An evidence-based algorithmic approach to cervical spinal disorders

Cervical injection procedures are commonly used for the nonsurgical management of cervical pain with or without radicular signs. Because the majority of studies investigating the utility of cervical injection procedures have been conducted in the last decade, there has been little time to develop pathways that systematically incorporate these procedures in daily clinical management. We review the literature concerning fluoroscopically guided interventional techniques in the nonsurgical management of cervical spinal disorders such as cervical radiculopathy, cervical radicular pain, cervical facet joint syndrome, and cervical internal disc disruption syndrome. A basic tenet underpinning the use of such techniques is that an accurate diagnosis allows for specific treatment and therefore, better outcomes. We adhere to this principle leading to our use of diagnostic and therapeutic algorithms. We offer a preliminary paradigm that provides the clinician with a mechanism to systematically formulate a differential diagnosis and therapeutic plan. This process necessitates continuous revision as new information is published, thereby implying plasticity to these algorithms.