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Cervical Region

Cervical spine pathology including degenerative disease, fractures, and congenital deformities, with a focus on myelopathy and instability.

Overview

Cervical spine surgery encompasses a range of interventions for degenerative, traumatic, and neoplastic conditions. For degenerative cervical radiculopathy, clinical effectiveness is equivalent between public and private hospital settings at 12 months post-surgery [16]. In cases of multi-level cervical spondylotic myelopathy, the choice between laminoplasty and laminectomy requires careful consideration of surgical and neurological complication risks, as well as radiologic and clinical outcomes [60]. Surgical treatment of metastases to the cervical spine yields good outcomes and should be considered a treatment of choice [24]. Additionally, patients with substantial preoperative motor deficits undergoing anterior cervical discectomy and fusion may benefit from earlier surgical intervention [62].

For cervical disc herniation, both stand-alone titanium cage fixation and cage and plate fixation are effective for managing two-level disease, though each approach presents distinct advantages and limitations [66]. Cervical disc arthroplasty (CDA) utilization among Medicare beneficiaries has grown substantially and is projected to increase through 2040, reflecting rising demand for motion-preserving procedures [61]. However, most studies remain inconclusive or unreliable regarding clinical outcomes and revision or complication rates for cervical disc arthroplasty in patients presenting with neck and/or arm pain [20]. The presence of cervical Modic changes does not impact clinical outcomes in cervical spine procedures [4].

Anterior cervical spine surgery carries infrequent but potentially serious and life-threatening adverse events [12]. Surgeons must utilize appropriate strategies to avoid these events and understand how to detect and manage them when they arise [12]. Contemporary principles for adult cervical deformity include upper cervical parameters, regional cervical parameters, cervical shape classifications, and cervical deformity classifications [11]. Thorough familiarity with upper cervical spine anatomy and awareness of associated risks are essential to avoid complications and optimize outcomes [5]. Finally, guidelines used by private health insurance companies for cervical MRI authorization in the setting of neck pain with and without radiculopathy are inconsistent and rely on objective measures that have not been validated in the literature [13].

Anatomy & Pathophysiology

Thorough familiarity with upper cervical spine anatomy is essential to avoid complications and optimize outcomes [5]. Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than in the thoracic or lumbar spine [70]. The C2-C3 and C6-C7 segments are subjected to increased mechanical loads in straightened cervical alignment and kyphotic deformity, thereby increasing their susceptibility to facet joint degeneration [77]. A possible correlation exists between facet orientation and the development of degenerative cervical spinal stenosis [90].

The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI [32]. Kinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation [54]. The segmental contributions of the cervical spine during lateral bending movement were first described based on a validated radiographic protocol [56].

Axial loading of the cervical spine is the primary injury mechanism in catastrophic cervical spine injuries in football players [84].

Classification

Cervical degenerative disorders present with signs and symptoms ranging from mild neck pain to severe spinal cord and nerve root injury [1]. Symptoms of degenerative cervical spondylosis are categorized into three clinical syndromes: axial neck pain, cervical radiculopathy, and cervical myelopathy [6]. Pediatric cervical spine disorders present with disparate presentations from infancy through adolescence [8].

Adult Cervical Deformity: Classifications include upper cervical parameters, regional cervical parameters, and cervical shape classifications [11]. Cervical spinal deformity classification schemes are used to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment [43].

Atlantoaxial Deformity: A novel image-based classification system for atlantoaxial deformity caused by mucopolysaccharidosis type IVA has high reliability and clinical guidance value [59].

Quebec Task Force Classification System: This system is used to classify neck pain subgroups [42]. Differences between neck pain subgroups classified using the Quebec Task Force Classification System were typically small in a secondary care setting [42].

Congenital Osseous Anomaly: No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury [37].

Pediatric Clearance: Pediatric cervical spine clearance algorithms are based on Glasgow Coma Scale scores [64].

Clinical Presentation

Cervical degenerative disorders manifest as a spectrum ranging from mild axial neck pain to severe spinal cord and nerve root injury [1]. These conditions present clinically as one of three syndromes: Axial neck pain, Cervical radiculopathy, or Cervical myelopathy [6, 7]. Accurate diagnosis requires a comprehensive clinical history and physical examination, including screening of the contralateral anatomical region [3]. Shoulder and spine surgeons must accurately diagnose the etiology of presenting symptoms to ensure proper management and optimize prognosis [35].

