What type of Magnetic Resonance Imaging (MRI) does neurosurgery order for patients presenting with cervical pain?

From the Guidelines

Neurosurgery typically orders a noncontrast MRI of the cervical spine for patients presenting with cervical pain, as it provides detailed images of the vertebrae, discs, spinal cord, and surrounding soft tissues in the neck region. This is based on the most recent evidence from the American College of Radiology, which suggests that noncontrast MRI is usually appropriate for assessment of new or increasing radiculopathy due to improved nerve root definition 1. The standard protocol for cervical spine MRI includes T1-weighted and T2-weighted sequences, often with sagittal, axial, and sometimes coronal views.

Some key points to consider when ordering an MRI for cervical pain include:

• The presence of "red flag" symptoms, such as suspected infection or known malignancy, may necessitate the use of contrast with gadolinium 1
• Noncontrast CT can be complementary to radiographs for evaluation of new or changing symptoms in the setting of prior cervical spine surgery or in the assessment of extent of ossification in the posterior longitudinal ligament 1
• Imaging may not always be indicated for evaluation of cervicogenic headache without neurologic deficit 1
• MRI without IV contrast is usually appropriate as the next imaging study for patients with chronic cervical or neck pain with no neurologic findings when radiographs show degenerative changes 1

The use of MRI in this context is preferred due to its superior soft tissue contrast compared to CT scans and lack of radiation, allowing for detailed assessment of neural structures that may be causing pain or neurological symptoms. Overall, the choice of imaging modality will depend on the specific clinical presentation and symptoms of the patient, and should be guided by the most recent and highest quality evidence available 1.

From the Research

MRI Types for Cervical Pain

• The type of Magnetic Resonance Imaging (MRI) ordered for patients presenting with cervical pain is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that MRI is a useful diagnostic tool for evaluating cervical spine disorders, including disc herniation 2, 3, 4, 5, 6.
• The studies also highlight the importance of obtaining sagittal and coronal images to accurately diagnose disc herniations, particularly those located in the neural foramen or lateral to it 2.
• Additionally, the studies note that MRI can be used to evaluate the presence of other cervical spine findings, such as spinal stenosis, disc degeneration, and spondylolysis 3, 4, 6.

Comparison of MRI to Other Imaging Modalities

• One study compared the use of 64-slice multidetector-row computed tomography (MDCT) and 1.5-T MRI for evaluating cervical intervertebral disc herniation, and found that MDCT tended to underestimate the extent of herniated disc lesions compared to MRI 3.
• Another study compared MRI to contrast CT in the diagnosis of spinal stenosis, and found that the two modalities were comparable in their abilities to demonstrate spinal stenosis, but MRI was more sensitive in demonstrating disc degeneration 6.

Clinical Significance of MRI Findings

• The studies suggest that the clinical significance of MRI findings in patients with cervical pain is not always clear, and that further research is needed to fully understand the relationship between MRI findings and clinical outcomes 4, 5.
• One study found that the presence of rectus capitis posterior major cross-sectional area was smaller in people with chronic nonspecific neck pain than in controls, but the quality of evidence was mostly low due to small sample sizes and high heterogeneity 4.