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 .
Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma.
BACKGROUND Current literature supports the use of the three-view plain-radiograph series supplemented , when necessary , with helical computed tomography to evaluate the cervical spine in patients who have sustained trauma injury . The purpose of this study was to determine if helical computed tomography alone can be used to evaluate the cervical spine for acute osseous injury following high-energy trauma , thus eliminating the need to make radiographs . METHODS Patients were prospect ively evaluated with helical computed tomography scanning of the cervical spine and st and ard three-view plain radiography . At a later date , the plain radiographs and computed tomography scans were independently review ed by two radiologists who were blinded to both the initial interpretation and the interpretation of the corresponding study . The radiologists documented whether the plain radiographs were adequate and whether they showed an acute process . The findings in the study were compared with the initial findings and , when necessary , with the discharge summaries to determine if an injury had been identified . The accuracy of the plain radiographs , of the plain radiographs that had been deemed adequate , and of helical computed tomography used alone was ascertained . RESULTS Plain radiographs and helical computed tomography scans were made for 407 patients , and traumatic injuries were identified in fifty-eight of them .  Plain radiographs alone were adequate for 194 ( 48 % ) of the 407 patients .  Plain radiographs had a sensitivity of 45 % , a specificity of 97 % , a positive predictive value of 74 % , and a negative predictive value of 91 % . Adequate plain radiographs had a sensitivity of 52 % , a specificity of 98 % , a positive predictive value of 81 % , and a negative predictive value of 93 % . Helical computed tomography had a sensitivity and specificity of 98 % , a positive predictive value of 89 % , and a negative predictive value of > 99 % . The sensitivity , positive predictive value , and negative predictive value of adequate plain radiographs differed significantly from those of helical computed tomography alone ( p < 0.001 ) . Twelve ( 48 % ) of twenty-five adequate plain radiographs of patients in whom an injury had been identified on computed tomography missed that injury . Helical computed tomography alone missed one ( 2 % ) of the fifty-eight injuries . CONCLUSIONS Although helical computed tomography has a limited ability to detect pure ligamentous injury , it can be safely used without plain radiographs to evaluate the cervical spine for osseous abnormalities such as fractures and dislocations after high-energy trauma
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 .