Pediatric cervical spine disorders present with disparate presentations from infancy through adolescence [8]. In juvenile rheumatoid arthritis, neck pain is not a common complaint despite extensive roentgenographic involvement [14]. Cervical lesions are confirmed in 57% of patients with rheumatoid arthritis [19]. Early investigation is warranted in the presence of cervical vertebral anomalies and associated intermittent and significant pain [15].

Adult cervical deformity presentations involve Upper cervical parameters, Regional cervical parameters, Cervical shape classifications, and Cervical deformity classifications [11]. Neck pain in elderly men is common, but symptoms and morbidity vary [34]. Only neck flexibility showed a significant association with clinical features in neck pain patients [39]. People with a registered neck injury have more co-morbidity diagnoses both before and after the injury than those without a registered neck injury [40].

Major abnormalities on magnetic resonance scans of the cervical spine are found in 19 percent of asymptomatic subjects [9]. High-resolution upper neck MRI has limited value for the initial examination and follow-up of patients with acute whiplash injury [17]. Rapid on-field diagnosis of different clinical syndromes associated with catastrophic cervical spine injury can help optimize outcomes [36].

Clinical outcomes and revision or complication rates in patients presenting with neck and/or arm pain are often inconclusive or unreliable regarding cervical disc arthroplasty [20]. Adverse events associated with anterior cervical spine surgery can be serious and potentially life-threatening [12].

Investigations

Cervical degenerative disorders present with symptoms ranging from mild neck pain to severe spinal cord and nerve root injury [1]. These conditions typically manifest as axial neck pain, radiculopathy, or myelopathy [6, 7]. Differentiating shoulder pathology from cervical spine pathology requires a comprehensive clinical history and physical examination, including screening of the contralateral anatomical region [3]. In pediatric cases, diagnosis and management require a clear understanding of variations in normal growth and development [8]. Early investigation is warranted in the presence of cervical vertebral anomalies and associated intermittent and significant pain [15]. In juvenile rheumatoid arthritis, extensive roentgenographic involvement of the cervical spine does not commonly result in neck pain [14].

MRI: This non-invasive, high-resolution, multiplanar imaging modality provides detailed visualization of osseous and soft-tissue structures of the cervical spine [57]. Specifically, MRI provides detailed visualization of intervertebral discs, spinal cord, and nerve roots [57]. It is essential for evaluating the spectrum of cervical spinal disease [57]. The proposed method provides an option for quantifying cervical spine muscle composition and morphology using MRI [32]. Progression of degenerative changes in the cervical spine on MRI was detected in nearly all subjects over a 20-year period [30]. Dynamic magnetic resonance imaging, particularly extension MR scans, provides high reliability and accuracy in the diagnosis of cervical spondylotic myelopathy [82]. Extension MR scans could provide a more accurate diagnosis of cervical spondylotic myelopathy than other images [82]. Recent studies suggest benefits from early surgical decompression in acute traumatic myelopathy, particularly in patients with pathologic conditions revealed by radiography or MRI [85].

Although MRI is more sensitive for occult injuries, the standard addition of MRI to CT evaluation alone does not significantly increase the detection of clinically important cervical injuries in blunt trauma patients [52]. High-resolution upper neck MRI has limited value for the initial examination and follow-up of patients with acute whiplash injury [17]. Major abnormalities on magnetic resonance scans of the cervical spine are found in 19 percent of asymptomatic subjects [9]. Findings on magnetic resonance scans of the cervical spine in asymptomatic subjects must be strictly matched with clinical signs and symptoms before therapy is instituted [9].

CT: Advances in computed tomography scanning allow better diagnosis of the cause of radiculopathy in the presence of a cervical block vertebra [69]. For obtunded patients, a normal multidetector CT scan is sufficient to clear the cervical spine [76]. The utility of subsequent MRI in obtunded patients after a normal multidetector CT scan remains controversial due to insufficient information [76].

Myelography: Myelography provides the most reliable preoperative information for guiding cervical disc excision [74].

Other Considerations: Guidelines used by private health insurance companies for cervical MRI authorization in the setting of neck pain with and without cervical radiculopathy are inconsistent [13]. Guidelines for cervical MRI authorization use objective measures that have not been validated in the literature [13].

