When neck pain persists without neurological deficits, what is a common nonoperative diagnosis?

• A. Cervical cancer
• B. Non-specific neck pain or myofascial strain
• C. Meningitis
• D. Vertebral fracture

Answer: (B)

The main idea here is that neck pain lasting without any neurological signs is most commonly a musculoskeletal issue, typically described as non-specific neck pain or myofascial strain. This fits because the vast majority of persistent neck discomfort arises from soft-tissue overuse, poor posture, or muscle tension, especially when the neurological exam is normal and there are no red flags. Patients often have localized pain, stiffness, and tenderness in the neck muscles with pain that worsens with movement and improves with rest or gentle stretching. Treatment is usually conservative: activity as tolerated, NSAIDs or acetaminophen, heat or cold, and targeted physical therapy or exercises. Symptoms tend to improve over days to weeks.

In contrast, the other conditions are less likely in this scenario because they typically come with additional concerns or signs. Cervical cancer would usually present with systemic symptoms or other focal findings and is not a common cause of isolated neck pain without red flags. Meningitis shows fever, severe neck stiffness, altered mental status, and a rapid, acutely ill course. A vertebral fracture often follows a specific injury and presents with focal midline tenderness, severe pain, and sometimes neurological changes, making it unlikely when the presentation is persistent neck pain without deficits.