Cervical Spine X-Ray Interpretation: 34-Year-Old Female with Acute Neck Pain and Left-Sided Tingling
This X-ray demonstrates essentially normal findings with only mild degenerative changes that do not explain the patient's acute symptoms of neck pain with left-sided tingling, and given the presence of neurological symptoms (tingling), MRI cervical spine without contrast is indicated to evaluate for cervical radiculopathy or other soft tissue pathology that X-rays cannot detect. 1, 2
Key X-Ray Findings Analysis
The radiographic findings show:
- Preserved vertebral body and disc heights: This indicates no significant compression fractures or severe disc degeneration 3
- Normal alignment on lateral view: Rules out subluxation or dislocation 3
- Mild levoconvex curvature: This is a minor leftward curve that is typically incidental and not clinically significant 1
- Mild right-sided foraminal narrowing at C3-4: This is a degenerative finding, but notably on the wrong side relative to her left-sided symptoms 2
Critical Clinical Mismatch
The most important finding here is what the X-ray does NOT show: The patient has left-sided tingling to the upper back, but the only abnormality is mild right-sided foraminal narrowing at C3-4. 2 This anatomical mismatch means the X-ray findings do not explain her symptoms. 1, 2
Why Further Imaging Is Necessary
MRI cervical spine without contrast is the appropriate next step for the following reasons:
- X-rays have severe limitations: Plain radiographs cannot adequately assess soft tissue pathology, disc herniations, nerve root compression, or early inflammatory processes 1, 4
- Neurological symptoms require soft tissue evaluation: Tingling represents a neurological symptom suggesting possible cervical radiculopathy from disc herniation or nerve root compression, which requires MRI for diagnosis 1, 2
- MRI is superior for identifying the cause: The American College of Radiology recommends MRI as the preferred imaging modality for evaluating nerve root impingement and degenerative cervical disorders 2
Red Flag Assessment
While this patient does not have high-risk "red flags" requiring urgent evaluation (no fever, no history of malignancy, no immunosuppression, no IV drug use), she does have:
- Neurological symptoms (tingling) that warrant further investigation 1, 4
- Symptoms lasting long enough to justify advanced imaging if conservative management fails over 6-8 weeks 2
The absence of constitutional symptoms, fever, unexplained weight loss, or elevated inflammatory markers makes serious pathology like infection or malignancy less likely. 1, 4
Clinical Pitfall to Avoid
Do not assume the mild right-sided C3-4 foraminal narrowing explains left-sided symptoms. 2 Degenerative changes on imaging are extremely common in asymptomatic individuals—85% of people over 30 have spondylotic changes that correlate poorly with symptoms. 2 The key is clinical correlation, and in this case, the imaging findings do not match the symptom distribution.
Recommended Management Algorithm
If symptoms are acute (<6 weeks) and no red flags present: Trial of conservative management with NSAIDs, physical therapy, and reassessment 1, 2
If symptoms persist beyond 6-8 weeks, are progressive, or are severe/intractable: Obtain MRI cervical spine without contrast 2
Given the neurological component (tingling): Consider earlier MRI if symptoms worsen or new deficits develop 1, 2
MRI will evaluate for: Disc herniation, nerve root compression, spinal cord pathology, inflammatory conditions, or other soft tissue abnormalities not visible on X-ray 1, 2