Neck Pain in Ajax: Understanding Cervical Spine X-Rays

You wake up, try to look over your shoulder, and your neck refuses. Or the stiffness creeps in over weeks of long days at a laptop, then starts sending an ache down into your shoulder blade. Maybe it began after shovelling the driveway, or after a minor bump in a parking lot. Neck pain arrives in many ways, and for most people it is a nuisance that eases with time. For some, it lingers or comes with other symptoms, and their provider decides to take a closer look.

One of the most common first tests for the neck is a cervical spine X-ray. This article explains what that test involves, what the images can tell your provider, and how to make the visit easy. It is aimed at people in Ajax and the wider Durham Region who have been asked to get a neck X-ray, or who are simply curious about how it works. Decisions about whether you need one are always made with your own health-care provider.

The neck in brief

The cervical spine is the top section of the spine, made up of seven vertebrae stacked between the base of the skull and the top of the chest. Doctors number them C1 through C7. The top two are shaped differently from the rest: C1 is a ring that supports the skull, and C2 has an upward projection that allows the head to rotate.

Between most of the vertebrae sit discs that cushion and allow movement. Small paired joints at the back of each level guide the neck as it bends and turns. Nerves leave the spinal canal through openings on each side and travel out to the shoulders, arms and hands. Muscles and ligaments wrap around the whole structure, holding up the weight of the head all day.

That combination of flexibility, load and nerve traffic explains why neck problems can produce pain not only in the neck, but sometimes in the shoulder, arm or hand as well.

Why a provider might order a neck X-ray

Most short-lived neck pain related to posture, sleeping position or a minor strain settles without imaging, and providers often begin with an examination and a period of observation. A cervical spine X-ray is more likely to be requested in situations such as:

• Persistent pain that has not improved over a period of weeks
• Stiffness and reduced movement in an older adult, where wear-related changes are a question
• Pain after a minor injury where the provider wants to look at the bones and alignment
• Arm symptoms such as tingling or aching, where the provider is considering whether changes in the neck might be involved
• Known conditions such as inflammatory arthritis that can affect the neck
• Follow-up after previous treatment or to monitor a known finding

Tingling in the hand does not always come from the neck. It can also come from nerves being pinched further down the arm, as in carpal tunnel syndrome. Our post on carpal tunnel and wrist ultrasound looks at that side of the question.

When neck pain is an emergency

Some neck symptoms need urgent care rather than a walk-in imaging clinic. Call 911 or go to the nearest emergency department if you have:

1. Neck pain after a significant injury, such as a car collision, a fall from a height, a diving accident or a hard hit in sports. Try not to move your neck and wait for help.
2. New weakness, numbness or tingling in the arms or legs, or trouble walking or with balance.
3. Loss of bladder or bowel control.
4. Neck pain or stiffness with fever, a severe headache, confusion or sensitivity to light.
5. Signs of stroke, such as a drooping face, arm weakness or slurred speech.
6. Neck or jaw pain together with chest pain, shortness of breath or sweating, which can be a sign of a heart problem.

A community clinic like ours does not provide emergency assessment, and in these situations getting to emergency care quickly matters more than any one test.

What the X-ray can tell your provider

A cervical spine X-ray is a set of pictures that shows the bones of the neck from several angles. The radiologist reviewing the images may comment on:

• Alignment. The normal neck has a gentle forward curve. The images show whether that curve is present, straightened or reversed, and whether vertebrae line up properly with each other.
• Vertebral shape and height. The images can show fractures or changes in the shape of the bones.
• Disc space height. Like the joint spaces described in our article on arthritis imaging, the gap between vertebrae is an indirect clue to the disc. Narrowing can suggest disc wear.
• Bony spurs. Small outgrowths at the edges of vertebrae are common with age.
• The small joints at the back. Wear-related changes here can be visible on some views.
• Openings for the nerves. Certain angled views can show whether bony changes are narrowing the openings the nerves pass through.

What it will not show

A neck X-ray does not show discs, nerves, the spinal cord, muscles or ligaments directly. If your provider needs to see those, they may arrange a different test, such as MRI or CT, through another facility. It is also very common for a neck X-ray to show some wear-related changes in people who have no symptoms at all, so findings are always interpreted in the context of your history and examination. Our article on back pain and X-rays explores that same idea for the lower spine.

Words you may see on the report

Cervical spine reports use some recurring terms. “Straightening” or “loss of the normal curve” describes the shape of the neck on the side view; it can be seen with muscle spasm, and it can also be influenced by how a person was holding their head at the moment the image was taken. “Spondylosis” is a general word for wear-related change in the spine. “Foraminal narrowing” refers to the openings where nerves exit. These terms describe what the images look like. They are not diagnoses on their own, and only your provider can explain how they relate to your symptoms. If you see the report before your appointment, try to hold your questions for that conversation rather than searching each phrase.

The views, and why there are several

Because the vertebrae overlap and the neck is surrounded by the jaw, skull and shoulders, one image is rarely enough. A typical cervical spine series may include:

The front view

You stand or sit facing the X-ray tube or the detector, and an image is taken straight through the neck from front to back.

The side view

This view is often the most informative for alignment. You may be asked to relax and lower your shoulders as far as is comfortable so the lower neck is not hidden by the shoulders.

The open-mouth view

To see the top two vertebrae clearly, you will be asked to open your mouth wide so that the teeth do not block the view. It can feel a little strange, but it only takes a moment.

Angled views

Some requisitions call for views with your body turned partway. These show the side openings where the nerves exit.

Flexion and extension views

Occasionally, a provider asks for images with your chin tucked toward your chest and then tilted back. These show how the vertebrae move relative to each other. They are only taken when specifically requested, and you should only move as far as is comfortable. Tell the technologist right away if movement brings on pain, tingling or dizziness.

How to prepare

There is no fasting or medication preparation for a neck X-ray. A few simple steps help:

• Leave necklaces and earrings at home, or be ready to remove them.
• Take out hair clips, pins and elastic bands with metal, and be ready to take your hair down if it is pinned up at the back.
• Removable dental work such as dentures or a retainer may need to come out for the open-mouth view. The technologist will let you know.
• Wear a top without metal around the collar, such as a plain T-shirt, or be ready to change into a gown.
• Bring your health card and any paperwork from your provider. If you are unsure what is needed for a walk-in visit, call the clinic to confirm.
• Tell the technologist if there is any chance you are pregnant.

Your visit to Rossland Diagnostic Clinic

General digital X-ray at our Ajax clinic is available on a walk-in basis during opening hours, Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. The department may stop accepting walk-ins once the day’s capacity is reached, so please call 905-426-3111 for live availability before you come. We are at Unit 102, 300 Rossland Road East, with free parking and ground-floor access, which is helpful if turning your head to reverse or merge is uncomfortable and you are relying on someone else to drive.

The exam itself is short. Most of the time goes into careful positioning, and the technologist will guide you through each step. If an urgent finding is identified, the ordering physician is alerted. A report goes to the provider who requested the X-ray, and they will discuss the results and any next steps with you. If you need your images for a specialist, they can be provided on CD.

You can read more about the service on our X-ray page. Patients from Ajax, Pickering, Whitby and nearby communities are welcome. If you have questions, call us at 905-426-3111, or request an appointment for any of our booked imaging services.