Discomfort and invasiveness render this procedure less desirable than cervical MRI, which provides much of the anatomical information that provocative discography does.

Electrodiagnostic studies continue to be standard for evaluating neurologic function of the cervical spine. Advantages of these tests include limited expense and low morbidity.


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