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Chien JT, Hsieh MH, Yang CC, Chen IH, Lee RP. Anterior Cervical Discectomy and Fusion Versus Conservative Treatment for Cervical Angina Conservative Treatment. Clin Spine Surg 2021; 34:E514-E521. [PMID: 33828047 PMCID: PMC8560149 DOI: 10.1097/bsd.0000000000001178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This study employed a retrospective study design. OBJECTIVE This retrospective cohort study aimed to compare the outcomes of anterior cervical discectomy and fusion (ACDF), and those of conservative treatment for patients with cervical angina. SUMMARY OF BACKGROUND DATA Cervical angina is typically characterized by intolerable and paroxysmal angina-like precordial pain, which is caused by cervical disk degeneration in patients without definitive cardiovascular abnormalities. Diagnosis is either delayed or neglected because of its various clinical manifestations. Whether conservative or surgical treatment is appropriate remains controversial because of the lack of comparative studies. MATERIALS AND METHODS From 2009 to 2016, 163 patients with cervical angina with advanced chest pain, tightness, or palpitation were retrospectively studied. Twenty-three patients underwent ACDF, and the other 140 patients were treated nonsurgically by medication, physical therapy, collar immobilization, or stellate ganglion block. Japanese Orthopedic Association (JOA) score and 20-point autonomic nervous system (ANS) score were assessed pretreatment and posttreatment. Patients' satisfaction was assessed using the Odom criteria. RESULTS The average age of the patients was 50 years, and most of them were females. The average follow-up was 25.5 months. The pretreatment JOA and 20-point ANS scores in the conservative and ACDF groups were 13.3 versus 11.7 (P=0.110) and 13.0 versus 13.3 (P=0.928), respectively. Generalized estimating equation analysis showed that posttreatment JOA and ANS scores at each observation interval improved significantly in the ACDF group (P<0.001). Angina-like symptoms also improved significantly in the ACDF group (P<0.001). During an average 2-year follow-up, good or excellent results were obtained in 78.2% of surgical patients and 35% of nonsurgical patients. CONCLUSIONS Compared with conservative therapy, surgical treatment with ACDF for cervical angina provided better and more consistent relief from angina-like symptoms and overall sympathetic symptoms. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jui-Teng Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University
| | - Min-Hong Hsieh
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Chang-Chen Yang
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University
| | - Ing-Ho Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien
- School of Medicine, Tzu Chi University
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien
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Sharma R, Garg K, Agrawal S, Mishra S, Gurjar HK, Tandon V, Agrawal D, Singh M, Chandra SP, Kale SS. Atypical Symptoms of Cervical Spondylosis: Is Anterior Cervical Discectomy and Fusion Useful? - An Institutional Experience. Neurol India 2021; 69:595-601. [PMID: 34169849 DOI: 10.4103/0028-3886.317235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A significant proportion of patients with cervical spondylosis can present with atypical symptoms like vertigo, tinnitus, nausea, vomiting, headache, blurred vison, palpitations and gastrointestinal (GI) discomfort. The role of ACDF in alleviating these atypical symptoms remains unexplored. Objective The current study attempts to investigate the role of anterior cervical discectomy and fusion (ACDF) in alleviating atypical symptoms associated with cervical spondylosis. Materials and Methods The patients with cervical spondylosis who underwent ACDF between January 2011 and December 2015 were contacted by phone. Data regarding the severity and frequency of atypical symptoms was collected by a structured questionnaire. Wilcoxon signed rank test was used to compare the severity and frequency of these symptoms before the surgery and at last follow up. Results A total of 467 patients underwent ACDF for cervical spondylosis between January 2011 and December 2015, of which 358 patients were interviewed telephonically. 99 of 358 (27.65%) patients who met the eligibility criteria were included in the final analysis. The severity and frequency of vertigo, headache, nausea, vomiting and GI discomfort significantly improved at last follow-up (P < 0.001) compared to pre-operative period. Significant improvement in hypertension was also seen (P = 0.001). Improvements in severity and frequency of tinnitus (P = 0.083), palpitation (P = 0.317) and blurring of vision (P = 1.00) were not significant. Conclusions ACDF might improve the atypical symptoms like vertigo, headache, nausea, vomiting and GI discomfort in patients with cervical spondylosis. Some patients also show improvement in hypertension following surgery.
