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Neck and back pain are major causes of disability in the United States and are commonly seen in the ED. While the majority of cases have nonspecific or benign etiologies, serious underlying pathology may exist. Clinicians must be vigilant in obtaining a thorough history, focusing on risk factors for pathology, and physical examination that includes a detailed neurologic examination.


Neck and back pain have myriad causes, but can often be classified into two groups: uncomplicated musculoskeletal pain and those with pain attributable to radiculopathy (spinal nerve root compression) or myelopathy (spinal cord compression) (see Tables 177-1, 177-2, and 177-3). Thoracolumbar pain may also be categorized by symptom duration: acute (<6 weeks), subacute (6 to 12 weeks), or chronic (>12 weeks).

Table 177-1

Differentiating Cervical Radiculopathy from Uncomplicated Musculoskeletal Neck Pain

Table 177-2

Signs and Symptoms of Cervical Radiculopathy

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