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 .
Provocative cervical discography symptom mapping.
BACKGROUND CONTEXT In a small prospect i ve study assessing 10 symptomatic and 10 asymptomatic subjects , Schellhas et al. compared cervical discography to magnetic resonance imaging . Within that study he reported on the distribution of pain for the C3-C4 to C6-C7 levels . Four years later , Grubb and Ellis reported retrospective data from his 12-year experience using cervical discography from C2-C3 to C7-T1 in 173 patients . To date , no large prospect i ve study defining pain referral patterns for each cervical disc has been performed . PURPOSE To conduct a prospect i ve visual and statistical descriptive study of pain provocation of a cohort of subjects undergoing cervical discography .  STUDY DESIGN / SETTING Prospect i ve multicenter descriptive study . METHODS Pain referral maps were generated for each disc level from patients undergoing cervical discography with at least two levels assessed . If concordant pain was reproduced in a morphologically abnormal disc , the subject immediately completed a pain diagram . An independent observer interviewed the subject and recorded the location of provoked symptoms . Visual data were compiled using a body sector bit map , which consisted of 48 clinical ly relevant body regions . Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated . RESULTS A total of 101  symptom provocation maps  were recorded during cervical discography on 41 subjects . There were 10 at C2-C3 , 19 at C3-C4 , 27 at C4-C5 , 27 at C5-C6 , 16 at C6-C7 and 2 at C7-T1 . Predominantly unilateral symptoms were provoked just as often as bilateral symptoms . The C2-C3 disc referred pain to the neck , subocciput and face . The C3-C4 disc referred pain to the neck , subocciput , trapezius , anterior neck , face , shoulder , interscapular and limb . The C4-C5 disc referred pain to the neck , shoulder , interscapular , trapezius , extremity , face , chest and subocciput . The C5-C6 disc referred pain to the neck , trapezius , interscapular , suboccipital , anterior neck , chest and face . The C6-C7 disc referred pain to the neck , interscapular , trapezius , shoulder , extremity and subocciput . At C7-T1 we produced neck and interscapular pain . Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated . CONCLUSIONS In conclusion , these results confirm the observations of prior investigators that cervical internal disc disruption can elicit axial and peripheral symptoms . The particular patterns of pain generation allow the discographer to preprocedurally anticipate disc levels to assess . With these data , the number of disc punctures that are required can be limited rather than routinely assessing all cervical discs
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 .