Symptomatic care is indicated in this patient. Most patients with neck pain do not require diagnostic imaging. Imaging is indicated for neck pain following trauma or if a structural abnormality, such as a compression fracture, is suspected. Imaging may also be indicated in patients who have weakness or clinical evidence of spinal cord involvement as a cause of neck pain. Additionally, imaging may be useful in those with a clinical presentation suggestive of malignancy or infection as a cause of neck pain. This patient has no history of trauma, weakness, or findings suggestive of a spinal cause of her pain. Despite her history of breast neoplasm, she has not had evidence of recurrence and has no other symptoms or findings suggestive of metastatic disease (such as point tenderness to palpation over the spine). Her otherwise normal presentation does not support a systemic process such as infection. Therefore, imaging in this patient would not be expected to be of benefit. Instead, the focus should be on symptomatic treatment of her neck pain using usual therapeutic modalities including mobilization, exercise, and analgesic agents.

CT myelography involves injection of nonionic water-soluble contrast agents into the spinal canal followed by a CT scan. Because of the effectiveness of other imaging modalities, myelography is usually limited to specific situations in which it may provide more helpful information than other studies, such as multilevel disk abnormalities or radiculopathies, fragmented disks, and patients who have had spinal surgery. This patient has no clear indication for this form of imaging.

MRI of the cervical spine best delineates the spinal cord and nerve roots, intervertebral disks, surrounding soft tissue, ligamentous structures, and vertebral arteries, but it is not indicated in this patient who has no neurologic signs or findings suggestive of abnormalities of these structures.

Plain radiography of the cervical spine is useful in evaluating the bony structures of the spine and is therefore helpful in excluding fracture in patients with trauma or who are suspected of having other bony abnormalities, such as compression fractures, metastatic disease, or infection affecting the spine. However, this patient has no history suggestive of an abnormality likely to be detected with plain radiography.