What role do imaging studies play in the diagnosis and management of cervical spondylosis in primary care?

Role of Imaging in Diagnosis and Management of Cervical Spondylosis in Primary Care

In primary care, imaging studies have a limited but specific role in the diagnosis and management of cervical spondylosis. Initial assessment should focus on clinical evaluation, reserving imaging for cases where red flags or objective neurological signs are present. If a patient presents with symptoms suggestive of cervical radiculopathy or spondylosis but without severe or progressive neurological deficits, conservative management is recommended initially without immediate imaging. This includes reassurance, advice on activity, analgesia, and physiotherapy ¹,²,³.

Imaging, particularly magnetic resonance imaging (MRI), is indicated when symptoms persist beyond 4–6 weeks or when objective neurological signs such as motor weakness or sensory loss develop. MRI is the preferred modality to confirm diagnosis, assess nerve root or spinal cord compression, and guide further management including consideration of invasive procedures or surgery ¹,²,³. Plain X-rays and CT scans have limited roles and are generally not recommended for routine diagnosis of cervical spondylosis unless there is suspicion of trauma or other specific pathology ⁵.

In cases of suspected serious spinal abnormalities or spinal cord compression, urgent referral and MRI are essential to guide treatment ⁴. MRI sequences should include sagittal T1, STIR, and T2-weighted images to evaluate the spinal cord and nerve roots comprehensively ⁴. If MRI is contraindicated, CT may be used as an alternative ⁴.

Recent literature supports this approach, emphasizing that most patients with cervical spondylosis improve with conservative management and that imaging should be reserved for those with progressive or severe neurological symptoms (Lebl and Bono, 2015; Bakhsheshian et al., 2017). Imaging findings must be correlated with clinical presentation, as degenerative changes are common and not always symptomatic (Kalichman and Hunter, 2008). Thus, imaging in primary care is primarily a tool to exclude serious pathology and to confirm diagnosis when clinical progression warrants further investigation.