What imaging is recommended for diagnosing Cervical (Cervical) Radiculopathy?

Imaging for Cervical Radiculopathy

MRI is the recommended first-line imaging modality for diagnosing cervical radiculopathy, with plain films as complementary studies. CT myelography should be reserved for cases where MRI is contraindicated or inconclusive. 1

Initial Imaging Approach

• Plain radiographs + MRI: The combination provides comprehensive assessment
  • MRI visualizes soft tissue structures (discs, nerve roots, spinal cord)
  • Plain films help identify bony abnormalities that may be contributing factors

MRI Advantages

• Non-invasive nature
• Visualization of the entire cervical canal and spinal cord
• Two-plane visualization of spinal cord and nerve roots
• Better detection of unsuspected pathology at other cervical levels 2
• Superior for evaluating soft tissue structures 1

When to Consider Advanced or Additional Imaging

• MRI with contrast: Recommended when enhanced soft tissue evaluation is needed 1
• CT scan: Consider when better evaluation of bony structures is required 1
• CT myelography: Appropriate in specific scenarios:
  • When MRI is contraindicated (pacemakers, metal implants, claustrophobia)
  • When MRI results are inconclusive or technically suboptimal
  • For better visualization of lateral root canal herniated discs 3
  • When anticipated pathology is not clearly visualized on MRI 2

Special Considerations

• Quality of cervical MRI scans can vary more than lumbar spine imaging 2
• Accurate visualization of pathology location, nature, and extent is critical before considering surgical intervention 2
• Small osteophytes adjacent to herniated discs may sometimes be missed on MRI but are typically visible on plain films 3

Diagnostic Challenges in Multilevel Degeneration

When MRI shows multilevel degeneration, correlation with clinical symptoms can be challenging:

• MRI findings alone correlate with the symptomatic level in only about 60% of cases 4
• Neurological examination and pain distribution correlate with the symptomatic level in only about 28% of cases 4

In such cases, selective nerve root blocks (SNRB) may be considered as a diagnostic tool to identify the symptomatic level 4.

Clinical Correlation

Remember that imaging findings must always be correlated with clinical presentation, as asymptomatic degenerative changes are common in the cervical spine. The presence of neurological deficits, sensory changes, and specific pain patterns should guide the interpretation of imaging results 5.

Pitfalls to Avoid

• Relying solely on imaging without clinical correlation
• Attributing symptoms to incidental findings on imaging
• Delaying appropriate imaging in patients with progressive neurological deficits
• Using invasive imaging (CT myelography) as first-line when MRI is available and not contraindicated