Neck Strain

Exams and Tests continued...

The combination of a detailed history, physical examination and one or more imaging procedures should enable your doctor to exclude, or identify, any serious injury to your neck and thereby plan your treatment.

Diagnostic imaging

Many different types of imaging studies are available.

• Plain film radiography (x-rays)
  
  
  • Plain x-rays are still the primary means of looking for trauma to bones involving the cervical spine. They have the advantages of low cost, wide availability, and good anatomic resolution. X-rays do not give a good image of soft tissue structures (muscles and ligaments).
    
    
  • The technician will customarily obtain 3 views, using front, side, and open-mouth (or odontoid) projections. Some hospitals favor 2 additional views and obtain right and left oblique views also.
    
    
  • The actual reading of cervical spine radiographs is a science in itself and may be performed by any knowledgeable doctor with the backup of a radiologist.
  
  
• CT scan
  
  
  • This painless, noninvasive technique produces cross-sectional images of tissues.
    
    
  • CT scans offer far better tissue contrast resolution when compared to plain x-rays and are excellent for displaying bony architecture, although soft tissues are seen less well.
    
    
  • It is useful in assessing for complex fractures and dislocations, disk protrusions and disease of the joints of the vertebrae, and spinal stenosis (a narrowing of the space containing the spinal cord).
  
  
• Myelography (spinal cord imaging)
  
  
  • In this technique, a water-soluble contrast dye is injected into the epidural space via lumbar puncture and allowed to flow to different levels of the spinal cord.
    
    
  • Plain x-rays, or more commonly CT scan, are then performed, to indirectly visualize structures outlined by the dye.
    
    
  • This technique is very sensitive at detecting disk disease, disk herniation, nerve entrapment, spinal stenosis, and tumors of the spinal cord. Side effects of the procedure include headache, dizziness, nausea, vomiting, and seizures.
  
  
• MRI
  
  
  • MRI is another noninvasive, painless imaging technique used to obtain images of bone and soft tissue. It uses magnetic fields and is based on detecting the effect of a strong magnetic field on hydrogen atoms contained in water.
    
    
  • So-called T1 images show very good anatomic detail, whereas T2 images demonstrate any soft tissue problems that alter tissue water content. Both offer excellent tissue contrast and have no known side effects, although claustrophobia is a problem in some people.
    
    
  • MRI cannot be used for people with implanted or other metallic foreign bodies not firmly fixed to bone but is reportedly safe with prosthetic joints and internal fixation devices. It is often preferred over myelography for the assessment of disk disease because it is noninvasive. Its principal disadvantages include cost and lack of availability.
  
  
• Diskography
  
  
  • This involves the injection of radiopaque dye into the center of an intervertebral disk (nucleus pulposus), using radiographic guidance, and may be used to determine disk disruptions.
    
    
  • It is uncommonly performed but is sometimes used in cases where the precise cause of your symptoms is difficult to ascertain to see whether the injection brings on your symptoms.
  
  
• Radionuclide scanning
  
  
  • This technique uses a very short-lived radioactive isotope (technetium 99m) to label methyl diphosphonate complexes, which are then administered by IV and are absorbed by actively metabolizing bone tissue during bone turnover. The amount of uptake is proportional to the amount of metabolism.
    
    
  • Localized "hot spots" may then be visualized through the use of a special camera, which can detect the gamma rays emitted by the radioisotope. This technique is very sensitive for localizing increased bone turnover due to any cause, but has low specificity (that is, it will detect almost everything abnormal if present but may not provide a specific diagnosis).