Treatment

Non-Operative Management

Acute cervical radiculopathy follows a self-limited clinical course, with up to a 75% rate of spontaneous improvement, establishing nonsurgical treatment as the appropriate initial approach for most patients [33]. For mild cervical spondylotic myelopathy, nonoperative treatment involving collar immobilization and activity modification improves functional status in selected patients, though careful monitoring is required due to the risk of neurological deterioration [73]. In patients with cervical spondylosis, combining kinesio taping with multi-angle isometric training of cervical muscles yields uncertain effects on the range of cervical motion [2]. Evidence regarding upper cervical spine interventions for cervical-related dizziness indicates low to very low certainty of a difference in effectiveness compared to control or placebo treatments for improving dizziness impact and intensity [47]. For idiopathic, non-traumatic neck pain, consensus identifies 26 prognostic factors for persistent pain after a first episode, with 21 factors potentially modifiable by physiotherapists [80]. In the context of rheumatoid arthritis of the cervical spine, nonoperative management does not alter the natural history of the disease [10].

Operative Management

Indications: Surgical indications for herniated discs vary by level, with six months of persisting symptoms serving as a relative indication for cervical disc herniation [71]. Fusion of the first three cervical vertebrae is indicated for unstable lesions involving abnormalities of the atlas and axis vertebrae where spinal cord damage is possible [72]. Surgical treatment of metastases to the cervical spine yields good outcomes and should be considered a treatment of choice [24].

Surgical Approach / Technique: Three anterior cervical surgical approaches demonstrate good curative effects for single-level cervical spondylotic myelopathy [41]. Percutaneous endoscopic cervical discectomy offers a high success rate for treating cervical disc herniation, relieving neck pain with low recurrence and adverse event rates [45]. Cervical laminectomy combined with crossing the cervicothoracic junction fusion is an effective and safe method for treating multilevel cervical ossification of the posterior longitudinal ligament [46]. Posterior fixation of the upper cervical spine requires thorough familiarity with upper cervical anatomy and awareness of associated risks to avoid complications and optimize outcomes [5]. Posterior surgery is noninferior to anterior surgery regarding success rate and arm pain reduction in patients with cervical radiculopathy at 2-year follow-up [49]. The COSMIC study is designed to compare clinical outcomes between early surgical and conservative strategies to determine the best quality of life for patients with incomplete cervical cord syndrome without spinal instability [51].

Implant Selection: Both Zero-profile devices and conventional cage-plate constructs are safe in anterior cervical surgeries, showing similar efficacy in correcting radiologic outcomes; however, Zero-profile devices demonstrated greater changes in cervical alignment as follow-up time increased [18]. Cervical disc arthroplasty for single-level cervical disc disease yields satisfactory clinical outcomes with a minimum 5-year follow-up [38].

Alignment / Balancing Strategy: Cervical alignment was comparably improved between groups in consecutive three-level hybrid surgery and anterior cervical discectomy and fusion with a minimum 5-year follow-up [23].

Other Considerations: The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes [81].

Complications

Adverse events associated with anterior cervical spine surgery are infrequent but can be serious and potentially life-threatening [12]. Surgeons must utilize appropriate strategies to avoid these adverse events [12] and must understand how to detect and manage them when they arise [12].

Nerve palsy: Continued research is required to decrease common complications of cervical laminoplasty, such as C5 nerve palsy [22].

Axial neck pain: Continued research is required to decrease common complications of cervical laminoplasty, such as axial neck pain [22].

Loss of lordosis: Continued research is required to decrease common complications of cervical laminoplasty, such as loss of lordosis [22].

Instability: Resection of the nuchal ligament, particularly involving ≥2 cervical segments, is moderately associated with an increased likelihood of cervical instability in long-term follow-up after laminoplasty [28].

Abnormal sagittal alignment: Resection of the nuchal ligament, particularly involving ≥2 cervical segments, is moderately associated with abnormal sagittal alignment in long-term follow-up after laminoplasty [28].

Other Considerations: Thorough familiarity with upper cervical spine anatomy is essential to avoid complications in posterior fixation of the upper cervical spine [5]. Awareness of risks is essential to avoid complications in posterior fixation of the upper cervical spine [5]. Patients undergoing shoulder surgery with a history of a cervical spine condition have increased rates of surgical complications compared to patients without dual shoulder-cervical spine pathology [29]. Progressive cervical rheumatoid disease can result in the recurrence of long-tract symptoms due to further subaxial subluxation distal to the original fusion site [31]. Osteoporosis is associated with a higher risk of adverse postoperative outcomes at two years among patients undergoing multilevel cervical fusion [53].

