A 71-year-old woman presents to the emergency department with a 2- to 3-week history of waxing and waning constant pain in her lower posterior neck. The patient reports no fever, weakness, numbness, chest pain, or shortness of breath. On further questioning, she states that she experiences occasional chills.

Physical examination reveals normal vital signs except for a temperature of 37.2°C. The patient has restricted range of motion in her neck, and movement exacerbates her pain. Her neurologic examination is normal.

Magnetic resonance imaging (MRI) of the cervical and thoracic spine is obtained (Figure 1).

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