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Affiliation(s)
- Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agrawal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh K Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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He L, Zhao W, Yue L, Rich L, Yue J, Ni J, Yang L. Coblation Discoplasty Alleviates Cervical Chest Pain After Positive Ultrasound-Guided Nerve Root Block: A Retrospective Study. World Neurosurg 2021; 151:e927-e934. [PMID: 33991730 DOI: 10.1016/j.wneu.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block. METHODS From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety. RESULTS Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed. CONCLUSIONS After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.
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Affiliation(s)
- Liangliang He
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenxing Zhao
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Yue
- Department of Pain Management, Changzhou Cancer Hospital, Changzhou, China
| | - Liang Rich
- Center for Cerebrovascular Research, University of California, San Francisco, California, USA
| | - Jianning Yue
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Jammal OMA, Diaz-Aguilar LD, Srinivas S, Plonsker J, Sahyouni R, Pham MH. Cervical Arthroplasty in the Treatment of Cervical Angina: Case Report and Review of the Literature. Neurospine 2020; 17:929-938. [PMID: 33401872 PMCID: PMC7788421 DOI: 10.14245/ns.2040074.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Cervical angina is an often-overlooked etiology of noncardiac chest pain that may mimic true angina pectoris but is due to cervical spine disease. Diagnosis can be difficult, and treatment ranges from conservative therapy to surgical management. However, of patient’s refractory to conservative therapy, approximately ninety percent experience postoperative relief of angina symptoms. Here, we present a case report on cervical angina and performed a systematic review of the literature. A 34-year-old male with prior surgery for thoracic outlet syndrome presented with persistent anterior neck and chest pain as well as posterior left scapular and upper lateral arm pain. The pain was refractory to 12 months of conservative therapy. Cardiac workup was negative and cervical spine imaging revealed a C6–7 herniation with neuroforaminal stenosis. A systematic literature search was conducted in PubMed, Web of Science, and Cochrane databases from database inception to April 2020. Studies reporting cervical level, average symptom duration, location of pain, and postoperative pain improvement were included. The patient's atypical symptoms were completely resolved after C6–7 anterior cervical discectomy and arthroplasty. To our knowledge, this is the first study which reports on the use of arthroplasty in the treatment of cervical angina. The systematic review included 11 articles from 1989–2020 consisting of 1,186 total patients and 109 patients (age range, 36–84 years; 60.7% male) meeting inclusion criteria. Symptom duration range was 2 days to 90 months, with the most common location of pain being localized to the anterior chest wall (66.7% of patients). All patients (100%) had postoperative resolution of their pain symptoms. The most common herniation level was C6–7 (87.3% of patients). We conclude that a broad and multidisciplinary approach is necessary for the diagnosis and management of noncardiac chest pain. When cervical disease is identified as the underlying cause for the angina-like pain, conservative therapy should be sought. Refractory cases should be treated surgically depending on the cervical pathology.