Recovery

Light activity (weeks): Acute cervical radiculopathy generally follows a self-limited clinical course, with up to a 75% rate of spontaneous improvement, making nonsurgical treatment the appropriate initial approach for most patients [33].

Full activity (months): Long-term follow-up of operative treatment for two-level cervical spine fracture in a young child showed normal cervical growth with good alignment and solid fusion [21]. Both cervical disk replacement (CDR) and anterior cervical diskectomy and fusion at C5-C6 demonstrated similar long-term clinical outcomes for arm/neck pain and physical function [48]. Patients undergoing CDR at C5-C6 demonstrated an improved ability to maintain 1-year postoperative progress for neck disability with improved 1-year NDI MCID achievement compared to fusion [48]. Approximately 20% of patients undergoing upper cervical spinal fusion surgery experienced delayed bony union [93].

Complete recovery / outcome plateau (months): Cervical laminoplasty is considered safe and effective in the long term, but continued research is required to decrease common complications such as C5 nerve palsy, axial neck pain, and loss of lordosis [22]. A progression of degenerative changes in the cervical spine on MRI was detected in nearly all subjects over a 20-year period [30]. Long-term follow-up of intervertebral-disc calcification in childhood revealed abnormalities in the cervical spine in four of six patients, suggesting a more guarded prognosis for long-term normal function than previously assumed [44].

Rehabilitation protocol: Kinesio taping combined with cervical muscles multi-angle isometric training has uncertain effects on the range of cervical motion [2]. Resection of the nuchal ligament, particularly involving ≥2 cervical segments, is moderately associated with an increased likelihood of cervical instability and abnormal sagittal alignment in long-term follow-up after laminoplasty [28].

Functional milestones: The presence of cervical Modic changes does not impact clinical outcomes in cervical spine procedures [4]. Diabetes with advanced age and long-term cervical spondylotic myelopathy symptoms adversely affect outcomes of cervical laminoplasty [26]. There is no evidence for an association between neck muscle strength or cervical spine mobility and the occurrence of neck pain and disability in later life [25].

Other Considerations: Nonoperative management does not change the natural history of cervical disease in patients with rheumatoid arthritis [10]. The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site [31]. Patients undergoing shoulder surgery with a history of cervical spine condition have increased rates of surgical complications and mixed but consistently nonsuperior patient-reported outcomes compared to patients without dual shoulder-cervical spine pathology [29]. Altered motor control patterns in whiplash and chronic neck pain are likely due to long-lasting pain rather than a history of neck trauma or current pain [27]. The prognosis for primary osteogenic sarcoma of the cervical spine is poor, but adequate chemotherapy following prompt recognition and wide excision may improve the prognosis [94].

