Table 1 Comparison of mechanical and nonmechanical neck pain [5, 6]

Pain character

• Unilateral or bilateral pain

• Unilateral or bilateral pain

• Often accompanied by severe headches

• Progressive worsening

• Pain disappears in rest

• No relation to activities

• Maximum of pain rather in the evening

• Frequent sleep interruption

• Slow worsening

• No alteration by rest or activity

• Activity related

• Maximum of pain in the early morning

• Reproducible

• Patients feel head heaviness and instability

• Significant loss of cervical spine rotation

Reason for pain

• Structural alterations of the cervical spine

• Tumor invasion into the vertebra

○ (Pathologic) fracture

• Vertebral destruction stretching the periosteum

○ Instability

• May become mechanical pain after pathologic fracture

○ Degenerative cervical spine changes

○ Cervical strain

○ Whiplash-trauma

○ Rheumatological disorders

Pain onset

• Insidious onset with slow worsening

• Insidious onset

• Sudden onset after appropriate trauma

• Sudden onset after minimal trauma

Age of patients

• Patients of all ages

• Elder patients often with "red flacs" in their anamnesis:

• Degenerative cervical spine disease rather in elderly patients

○ Tumor

○ Trauma

○ Infection

○ Vascular disease

Radiological diagnostic steps

• X-ray imaging 6-8 weeks after unsuccessful conservative treatment

• Complete neurological examination

• CT scan or MRI only in cases of neurological dysfunction or fracture

• Both X-ray imaging and MRI

Neurologic dysfunction

• Can be accompanied by all kinds of neurological dysfunction

• Relatively rare (5 to 10%)

• Can be accompanied by all kinds of neurological dysfunctions.