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Affiliation(s)
- Omar M Al Jammal
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Shanmukha Srinivas
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Jillian Plonsker
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Ronald Sahyouni
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
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Brown NJ, Shahrestani S, Lien BV, Ransom SC, Tafreshi AR, Ransom RC, Sahyouni R. Spinal pathologies and management strategies associated with cervical angina (pseudoangina): a systematic review. J Neurosurg Spine 2020:1-8. [PMID: 33276331 DOI: 10.3171/2020.7.spine20866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical angina, or pseudoangina pectoris, is a noncardiac syndrome of chest pain that often mimics angina pectoris but is a disease of the spine. Diagnosis of cervical angina can be difficult and is often overlooked, although once identified, it can be successfully managed through conservative therapies and/or a variety of surgical interventions. Ultimately, cervical angina is an important component of the list of differential diagnoses in noncardiac chest pain. In the present study, the authors report the first comprehensive systematic review of the range of cervical and thoracic pathologies associated with cervical angina, as well as the different treatment methods used to manage this condition. METHODS A systematic review was performed according to PRISMA guidelines and using PubMed, Web of Science, and Cochrane databases from database inception to April 29, 2020, to identify studies describing spinal pathologies related to cervical angina. The following Boolean search was performed: ("cervical" OR "thoracic") AND ("angina" OR "chest pain") AND ("herniation" OR "OPLL"). Variables extracted included patient demographics, cervical angina pain location, pathology and duration of symptoms, treatment and/or management method, and posttreatment pain relief. RESULTS Upon careful screening, 22 articles published between 1976 and 2020 met the study's inclusion/exclusion criteria, including 5 case series, 12 case reports, and 5 retrospective cohort studies. These studies featured a total of 1100 patients, of which 95 met inclusion criteria (mean patient age 51.7 years, age range 24-86 years; 53.6% male). Collectively, symptom durations ranged from 1.5 days to 90 months. Cervical herniation (72.6%) accounted for the majority of cervical angina cases, and surgical interventions (84.4%) predominated over physical therapy (13.0%) and medical management strategies (9.1%). Every patient assessed at follow-up reported relief from symptoms related to cervical angina. CONCLUSIONS Cervical angina is a noncardiac syndrome of chest pain associated with a broad range of cervical and thoracic spinal pathologies, the most common of which is cervical disc herniation. Although difficult to diagnose, it can be successfully treated when identified through first-line conservative management or surgical interventions in refractory cases.
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Affiliation(s)
- Nolan J Brown
- 1School of Medicine, University of California, Irvine, California
| | | | - Brian V Lien
- 1School of Medicine, University of California, Irvine, California
| | - Seth C Ransom
- 3College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ali R Tafreshi
- 4Department of Neurological Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Ryan Chase Ransom
- 5Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
| | - Ronald Sahyouni
- 1School of Medicine, University of California, Irvine, California.,6Department of Neurological Surgery, University of California, San Diego, California
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Feng F, Chen X, Shen H. Cervical Angina: A Literature Review on Its Diagnosis, Mechanism, and Management. Asian Spine J 2020; 15:550-556. [PMID: 33108845 PMCID: PMC8377215 DOI: 10.31616/asj.2020.0269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022] Open
Abstract
Cervical angina has been defined as chest pain that resembles true cardiac angina but originates from the disorders of the cervical spine. Thus, physicians and spine surgeons alike should raise awareness of this unusual condition for diagnosis and treatment. Particularly when neurologic signs and symptoms are present, there should be a strong suspicion for cervical angina in any patient with inadequately explained noncardiac chest pain. Cervical angina can be diagnosed according to negative cardiac workups, positive neurologic examination, and cervical radiographic findings (herniated disk, spinal cord compression, or foraminal encroachment). However, the mechanisms of pain production in cervical angina remain unclear. Previous studies attributed the pain to cervical nerve root compression, cervical sympathetic afferent fibers, referred pain, or lesions of the posterior horn of the spinal cord. Conservative treatments, which include neck collar fixation, head traction, and nonsteroidal anti-inflammatory drugs, have been determined to be successful in most patients with cervical angina. But when conservative treatment fails, anterior cervical surgery with complete decompression of the spinal cord and/or nerve root has been identified to effectively relieve cervical angina symptoms.