Key Evidence

  • [L2] But its effects on the range of cervical motion remain uncertain. (10.1186/s12891-023-06154-x)
  • [L5] The purpose of this review was to describe a systematic approach for evaluating and differentiating pathologies of the shoulder and cervical spine, emphasizing that accurate diagnosis requires a comprehensive clinical history and physical examination including screening of the contralateral anatomical region. (10.5435/jaaos-d-23-00210)
  • [L1] The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures. (10.3390/ijerph191610158)
  • [L5] Thorough familiarity with upper cervical spine anatomy and awareness of risks are essential to avoid complications and optimize outcomes. (10.5435/00124635-201102000-00001)
  • [L5] Symptoms are categorized into three clinical syndromes: axial neck pain, cervical radiculopathy, and cervical myelopathy, each with distinct pathophysiological mechanisms and management strategies. (10.2106/00004623-200706000-00026)
  • [L4] The finding of major abnormalities on magnetic resonance scans of the cervical spine in 19 percent of asymptomatic subjects suggests that such findings must be strictly matched with clinical signs and symptoms before therapy is instituted. (10.2106/00004623-199173070-00028)
  • [L5] Nonoperative management does not change the natural history of cervical disease. (10.5435/00124635-199709000-00002)
  • [L4] The purpose of this review is to provide a comprehensive overview of contemporary principles pertaining to adult cervical deformity, including upper cervical parameters, regional cervical parameters, cervical shape classifications, and cervical deformity classifications based on current literature. (10.5435/jaaos-d-25-00019)
  • [L4] Adverse events associated with anterior cervical spine surgery are infrequent but can be serious and potentially life-threatening; appropriate strategies must be utilized to avoid these events, and surgeons must understand how to detect and manage them when they arise. (10.5435/00124635-200812000-00005)
  • [L4] The guidelines used by private health insurance companies for cervical MRI authorization in the setting of neck pain with and without cervical radiculopathy are inconsistent and use objective measures that have not been validated in the literature. (10.5435/jaaos-d-22-00517)
  • [L4] Despite extensive roentgenographic involvement, pain in the neck was not a common complaint. (10.2106/00004623-198668020-00003)
  • [L3] The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery. (10.1302/0301-620x.105b1.bjj-2022-0591.r1)
  • [L2] High-resolution upper neck MRI has limited value for the initial examination and follow-up of such patients. (10.1186/1471-2474-11-260)
  • [L1] Both devices were safe in anterior cervical surgeries, and they had similar efficacy in correcting radiologic outcomes, although ZP group showed greater changes in cervical alignment as follow-up time increased. (10.1186/s13018-022-03400-1)
  • [L3] Cervical lesions were confirmed in 57% of the patients. (10.1186/s12891-021-04285-7)
  • [L2] Most studies were inconclusive or unreliable regarding clinical outcomes and revision and/or complication rates in patients who present with neck and/or arm pain. (10.5435/00124635-201010000-00006)
  • [Case_report] Long-term follow-up showed normal cervical growth with good alignment and solid fusion. (10.2106/00004623-198365010-00019)
  • [L5] Although long-term outcomes suggest that cervical laminoplasty is safe and effective, continued research on the development of novel modifications that decrease common complications, such as C5 nerve palsy, axial neck pain, and loss of lordosis, is required. (10.5435/jaaos-d-16-00242)
  • [L3] Cervical alignment was comparably improved between groups. (10.1186/s13018-020-01589-7)
  • [L4] Surgical treatment of metastases to the cervical spine gives good outcomes and it ought to be a treatment of choice. (10.1186/s12891-016-1175-8)
  • [L2] This 16-year prospective study found no evidence for an association between either neck muscle strength or mobility and the occurrence in later life of neck pain and disability. (10.1186/s12891-021-04807-3)
  • [L2] Diabetes with advanced age and long-term cervical spondylotic myelopathy symptoms adversely affected cervical laminoplasty outcomes. (10.2106/jbjs.n.00064)
  • [L3] The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. (10.1186/1471-2474-9-90)
  • [L3] Resection of the ONL, particularly involving ≥2 cervical segments, is moderately associated with an increased likelihood of cervical instability and abnormal sagittal alignment in long-term follow-up after laminoplasty. (10.1186/s12891-025-08729-2)
  • [L2] Patients undergoing shoulder surgery with a history of a cervical spine condition have increased rates of surgical complications and mixed but consistently nonsuperior patient-reported outcomes compared to patients without dual shoulder-cervical spine pathology. (10.1016/j.arthro.2025.01.010)
  • [L3] A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. (10.2106/jbjs.17.01347)
  • [L4] The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site. (10.2106/00004623-198163080-00003)
  • [L5] The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. (10.1186/s12891-018-2074-y)
  • [L5] Acute cervical radiculopathy generally has a self-limited clinical course, with up to a 75% rate of spontaneous improvement, making nonsurgical treatment the appropriate initial approach for most patients. (10.5435/00124635-200708000-00005)
  • [L4] Neck pain in elderly men is common but symptoms and morbidity vary. (10.1186/s13018-023-03508-y)
  • [L5] Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis. (10.1016/j.xrrt.2024.02.007)
  • [L4] This article provides a rational approach to the early recognition of the different clinical syndromes associated with catastrophic cervical spine injury, noting that rapid on-field diagnosis can help to optimize the outcomes of these catastrophic injuries. (10.1177/0363546504265605)
  • [L5] No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury. (10.2106/00004623-200202000-00017)
  • [L3] Satisfactory clinical outcomes were observed following CDA for the treatment of single-level cervical disc disease. (10.1186/s13018-016-0440-8)
  • [L3] Only neck flexibility showed a significant association with clinical features in neck pain patients. (10.1186/s12891-015-0517-2)
  • [L3] Those people having a registered neck injury had more co-morbidity diagnoses both before and after the injury than those without a registered neck injury. (10.1186/s12891-016-0877-2)
  • [L3] Three anterior cervical surgical approaches have good curative effects on single level cervical spondylotic myelopathy. (10.1186/1471-2474-15-233)
  • [L3] This study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. (10.1186/s12891-015-0609-z)
