Cervical and Thoracic Spine

Non specific neck pain/ degenerative cervical spine pain (~90-95% cases in primary care)

Research has revealed that the majority of neck pain (90-95%) has no underlying specific pathology or identifiable cause and as such the vast majority of cases at this lower end of the complexity spectrum are managed within primary care +/- MSK Physiotherapy. As detailed within the NHS Lothian Neurology ref help advice section “EVERYONE gets cervical spondylosis as they get older – like grey hair. There is poor correlation between radiological ‘age-related’ changes and neck pain. Doing a plain cervical x-ray on someone with neck pain and telling them they have cervical spondylosis/arthritis/”wear and tear” may be harmful /reduce the effectiveness of physiotherapy”.

People with cervical spine problems who are referred to MSK Physiotherapy are managed within agreed pathways of care. Prognosis is good. For these cases imaging will not guide management and can cause more harm than benefit. Research has shown that imaging does not improve clinical outcomes with liberal use being linked with greater work absence, unnecessary use of health services through action on incidental findings and provoke unnecessary worry or concerns in patients from a labelling effect.

Radicular arm pain/ radiculopathy/ (~5-10% case in primary care)

Less than 5-10% of all cervical related presentations. For those people whose pain is persistent, resistant to conservative management and wish to consider invasive options, MSK Physiotherapist’s will be able to arrange an opinion with spinal advanced practice physiotherapists within the integrated MSK service (iMSK). These spinal APP’s work closely with Consultant Neurosurgeons, radiologists, MSK Physiotherapists and the Pain Management Service. They are able to arrange investigations, undertake regular virtual clinics with Consultant Neurosurgeon’s and onward referral to Neurosurgery as appropriate.

As detailed within the NHS Lothian Neurology ref help advice: “We often are asked for MR Cervical Spine to ‘show the cause’ of someone’s pain……………….MR C-spine is rarely helpful:
a) because usually it is muscular pain with radiation not radiculopathy;
b) cervical radiculopathy usually improves with conservative treatment;
c) neurosurgery is rarely offered/has little evidence base in this area. MR C-Spine is not available open access in NHS Lothian . We request it mainly to look for spinal cord pathology.”

Please consider further information and support ;

 Neck and Arm Pain- Neurology Ref Help Advice opens a new window

Neurology- Neck and Arm pain advice and pathway – Ref help opens a new window

Specific spinal pathology (~1% of cases in primary care)

These conditions include cancer, infection, inflammatory disease, cauda equina syndrome, acute foot drop and fracture. If there is suspicion of a specific underlying spinal pathology, please follow the ‘red flag’ pathways

Support and guidance

For guidance and support refer to Spine pathways | Right Decisions (scot.nhs.uk) opens a new window

• Link to NHS Inform page neck problems  https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/neck-problems opens a new window
• Link to NHS Inform page- cervical spondylosis https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/cervical-spondylosis opens a new window