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Affiliation(s)
- Fan Feng
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiuyuan Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Feng F, Chen XY, Shen L, Li Q, Lao LF, Shen HX. Different Surgical Strategy for Patients with Cervical Angina: A Potential Role of Luschka's Joint Osteophyte. Orthop Surg 2020; 12:1612-1620. [PMID: 32830436 PMCID: PMC7767664 DOI: 10.1111/os.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
Objective Cervical angina is an underrecognized type of noncardiac chest pain and its mechanism of pain remains obscure. The objective of the current study was to investigate the clinical outcomes of different surgical strategies for patients with cervical angina and to analyze the potential pathogenesis of Luschka's joint osteophyte. Methods From February 2013 to March 2018, a prospective study on cervical angina was performed in our hospital. All patients who were diagnosed with both noncardiac chest pain and cervical pathology were identified. During admission, they consulted with a cardiologist and underwent strict cardiac workups to exclude true angina pectoris. The included 41 patients were randomly divided into two groups according to different surgical strategies of whether or not to remove Luschka's joint osteophyte during anterior cervical decompression surgery: the osteophyte resection (OR group) and the nonresection (NR group). Results The OR group consisted of 21 patients (8 men and 13 women) with a mean age of 54.7 years (range, 41–65 years). The NR group was composed of 20 patients (9 men and 11 women) with an average age of 56.3 years (range, 43–68 years). Before surgery, the mean duration of symptoms was 6.1 months (range, 4–20 months). The Luschka's joint osteophytes were located at C6–C7 (19 cases, 46.3%), C5–C6 (17 cases, 41.5%), and C4–C5 (4 cases, 12.2%). Their average area was 34.85 mm2 and the average length were 5.09 mm. No statistically significant differences in demographic characteristics were detected between the two groups (P > 0.05). After operation, there were significant improvements in the Japanese Orthopedic Association score and the Neck Disability Index score in both groups (P < 0.05). However, the visual analogue scale score for chest pain in the OR group was statistically lower than that in the NR group (1.4 ± 1.0 vs 2.1 ± 1.6, P < 0.05). In the OR group, the results of cervical spine surgery were excellent in 18 patients (85.7%), and fair in 3 patients (14.3%). In the NR group, there were 10 patients (50.0%) with excellent results, 9 patients with fair results (45.0%), and 1 patient with poor results (5.0%). Notably, there were statistically significant differences between the two groups (χ2 = 6.265, P = 0.044). The average follow‐up was 31 months (24–52 months). Conclusion Anterior cervical decompression surgery with resection of Luschka's joint osteophyte can effectively reduce cervical angina symptom and improve the patient's quality of life. In addition to nerve root compression, Luschka's joint osteophyte may be another pathogenic factor in cervical angina.
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Affiliation(s)
- Fan Feng
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiu-Yuan Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Long Shen
- Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Quan Li
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li-Feng Lao
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong-Xing Shen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Sun Y, Muheremu A, Tian W. Atypical symptoms in patients with cervical spondylosis: Comparison of the treatment effect of different surgical approaches. Medicine (Baltimore) 2018; 97:e10731. [PMID: 29768345 PMCID: PMC5976300 DOI: 10.1097/md.0000000000010731] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To compare the effectiveness of total disk replacement (TDR), anterior cervical discectomy and fusion (ACDF), and laminoplasty on atypical symptoms of cervical spondylosis.Patients with confirmed diagnosis of cervical spondylosis and reported atypical symptoms such as blurred vision, headache, nausea, palpitation, tinnitus, vertigo, hypomnesia, and abdominal discomfort were retrospectively included in the present study. They were treated with TDR, ACDF, or laminoplasty depending on the etiology and patient preference. Severity of the atypical symptoms before the surgery and at the end of 2-year follow-up was recorded and the degree of severity alleviation was compared between different surgical approaches.A total number of 336 patients who were treated in our institute from February 2002 to March 2011 were included in the final analysis. Atypical symptoms were significantly alleviated in most patients after surgical intervention. No significant differences were found regarding the change of severity of those symptoms among patients in different surgery groups.TDR, ACDF, and laminoplasty can equally alleviate the severity of atypical symptoms in patients with cervical spondylosis. This indicates that the neural network in the posterior longitudinal ligament may not be the cause of atypical symptoms in patients with cervical spondylosis.
