Plain films of the cervical spine are virtually always the first step. Many evaluations end here with the discovery of significant degenerative change but no radicular symptoms. MRI should be reserved for significant neurological symptoms or for persistent symptoms that do not respond to conservative therapy. When deciding whether or not to employ advanced imaging applications please consider whether or not the patient is a potential surgical candidate. If subsequent surgical intervention is not feasible there may be no need to proceed with further imaging evaluation. MRI without contrast is indicated for cervical disc disease. MRI with contrast is only indicated for evaluation of potential tumor, infection, MS, or other uncommon disease processes.