Neck pain is a common complaint, ranging from a simple muscle strain to conditions that threaten the spinal cord. While mild stiffness often resolves with rest, severe or acute pain can signal a medical emergency. The emergency department (ED) is equipped to rapidly assess and stabilize patients, aiming to quickly identify and treat debilitating conditions and protect the patient from potential neurological damage.
Determining the Need for Emergency Care
The decision to go to the emergency room rests on the presence of “red flag” symptoms suggesting unstable injury, infection, or neurological compromise. Pain following high-impact trauma, such as a severe fall or motor vehicle accident, mandates immediate evaluation due to the risk of fracture or ligament instability. Neurological deficits are a concern, including sudden weakness, numbness, or tingling radiating into the arms or legs, which may indicate spinal cord or nerve root compression.
Other signs include a severe headache combined with a stiff neck and fever, which can point toward meningitis. Loss of bowel or bladder control is an urgent sign of potential spinal cord compression (cauda equina syndrome). Unexplained fever, sudden weight loss, or constant pain, even at rest, should also prompt an ER visit as these can signal infection or malignancy.
Initial Assessment and Stabilization
Upon arrival, triage nurses determine the priority level based on symptom severity and mechanism of injury. For suspected trauma, immediate stabilization is initiated using a rigid cervical collar (C-collar) to immobilize the neck. This prevents movement that could worsen a spinal cord injury and is maintained until imaging rules out an unstable fracture or ligament injury.
The emergency physician then conducts a detailed history, focusing on pain onset, injury mechanism, and pre-existing conditions like cancer. A physical examination assesses mental status, range of motion, and tenderness. A neurological examination checks muscle strength, reflexes, and sensation in all four extremities to identify signs of myelopathy or nerve root impingement.
Diagnostic Procedures in the ER
Diagnostic procedures are driven by the red flags identified during the assessment. For suspected trauma, a Computed Tomography (CT) scan of the cervical spine is often the initial imaging choice, providing superior detail of bony structures to rapidly identify fractures or malalignment. Plain X-rays may be used but are less sensitive for subtle fractures.
If the CT scan is normal but suspicion of ligamentous injury or spinal cord involvement remains, a Magnetic Resonance Imaging (MRI) scan may be ordered. MRI is effective for visualizing soft tissues, including the spinal cord, ligaments, and discs, which helps diagnose nerve compression or spinal cord contusion. Blood tests may also be drawn to check for inflammatory markers, such as C-reactive protein (CRP) or white blood cell count, to help rule out systemic infection or conditions like vertebral osteomyelitis.
Treatment, Disposition, and Follow-Up
Immediate treatment focuses on pain control and addressing the underlying cause. Pain management often involves intravenous (IV) nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, or sometimes IV opioids for severe pain. If severe infection is suspected, broad-spectrum antibiotics may be started immediately, even before culture results are available.
Once a diagnosis is made, the patient’s disposition is determined. Patients with stable muscle strains or controlled disc issues are typically discharged home with oral medication prescriptions. Those diagnosed with unstable fractures, spinal cord compression, or severe infections are admitted to the hospital, often requiring consultation with neurosurgeons or orthopedic specialists for intervention. Discharge instructions include guidance on activity modification and follow-up with a primary care physician or specialist within a week. Patients are also educated on warning signs requiring an immediate return, such as worsening numbness or loss of bowel or bladder function.