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Affiliation(s)
- Yuqing Sun
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, Xicheng, Beijing
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, Xicheng, Beijing
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Effect of double-door laminoplasty on atypical symptoms associated with cervical spondylotic myelopathy/radiculopathy. BMC Surg 2016; 16:31. [PMID: 27160834 PMCID: PMC4862188 DOI: 10.1186/s12893-016-0146-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Double-door laminoplasty is an effective method in treating patients with cervical spondylosis. Many patients with cervical spondylosis experience a set of atypical symptoms such as vertigo and tinnitus, and wish to know if the surgical treatment for cervical spondylosis can also alleviate those symptoms. The current research was carried out to investigate if atypical symptoms can be alleviated in patients who received laminoplasty for the treatment of cervical spondylosis. METHODS One hundred ninety patients who received laminoplasty to treat cervical spondylotic myelopathy/radiculopathy in our center and complained about one or more of the atypical symptoms before the surgery were followed for a mean of 61.9 months (from 39 to 87 months) after the surgery. Severity scores were retrospectively collected by follow up outpatient visits or phone interviews. The data was calculated based on patient feedback on the frequency and severity of those symptoms before the surgery and at last follow up, and were compared by paired sample t-tests. RESULTS Most patients reported that the atypical symptoms such as vertigo (P <0.001), nausea (P <0.001), headache (P <0.001), tinnitus (P = 0.001), blur vision (P = 0.005), palpitation (P <0.001) and gastrointestinal discomfort (P = 0.001) were significantly alleviated at the last follow up; there was no significant change in the severity of hypomnesia (P = 0.675). CONCLUSION Double-door laminoplasty can significantly alleviate most of the atypical symptoms in patients with cervical spondylosis. Further research is needed to explore mechanisms underlying this extra benefit of laminoplasty.
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Muheremu A, Sun Y. Atypical symptoms in patients with cervical spondylosis might be the result of stimulation on the dura mater and spinal cord. Med Hypotheses 2016; 91:44-46. [PMID: 27142142 DOI: 10.1016/j.mehy.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022]
Abstract
Patients with cervical spondylosis often present with some atypical symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus and blurred vision and hypomnesia. Although there are a few hypotheses about the etiology of those symptoms, none of them have provided evidence convincing enough to explain the clinical, pathological and anatomic manifestation of those symptoms. One of the more acceptable explanations is that those symptoms are the results of stimulation of the sympathetic nerves in the posterior longitudinal ligament. The clinical fact that dissection of the posterior longitudinal ligament significantly alleviates the severity of those symptoms seems like an evidence for the validity of this hypothesis. However, recent clinical studies showed that laminoplasty, which has no effect on the posterior longitudinal ligament, can achieve the similar effect. In this paper, we hypothesize that stimulation of the dura mater and spinal cord might be the cause of atypical symptoms in patients with cervical spondylosis.
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Affiliation(s)
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Sussman WI, Makovitch SA, Merchant SHI, Phadke J. Cervical angina: an overlooked source of noncardiac chest pain. Neurohospitalist 2015; 5:22-7. [PMID: 25553225 PMCID: PMC4272356 DOI: 10.1177/1941874414550558] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical angina has been widely reported as a cause of chest pain but remains underrecognized. This series demonstrates the varied clinical presentation of patients with cervical angina, the delay in diagnosis, and the extensive cardiac examinations patients with this condition typically undergo prior to a definitive diagnosis. Recognition of this condition in patients with acute chest pain requires a high index of suspicion and an awareness of the common presenting features and clinical findings of cervical angina.
