[Neckpain: additional investigations only when there is an indication--treatment is rarely necessary].
In this article, we describe the case of a 44-year-old secretary who developed neck pain. Without first having consulted her general practitioner, she visited a chiropractor who concluded that she had 'irritation of the nerves', which the patient interpreted as a herniation of a cervical disc. She believed an MRI to be necessary. She underwent a total body scan at a commercial facility which revealed degenerative changes of the cervical and lumbar spine and an arachnoid cyst in the brain. We could not reassure this patient; however, unnecessary investigations and treatment in a different patient could be prevented. Additional investigations for neck pain without neurological signs on examination are only necessary for a few patients. Chiropractic may have serious side effects. Confusing information about neck pain appearing on the Internet and in medical journals should be contested with information based on the solid, critical appraisal of studies.
Academisch Medisch Centrum, afd. Neurologie, Amsterdam, the Netherlands. m.vermeulen@amc.uva.nl
M Rien
MR
Vermeulen
D000328:Adult; D016080:Arachnoid Cysts / Q000175:diagnosis*; D002574:Cervical Vertebrae / Q000473:pathology*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D026882:Manipulation, Chiropractic / Q000009:adverse effects / Q000379:methods; D019547:Neck Pain / Q000175:diagnosis* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors