The radiology of chronic neck pain: sequelae of occult traumatic lesions.

Occult traumatic lesions of the cervical spine usually involve the smaller, posterior elements of the vertebrae. Chronic neck pain associated with these lesions is intermittent and of variable severity, but with patterns that are fairly characteristic of the osseous lesions. Similarly, the long-term radiographic sequelae occur in fairly predictable patterns. The original osseous injury characteristically involves a fracture deformity and frequently some instability. There is a closed five point suspension system at each of the levels of the lower cervical spine, so that each of these five points is stressed whenever any one of them is deformed. Thus there follows bilateral hypertrophic changes and disc deterioration. Satellite changes also occur. The original deformity usually leads to rotation at the level of the lesion, cervical malalignment, and muscle imbalance. Therefrom the osseous and disc changes associated with chronic torticollis may occur, as well as distant instabilities.