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Assessment of Neck Pain and Its Associated Disorders

Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

  • Best Evidence
  • Published:
European Spine Journal Aims and scope Submit manuscript

An Erratum to this article was published on 12 February 2009

Abstract

Study Design

Best evidence synthesis.

Objective

To critically appraise and synthesize the literature on assessment of neck pain.

Summary of Background Data

The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature.

Methods

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980– 2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.

Results

We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain.

Conclusion

The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients’ course, response to treatment, and in clinical research.

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Authors and Affiliations

  1. Departments of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, New York, NY, USA

    Margareta Nordin PT, Dr Med Sc

  2. Occupational and Industrial Orthopaedic Center (OIOC), New York University-Hospital for Joint Diseases, New York University Medical Center, New York, USA

    Shira Schecter Weiner PT, PhD (Candidate)

  3. Program of Ergonomics and Biomechanics. Graduate School of Arts and Science and School of Medicine, New York University, New York, USA

    Shira Schecter Weiner PT, PhD (Candidate)

  4. Occupational and Industrial Orthopaedic Center (OIOC), New York University Medical Center, New York, NY, USA

    Margareta Nordin PT, Dr Med Sc

  5. Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Eugene J. Carragee MD, FACS

  6. Orthopaedic Spine Center and Spinal Surgery Service, Stanford University Hospital and Clinics, Stanford, CA, USA

    Eugene J. Carragee MD, FACS

  7. Institute for Work and Health, Toronto, Canada

    Sheilah Hogg-Johnson PhD

  8. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    Sheilah Hogg-Johnson PhD

  9. Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Mânoa, Honolulu, HI, USA

    Eric L. Hurwitz DC, PhD

  10. Endocrinology, Analgesia and Inflammation, Merck & Co., Rahway, NJ, USA

    Paul M. Peloso MD, MSc, FRCP(C)

  11. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  12. Occupational Health and Safety Agency for Healthcare in BC, Vancouver, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  13. Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Pierre Côté DC, PhD & J. David Cassidy PhD, Dr Med Sc

  14. Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada

    Gabrielle van der Velde DC, Pierre Côté DC, PhD & J. David Cassidy PhD, Dr Med Sc

  15. Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, Canada

    Linda J. Carroll PhD

  16. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Lena W. Holm Dr Med Sc

  17. Institute for Work & Health, Toronto, Canada

    Gabrielle van der Velde DC & Pierre Côté DC, PhD

  18. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Gabrielle van der Velde DC

  19. Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada

    Gabrielle van der Velde DC, Pierre Côté DC, PhD & J. David Cassidy PhD, Dr Med Sc

  20. Department of Neurology, University of California, Irvine, CA, USA

    Scott Haldeman DC, MD, PhD

  21. Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA

    Scott Haldeman DC, MD, PhD

  22. OIOC-NYU HJD, 63 Downing Street, New York, NY, 10014, USA

    Margareta Nordin PT, Dr Med Sc

Authors
  1. Margareta Nordin PT, Dr Med Sc
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  2. Eugene J. Carragee MD, FACS
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  3. Sheilah Hogg-Johnson PhD
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  4. Shira Schecter Weiner PT, PhD
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  5. Eric L. Hurwitz DC, PhD
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  6. Paul M. Peloso MD, MSc, FRCP(C)
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  7. Jaime Guzman MD, MSc, FRCP(C)
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  8. Gabrielle van der Velde DC
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  9. Linda J. Carroll PhD
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  10. Lena W. Holm Dr Med Sc
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  11. Pierre Côté DC, PhD
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  12. J. David Cassidy PhD, Dr Med Sc
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  13. Scott Haldeman DC, MD, PhD
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Corresponding author

Correspondence to Margareta Nordin PT, Dr Med Sc.

Additional information

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Reprinted with permission from Lippincott Williams & Wilkins, Nordin M, Carragee EJ, Hogg-Johnson S, et al., Assessment of Neck Pain and Its Associated Disorders, Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, SPINE, Volume 33, Number 4S, pp S101–S122

An erratum to this article can be found at http://dx.doi.org/10.1007/s00586-009-0888-x.

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Nordin, M., Carragee, E.J., Hogg-Johnson, S. et al. Assessment of Neck Pain and Its Associated Disorders. Eur Spine J 17 (Suppl 1), 101–122 (2008). https://doi.org/10.1007/s00586-008-0630-0

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