  • [L4] Cervical spinal deformity is a debilitating condition with diverse etiologies; recent efforts focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment. (10.5435/jaaos-d-17-00546)
  • [L1] PECD has a high success rate in the treatment of cervical disc herniation and can relieve neck pain, with low recurrence and adverse event rates. (10.1186/s13018-022-03365-1)
  • [L4] Cervical laminectomy and crossing the cervicothoracic junction fusion are effective and safe methods to treat multilevel cervical OPLL. (10.1186/s12891-022-05417-3)
  • [L1] There is low to very low certainty evidence indicating a difference in effectiveness between upper cervical spine interventions and control/placebo treatments for improving the impact and intensity of dizziness in patients with cervical-related dizziness. (10.1186/s12891-025-08899-z)
  • [L3] Both procedural cohorts demonstrated similar long-term clinical outcomes for arm/neck pain and physical function; however, patients undergoing CDR at C5-C6 demonstrated an improved ability to maintain 1-year postoperative progress for neck disability with improved 1-year NDI MCID achievement. (10.5435/jaaos-d-21-01276)
  • [L1] This trial demonstrated that, after a 2-year follow-up, posterior surgery was noninferior to anterior surgery with regard to the success rate and arm pain reduction in patients with cervical radiculopathy. (10.2106/jbjs.23.00775)
  • [L2] The study is designed to compare clinical outcomes between early surgical and conservative strategies to determine which treatment results in the best quality of life and to contribute to more uniformity of treatment for patients with incomplete cervical cord syndrome without spinal instability. (10.1186/1471-2474-14-52)
  • [L4] Although MRI is more sensitive for occult injuries, the standard addition of MRI to CT evaluation alone does not significantly increase the detection of clinically important cervical injuries. (10.5435/jaaos-d-18-00695)
  • [L3] Among patients who underwent multilevel cervical fusion, those with osteoporosis had higher risk of adverse postoperative outcomes at two years. (10.5435/jaaos-d-22-00361)
  • [L4] Kinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation. (10.1186/s13018-023-03745-1)
  • [L3] The segmental contributions of cervical spine during lateral bending movement were first described based on the validated radiographic protocol. (10.1186/1471-2474-15-273)
  • [L5] MRI is a non-invasive, high-resolution, multiplanar imaging modality that provides detailed visualization of osseous and soft-tissue structures of the cervical spine, including the intervertebral discs, spinal cord, and nerve roots, and is essential for evaluating the spectrum of cervical spinal disease. (10.2106/00004623-200200002-00009)
  • [L4] The new classification system has a high reliability and clinical guidance value for diagnosis and treatment planning. (10.1186/s13018-025-06085-4)
  • [L2] In deciding between the two procedures, the risks of surgical and neurological complications, and radiologic and clinical outcome, must be taken into consideration if both options are available in multi-level cervical spondylotic myelopathy. (10.1186/1749-799x-8-45)
  • [L3] CDA utilization among all Medicare beneficiaries has grown substantially and is projected to continue increasing through 2040, reflecting rising demand for motion-preserving cervical spine procedures. (10.5435/jaaos-d-25-00461)
  • [L3] Patients being considered for anterior cervical diskectomy and fusion who have substantial preoperative motor deficits may benefit from earlier surgical intervention. (10.5435/jaaos-d-16-00606)
  • [L5] The Pediatric Cervical Spine Clearance Working Group established consensus definitions and developed an algorithmic approach for pediatric cervical spine clearance based on Glasgow Coma Scale scores to guide institutional protocols. (10.2106/jbjs.18.00217)
  • [L3] While both approaches are effective for managing cervical disc herniation, each has distinct advantages and limitations. (10.1186/s13018-025-05654-x)
  • [L5] Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than they do in the thoracic or lumbar spine. (10.1186/s13018-022-03105-5)
  • [L5] Relative indications vary by level: six months of persisting symptoms for cervical, failure of conservative measures for thoracic, and failure to improve after six weeks for lumbar. (10.1302/2058-5241.6.210020)
  • [L4] Fusion of the first three cervical vertebrae is indicated for unstable lesions where spinal cord damage is a possibility. (10.2106/00004623-196446080-00019)
  • [L5] Nonoperative treatment with collar immobilization and modification of activities improves functional status in selected patients with mild cervical spondylotic myelopathy, but careful monitoring is necessary as neurological deterioration can occur. (10.2106/jbjs.f.00014)
  • [L5] For obtunded patients, a normal multidetector CT scan is sufficient to clear the cervical spine, though the utility of subsequent MRI remains controversial due to insufficient information. (10.5435/00124635-201003000-00004)
  • [Paper] The C2-C3 and C6-C7 segments are subjected to increased mechanical loads in straightened cervical alignment and kyphotic deformity, thereby increasing their susceptibility to facet joint degeneration. (10.1186/s12891-025-09285-5)
  • [L5] Based on an expert meeting (m-NGT) and a two-round Delphi survey, the study documents consensus (> 70%) on 26 prognostic factors for persistent pain after a first episode of idiopathic, non-traumatic neck pain, with 21 of these factors found to be potentially modifiable by physiotherapists. (10.1186/s12891-020-03682-8)
  • [L3] The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. (10.1186/s13018-018-0717-1)
  • [L3] In particular, extension MR scans could provide a more accurate diagnosis than other images. (10.1186/s12891-022-06097-9)
  • [L5] Axial loading of the cervical spine is the primary injury mechanism in catastrophic cervical spine injuries in football players, with profound implications for preventative measures. (10.2106/00004623-200201000-00017)
  • [L5] Recent studies suggest benefits from early surgical decompression, particularly in patients with pathologic conditions revealed by radiography or MRI. (10.5435/jaaos-d-22-00260)
  • [L3] Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS. (10.1186/s12891-024-07279-3)
  • [L3] Approximately 20% of patients undergoing upper cervical spinal fusion surgery experienced delayed bony union. (10.1186/s12891-025-08582-3)
  • [Case_report] Although the prognosis in the presence of primary osteogenic sarcoma of the cervical spine is poor, adequate chemotherapy following prompt recognition and wide excision may improve the prognosis. (10.2106/00004623-197658060-00031)

