Screening protocol s 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 question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s 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 .
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 review s of this literature .
Are five-view plain films of the cervical spine unreliable? A prospective evaluation in blunt trauma patients with altered mental status.
OBJECTIVES Clearing the cervical spine in a time-sensitive fashion is difficult . We hypothesized that admission computed tomographic scan of the occiput to T1 ( CTS ) with multiplanar reformatted images will replace five-view ( odontoid , anteroposterior , lateral , and oblique ) plain films of the cervical spine ( CSX ) in the initial evaluation of blunt trauma patients with altered mental status . METHODS Between January and July 2001 , all patients aged 16 years or older with altered mental status undergoing both CTS and CSX were prospect ively entered into the study group . Attending physician interpretation defined the presence of cervical spine injury . Unstable fractures were defined as requiring surgical or halo stabilization . RESULTS One thous and six patients met study criteria . One hundred sixteen patients had 172 cervical spine injuries ( CSIs ) ( fracture and subluxation ) .  CSX missed 90 of 172 ( 52.3 % ) CSIs in 65 of 172 ( 56.0 % ) patients . Anatomically , CSX failed to identify 14 of 15 occipital fractures ( 93.3 % ) , 17 of 36 ( 47.2 % ) C1 - 3 fractures , and 59 of 121 ( 48.8 % ) C4-T1 CSIs . CSX failed to identify 5 of 29 ( 17.2 % ) patients with unstable CSIs . CTS failed to diagnose 3 of 172 ( 1.7 % ) CSIs that were stable ( spinous process fractures at C6 - 7 ) . Two patients exhibited spinal cord injury without radiologic abnormality missed by both modalities . CTS had a sensitivity of 97.4 % , a specificity of 100 % , a prevalence of 11.5 % , a positive predictive value of 100 % , and a negative predictive value of 99.7 % . CSX had a sensitivity of 44.0 % , a specificity of 100 % , a prevalence of 11.5 % , a positive predictive value of 100 % , and a negative predictive value of 93.2 % . CONCLUSION CTS outperformed five-view CSX in a group of patients with altered mental status or distracting injuries . Five-view CSX failed to diagnose 52.3 % of cervical spine fractures identified by CTS . Five-view CSX failed to diagnose five patients with unstable cervical fractures and failed to identify 93.3 % of patients with occipital condyle fractures
Screening protocol s 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 question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s 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 .
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 review s of this literature .