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Affiliation(s)
| | | | | | - Jayant Phadke
- Department of Neurology, Saint Vincent Hospital, Worcester, MA, USA
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13
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Sun YQ, Zheng S, Yu J, Yan K, Tian W. Effect of total disc replacement on atypical symptoms associated with cervical spondylosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1553-7. [PMID: 23653130 DOI: 10.1007/s00586-013-2785-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 02/24/2013] [Accepted: 04/14/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the efficacy of total disc replacement (TDR) for the treatment of cervical spondylosis associated with atypical symptoms. METHODS In this retrospective study, patients with myelopathy and/or radiculopathy related to cervical spondylosis that were treated with TDR were contacted by phone. Atypical symptoms involved in the questionnaire included dizziness, headache, nausea, vomiting, blurred vision, tinnitus, palpitations, hypomnesia, and abdominal discomfort. The severity of each atypical symptom was evaluated separately based on an numerical rating scale. The radiographs and charts before and after the surgery were reviewed. Paired samples t tests were used to compare the severity of the symptoms before and after surgery. RESULTS Between 2003 and 2010, 73 of 133 patients diagnosed with cervical spondylotic myelopathy and/or radiculopathy treated by TDR experienced atypical symptoms before surgery. The mean follow-up was 34.6 months. There were 47 males and 26 females (mean age 48.9 years). Of the 73 patients, 41 were diagnosed with myelopathy; 13 with radiculopathy; and 19 with mixed-type spondylosis. The incidence of each symptom before surgery was dizziness (46.6%), tinnitus (41.1 %), facial flushing and sweating (41.1 %), palpitations (39.7%), headache (35.6%), hypomnesia (30.1%), nausea and vomiting (20.5%), blurred vision (20.5%), and gastroenterologic discomfort (5.5%). The severity of the following symptoms improved after surgery: dizziness (p = 0.000, α = 0.05), headache (p = 0.000, α = 0.05), nausea and vomiting (p = 0.000, α = 0.05), blurred vision (p = 0.004, α = 0.05), tinnitus (p = 0.000, α = 0.05), palpitations (p = 0.000, α = 0.05), hypomnesia (p = 0.010, α = 0.05), and other symptoms (p = 0.030, α = 0.05). The gastroenterologic discomfort did not improve (p = 0.731, α = 0.05). CONCLUSIONS TDR may have a positive effect on atypical symptoms associated with cervical spondylotic myelopathy and/or radiculopathy.
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Affiliation(s)
- Yu-Qing Sun
- Department of Spine, Beijing Ji Shui Tan Hospital, #31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
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Sudo H, Goto R. Cervical angina because of ossification of the posterior longitudinal ligament. Spine J 2012; 12:169. [PMID: 22325980 DOI: 10.1016/j.spinee.2012.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/22/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
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van Leersum NJ, van Leersum RL, Verwey HF, Klautz RJM. Pain symptoms accompanying chronic poststernotomy pain: a pilot study. PAIN MEDICINE 2011; 11:1628-34. [PMID: 21044253 DOI: 10.1111/j.1526-4637.2010.00975.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Despite the technical developments in surgical procedures, chronic poststernotomy pain (CPSP) is still very common. Many theories for its cause have been proposed in the literature, but the etiology is still not clear. Pain along the sternal scar and in the upper extremities (sometimes accompanied with paresthesia) persists in about 30% of cases. These symptoms have been regarded as two separate complications. This study investigated all pain symptoms in patients following sternotomy. DESIGN Retrospective pilot study. SETTING Outpatient clinic at the Leiden University Medical Center. PATIENTS A cohort of patients who underwent open heart surgery by median sternotomy between January 1, 2004 and January 1, 2006. INTERVENTIONS A questionnaire was completed by 631 patients, and a selected sample of 277 patients was examined for pain of the head, neck, back, and chest and upper extremities. OUTCOME MEASURES All pain locations were compared in two groups: 189 patients with sternal pain and 88 patients without sternal pain. RESULTS We found that pain and muscular tenderness in the investigated areas unrelated to the chest wall incision were significantly more common in patients with sternal pain compared to the nonsternal pain group. No surgical or demographic factors with the exception of female gender were consistent predictors of sternal pain. CONCLUSION CPSP is an extensive pain syndrome. Sternal pain is frequently accompanied by pain of the head, neck, back, and upper extremities. Further research on the possible etiology is warranted.
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