See Also

References

[1] Chapter 48 Cervical Degenerative Conditions. 2020.

[2] Short-term effects of Kinesio taping combined with cervical muscles multi-angle isometric training in patients with cervical spondylosis. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06154-x

[3] Differentiating Shoulder Pathology from Cervical Spine Pathology: An Algorithmic Approach. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00210

[4] Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022. DOI: 10.3390/ijerph191610158

[5] Posterior Fixation of the Upper Cervical Spine: Contemporary Techniques. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201102000-00001

[6] Degenerative Cervical Spondylosis. The Journal of Bone & Joint Surgery. 2007. DOI: 10.2106/00004623-200706000-00026

[7] Chapter 17 Degenerative Conditions of the Cervical Spine. 2019.

[8] Chapter 35 Pediatric Cervical Spine Disorders. 2020.

[9] Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects.. The Journal of Bone & Joint Surgery. 1991. DOI: 10.2106/00004623-199173070-00028

[10] Rheumatoid Arthritis of the Cervical Spine. Journal of the American Academy of Orthopaedic Surgeons. 1997. DOI: 10.5435/00124635-199709000-00002

[11] Current Concepts of Sagittal Alignment in Adult Cervical Deformity. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00019

[12] Adverse Events Associated With Anterior Cervical Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200812000-00005

[13] Comparison of Clinical Guidelines for Authorization of MRI in the Evaluation of Neck Pain and Cervical Radiculopathy in the United States. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00517

[14] Changes in the cervical spine in juvenile rheumatoid arthritis.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668020-00003

[15] Intradural cysts of the cervical spine: report of three cases.. The Journal of Bone and Joint Surgery. American Volume. 1978.

