Interventional Decision-Making Under Diagnostic Uncertainty in Axial and Referred Cervical Pain: A Scoping Review

Axial cervical pain without radiculopathy or myelopathy is common yet conceptually imprecise. Validated diagnostic criteria to reliably identify pain generators are lacking, resulting in heterogeneous decision-making. While some subgroups such as facet-mediated pain employ structured diagnostic approaches, other phenotypes—including cervical referred pain—often remain diagnostically indeterminate. This scoping review maps how diagnostic uncertainty is addressed when adults are evaluated for interventional or surgical treatment. No effectiveness comparison was performed. Objective: To map how diagnostic uncertainty is acknowledged, managed, assumed, or left unaddressed in studies involving adults with axial or referred cervical pain, without radiculopathy or myelopathy, evaluated for interventional or surgical treatment. Eligibility Criteria Inclusion: Adults (≥18 years) with axial or referred cervical pain evaluated for interventional or surgical treatment, with explicit or implicit diagnostic rationale. Study designs include clinical studies, case series ≥10 patients, and guidelines. Exclusion: Pediatric populations; predominant radiculopathy or myelopathy; combined cervical and lumbar pain without separate cervical analysis (unless axial pain is analyzed separately); mixed axial and radicular pain without separate axial analysis; trauma, infection, tumor, inflammatory disease; exclusively conservative treatment; postoperative pain as main focus; single case reports. Information Sources The search will be conducted initially in PubMed (MEDLINE) and Scopus. Search Strategy (PubMed) ("neck pain"[MeSH] OR "axial neck pain" OR cervicalgia OR "cervical referred pain" OR "interscapular pain") AND ("diagnostic block" OR "medial branch" OR radiofrequency OR fusion OR arthrodesis OR intradiscal OR percutaneous) NOT (radiculopathy OR myelopathy OR trauma OR tumor OR infection OR headache OR migraine OR lumbar OR "back pain") Study Selection Two reviewers will independently screen titles/abstracts and full texts. In cases of uncertainty, studies will be included for full-text review. Disagreements will be resolved by discussion, with arbitration by the senior investigator if needed. Data Extraction Items 1. Author/year 2. Country 3. Study design 4. Pain phenotype 5. Diagnostic approach 6. Declared pain generator 7. Intervention evaluated 8. Outcomes reported 9. Numeric result (descriptive only) 10. Follow-up duration 11. Role of outcome in decision-making (A–E categories) Synthesis Plan Data will be synthesized descriptively and thematically, focusing on decision-making models under diagnostic uncertainty. Outcomes will be used only to contextualize how success is defined and interpreted. No effectiveness comparison was performed. Stop Rule If insufficient diagnostic rationale is present in the literature to meaningfully map decision-making patterns, the project will pivot to a narrative critical review focused on conceptual gaps.