Cervical angina: a seemingly still neglected symptom of cervical spine disorder?

Nakajima, Hideaki; Uchida, Kenzo; Kobayashi, Shigeru; Kokubo, Yasuo; Yayama, Takafumi; Sato, Ryuichiro; Inukai, Tomoo; Godfrey, Timothy; Baba, H.

doi:10.1038/sj.sc.3101888

Cited by 23 publications

(85 citation statements)

References 13 publications

(16 reference statements)

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“…The radiological criteria and definition, including segmental instability, have been described in more detail in our previous publications. 13,15 The type of spinal cord compression from a force acting from in front was classified on T2-weighted MR images and intraoperatively confirmed as a medial, paramedial, or foraminal lesion (Fig. 1).…”

Section: Radiological Studiesmentioning

confidence: 99%

“…The cervical spine anterior decompression procedure has been described in detail in our previous reports. 2,13,15,18 Briefly, the affected discs were exposed using a left-sided anterolateral approach, and ~ 1.8-to 2.2-cm-wide vertebral resections were performed. Decompression was accomplished using a diamond bur (1-2 mm in diameter) to remove the posterior cortices of the vertebrae and endplates, herniated discs, and the deep and superficial layers of the posterior longitudinal ligament, which required a surgical microscope (OPM16CFC, Carl-Zeiss).…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Uchida

Nakajima

Yayama

et al. 2009

SPI

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Object The aims of this study were to review the clinicoradiological findings in patients who underwent decompressive surgery for proximal and distal types of muscle atrophy caused by cervical spondylosis and to discuss the outcome and techniques of surgical intervention. Methods Fifty-one patients (43 men and 8 women) with proximal (37, with arm drop) and distal muscle atrophy (14, with wrist drop) underwent cervical decompression (39 anterior decompressions and 12 open-door C3–7 laminoplasties with microsurgical foraminotomy) for muscle weakness in the upper extremities. The clinical course, type of spinal cord compression, abnormal signal intensity on high-resolution MR imaging, and postdecompression improvement in muscle power were reviewed at a mean follow-up of 2.6 years (range 0.8–9.4 years). Results The most commonly affected vertebrae were C4–5 and C5–6, and C5–6 and C6–7 in patients with proximal or distal muscle atrophy, respectively; the respective numbers of affected vertebrae were 1.5 and 2.2. Transaxial MR imaging showed medial compression of the spinal cord in 20 patients (in 12 with proximal and 8 with distal muscle atrophy), paramedial compression in 22 (17 and 5 patients, respectively), and foraminal compression in 9 (8 and 1 patient, respectively). Increased signal intensity on MR imaging was observed in 85.0, 22.7, and 11.1% of cases of medial, paramedial, and foraminal compression, respectively. Increased signal intensity at the affected muscle segment level was observed in 52.9, 40.0, and 0% of cases, respectively. Sixty-two percent of patients with proximal muscle atrophy gained 1 or more grades of muscle power on manual muscle testing (MMT), whereas 64.3% with distal muscle atrophy failed to gain even 1 grade of improvement. The recovery of muscle power correlated with disease duration and the percent voltage of Erb point or wrist-stimulated muscle evoked potentials but not with preoperative MMT, longitudinal range of spinal cord compression, signal change on T2-weighted MR imaging, or surgical procedure. Conclusions Surgical outcome in patients with distal muscle atrophy was inferior to that in patients with proximal atrophy. The distal type was characterized by a long preoperative period, a greater number of cervical spine misalignments, a narrow spinal canal, and increased signal intensity on T2-weighted MR imaging. It is essential to perform a careful neurological evaluation, including sensory examination of the lower limbs, as well as neuroradiological and neurophysiological assessments to avoid confusion with motor neuron disease and to detect the coexistence of amyotrophic lateral sclerosis, especially when surgical treatment of cervical spondylosis is planned. The results of careful physical examination, MR imaging studies, and electromyography studies should be comprehensively evaluated to ascertain the pathophysiology of the muscle atrophy. It is very important to distinguish the pathophysiology caused by nerve root impingements from anterior horn dysfunction when making decisions about treatment strategy. Surgical treatment—with or without foraminotomy—for amyotrophy in cervical spondylosis requires urgent action with regard to human neuroanatomy and neural innervation of the paralyzed muscles.

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Section: Radiological Studiesmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Uchida

Nakajima

Yayama

et al. 2009

SPI

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“…They include rest, drugs, physiotherapy and exercise and manipulation 19 . Sometimes injecting medication (corticosteroids and a local anesthetic) into the joints of the spine may be needed 20 .…”

Section: Discussionmentioning

confidence: 99%

Clinico-Demographic Characteristics of Cervical Spondylosis Patients Presented with Chest Pain

Hafez

Yusuf

Nessa³

et al. 2018

J Curr Adv Med Res

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“…The pathogenesis of cervical angina can be explained by the fact that cervical neural roots from C4 to C8 contribute to the sensory and motor innervations associated with anterior chest pain, and patients with true cervical angina are more likely to have disease at the C6 and/or C7 level [2,4]. Some reports have indicated that anterior cervical surgery to correct nerve root or spinal cord compression can be a useful option for pain relief [1,3,5]. A few cases have been reported in which cervical angina was caused by spinal cord tumors such as ependymoma [6], atlantoaxial instability [7], or spinal cord infarction [8] without cervical spondylosis.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord infarction with cervical angina

Nakae

Johkura

Kudo

et al. 2013

Journal of the Neurological Sciences

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Cervical angina: a seemingly still neglected symptom of cervical spine disorder?

Cited by 23 publications

References 13 publications

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Clinico-Demographic Characteristics of Cervical Spondylosis Patients Presented with Chest Pain

Spinal cord infarction with cervical angina

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