Cervical Facet Syndrome: This condition is characterized by pain stemming from the facet joints in the cervical spine, which can be exacerbated by arthritis. The presence of facet arthritis on the cervical X-ray without significant degenerative disc disease supports this diagnosis, as the pain is likely originating from the inflamed facet joints.

Cervical Spondylosis: Although the X-ray shows no significant degenerative disc disease, spondylosis can still cause neck pain through other mechanisms such as ligamentous strain or osteophyte formation. It's a common condition in the aging population and can coexist with facet arthritis.
Muscle Strain or Tension: Neck muscles can become strained or tense, leading to pain. This could be either a primary issue or secondary to the facet arthritis, as patients may alter their posture or movement patterns in response to pain, straining the muscles.

Cervical Spinal Stenosis: Although less likely given the absence of significant degenerative disc disease, spinal stenosis can still occur, especially if there are other contributing factors like osteophytes or a congenitally narrow spinal canal. Missing this diagnosis could lead to serious neurological complications if left untreated.
Rheumatoid Arthritis or Other Inflammatory Arthropathies: These conditions can cause neck pain and arthritis. While facet arthritis is noted, an inflammatory arthropathy could be a systemic cause that needs to be addressed to prevent further joint damage and other complications.
Infection (e.g., Osteomyelitis, Discitis): Infections of the spine are rare but can be devastating if not promptly treated. They might present with pain and could potentially show up on an X-ray as destructive changes, although early stages might require additional imaging like MRI for diagnosis.

Cervical Dystonia: A neurological disorder characterized by involuntary muscle contractions, which can lead to abnormal postures and pain. It's less common and might not be directly related to the facet arthritis but could be a consideration in patients with unusual or unexplained neck pain.
Neoplastic Processes (e.g., Metastases, Primary Tumors): Tumors can cause neck pain and might show up on an X-ray as destructive lesions. While rare, they are critical to diagnose early for appropriate treatment.
Paget's Disease of Bone: A condition that can affect the spine, leading to enlarged and misshapen bones due to abnormal bone destruction and regrowth. It could potentially cause neck pain and show up on an X-ray, although it's less common in the cervical spine compared to other parts of the skeleton.