From the Guidelines
For patients presenting with neck popping and grinding, I recommend starting with MRI of the cervical spine without contrast as the initial imaging study, especially if radiographs show degenerative changes and there are no neurologic findings. This approach is supported by the American College of Radiology's appropriateness criteria for cervical neck pain or cervical radiculopathy 1. The use of MRI without contrast is usually appropriate for patients with chronic cervical or neck pain with no neurologic findings when radiographs show degenerative changes.
Some key points to consider when evaluating neck popping and grinding include:
- The clinical presentation and suspected underlying cause of the symptoms
- The presence of degenerative changes on radiographs
- The absence of neurologic findings
- The potential for disc pathology or nerve compression
In general, imaging studies such as MRI, CT, and radiographs can help determine if the popping and grinding is related to degenerative disc disease, facet joint arthropathy, or other structural abnormalities that may require specific treatment approaches. However, MRI of the cervical spine without contrast is the preferred initial advanced imaging study for patients with chronic neck pain and degenerative changes on radiographs, as it provides superior visualization of soft tissues including discs, ligaments, and the spinal cord 1.
From the Research
Imaging Options for Neck Popping and Grinding
- Computed Tomography (CT) is commonly used for initial evaluation of cervical spine trauma, providing information on osseous and soft tissue structures 2, 3, 4.
- Magnetic Resonance Imaging (MRI) is used for complementary evaluation of neural structures and soft tissues, and is particularly useful in cases with neurological involvement or advanced cervical degenerative changes 2, 3, 4, 5, 6.
- CT and MRI have been shown to have high sensitivity and specificity in detecting cervical spine injuries, with CT being more sensitive for detecting unstable injuries and MRI being more sensitive for detecting soft tissue injuries and spinal cord damage 3, 5, 6.
- X-ray and LODOX scans are not recommended as primary imaging modalities for evaluating cervical spine trauma due to their low sensitivity and specificity 3, 4.
Specific Imaging Recommendations
- For patients with blunt trauma and neck pain, CT is recommended as the initial imaging modality, followed by MRI if necessary 3, 4.
- For patients with neurological symptoms, MRI is recommended to evaluate the extent of soft tissue injury and spinal cord damage 4, 5, 6.
- For patients with altered level of alertness (i.e., obtunded patients), CT is recommended as the initial imaging modality, with MRI used to evaluate the cervical spine if CT is negative or inconclusive 5.