[16] Clinical outcomes after surgery for cervical radiculopathy performed in public and private hospitals. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b1.bjj-2022-0591.r1

[17] Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-260

[18] Changes in cervical alignment of Zero-profile device versus conventional cage-plate construct after anterior cervical discectomy and fusion: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03400-1

[19] Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04285-7

[20] Cervical Disc Arthroplasty. American Academy of Orthopaedic Surgeon. 2010. DOI: 10.5435/00124635-201010000-00006

[21] Two-level fracture of the cervical spine in a young child. A case report with operative treatment.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365010-00019

[22] Cervical Laminoplasty: Indications, Surgical Considerations, and Clinical Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00242

[23] Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01589-7

[24] "Quality of life of patients after surgical treatment of cervical spine metastases". BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1175-8

[25] Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04807-3

[26] Risk Factors for Poor Outcome of Cervical Laminoplasty for Cervical Spondylotic Myelopathy in Patients with Diabetes. The Journal of Bone and Joint Surgery-American Volume. 2014. DOI: 10.2106/jbjs.n.00064

[27] Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-90

[28] The impact of nuchal ligament ossification resection on cervical stability after modified laminoplasty: a long-term follow-up study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08729-2

[29] Concurrent Cervical Spine Pathology Is Associated With No Clear Difference in Clinical Outcomes, but Increased Complication Rates Following Shoulder Surgery: A Systematic Review. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.01.010

[30] A 20-Year Prospective Longitudinal Study of Degeneration of the Cervical Spine in a Volunteer Cohort Assessed Using MRI. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.17.01347

[31] Cervical fusion in rheumatoid arthritis.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163080-00003

[32] Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2074-y

[33] Cervical Radiculopathy. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200708000-00005

[34] Prevalence and morbidity of neck pain: a cross-sectional study of 3000 elderly men. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03508-y

[35] Untwining the intertwined: a comprehensive review on differentiating pathologies of the shoulder and spine. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.02.007

[36] Catastrophic Cervical Spine Injuries in the Collision Sport Athlete, Part 1. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546504265605

[37] Congenital Osseous Anomalies of the Upper and Lower Cervical Spine in Children. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200202000-00017

[38] Incidence and risk factors of axial symptoms after cervical disc arthroplasty: a minimum 5-year follow-up study. Journal of Orthopaedic Surgery and Research. 2016. DOI: 10.1186/s13018-016-0440-8

[39] Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0517-2

[40] Whiplash(-like) injury diagnoses and co-morbidities – both before and after the injury: A national registry-based study. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0877-2

[41] Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-233

[42] In a secondary care setting, differences between neck pain subgroups classified using the Quebec task force classification system were typically small – a longitudinal study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0609-z

[43] Cervical Spine Deformity: Indications, Considerations, and Surgical Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00546

[44] Intervertebral-Disc Calcification in Childhood: A DISTINCT CLINICAL SYNDROME.. The Journal of Bone and Joint Surgery. American Volume. 1964.

[45] Efficacy and safety of percutaneous endoscopic cervical discectomy for cervical disc herniation: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03365-1

[46] Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05417-3

[47] Is manual therapy effective for cervical dizziness? A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08899-z

[48] Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients With Myeloradiculopathy. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-01276

[49] Posterior Cervical Foraminotomy Compared with Anterior Cervical Discectomy with Fusion for Cervical Radiculopathy. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.23.00775

[51] Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-52

[52] Evaluating the Cervical Spine in the Blunt Trauma Patient. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00695

[53] The Impact of Osteoporosis on 2-Year Outcomes in Patients Undergoing Long Cervical Fusion. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00361

[54] Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03745-1

[56] The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-273

[57] MAGNETIC RESONANCE IMAGING OF THE CERVICAL SPINE. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200200002-00009

[59] A novel image-based classification system for atlantoaxial deformity caused by mucopolysaccharidosis type IVA: an efficacy evaluation. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06085-4

[60] Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature. Journal of Orthopaedic Surgery and Research. 2013. DOI: 10.1186/1749-799x-8-45

[61] Trends in Cervical Disk Arthroplasty Utilization in the Medicare Population: Projections Through 2040. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00461

[62] Prolonged Preoperative Weakness Affects Recovery of Motor Function After Anterior Cervical Diskectomy and Fusion. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00606

[64] Pediatric Cervical Spine Clearance. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.00217

[66] A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05654-x

[69] Cervical radiculopathy associated with an anomaly of the cervical vertebrae: successful surgical treatment. A case report.. The Journal of Bone and Joint Surgery. American Volume. 1988.

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[73] Operative Treatment of Cervical Spondylotic Myelopathy. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.f.00014

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