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Cervical Spondylosis and atypical symptoms: blurred vision, headache, nausea, palpitation, tinnitus, vertigo, hypomnesia, and abdominal discomfort

pattismith

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Atypical symptoms in patients with cervical spondylosis
Comparison of the treatment effect of different surgical approaches

Sun, Yuqing, MDa; Muheremu, Aikeremujiang, MD, PhDb,*; Tian, Wei, MDa,*

Section Editor(s): Figueiredo., Nicandro


Medicine: May 2018 -


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.

1 Introduction

Among the elderly population, cervical spondylosis is the most common reason for symptoms related to spinal cord dysfunction.[1,2] Patients with cervical spondylosis often demonstrate symptoms such as pain of the neck and shoulder, numbness, hypersensitivity, and impairment of the fine-motor performance of arms.[3,4] Main etiology of cervical spondylosis includes the herniation of cervical disk, ossification and hypertrophy of posterior longitudinal ligament and ligamentum flavum, osteoproliferation, cervical stenosis, and instability of cervical spine. Surgical approaches such as anterior cervical discectomy and fusion (ACDF), total disk replacement (TDR), and laminoplasty are routinely used to eliminate the compression on the spinal cord and nerve roots thus alleviate the symptoms of cervical spondylosis.[5–7]


Vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus, blurred vision, and hypomnesia are common symptoms in patients with cervical spondylosis.
However, their etiology is not as clear as the typical manifestations of cervical spondylosis such as pain, numbness, and fine-motor functions.
Because there are no specific pathologic or radiologic abnormalities that can be responsible for those symptoms, it is hard to choose effective treatment measures. To our knowledge, few studies have reported the efficacy of any surgical approaches on atypical symptoms in patients with cervical spondylosis. In the present study, we compared the efficacy of ACDF, TDR, and laminoplasty on atypical symptoms in patients with cervical spondylosis, and analyzed the possible mechanisms underlying those symptoms.


2 Objective

The present study compares the efficacy of TDR, ACDF, and laminoplasty on symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus, blurred vision, and hypomnesia in patients with cervical spondylosis and tries to explore its etiology.
 

pattismith

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5 Discussion

Prevalence of cervical spondylosis is high among the age group of over 55 years, and the with wide application of computers and increasing reliance of cell phones, the number of young patients with cervical spondylosis is also on the rise.[1,2] Pain, numbness, hypersensitivity in neck and upper extremities, impairment of the fine-motor skill of hands, difficulty in fast movement of lower extremities as well as abnormal reflex can be the main manifestations in patients with early-stage clinical cervical spondylosis. Patients with advanced cervical spondylosis may also suffer from trouble in steady walking, active reflex of tendons, and atrophy of related muscles.[8–11]


In our clinical practice, many patients who were diagnosed with cervical spondylosis also report discomfort caused by vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus, blurred vision, hypomnesia, and gastrointestinal discomfort. This set of symptoms in patients with cervical spondylosis was first reported by Barré and liéou in 1926, and was named “Barré and liéou syndrome.”[12,13] Because unlike the typical symptoms such as pain and numbness of the neck and shoulder, no specific pathologic or anatomic abnormalities were found to be responsible for those symptoms, we use “atypical” to include them all. Although the current literature has elaborate reports on the treatment for cervical spondylosis, little was known about the pathology and treatment of atypical symptoms in patients with cervical spondylosis.


One of the popular assumptions is that the degenerated structures such as osteophytes and hyperplasia of ligaments in the cervical spine could compress the surrounding blood vessels, which can partially block the blood flew into brain and cause headache and vertigo.[14–16]
Some authors also proposed that whiplash injury and instability of cervical spine are related to the onset of atypical symptoms.[17,18] However, the evidence provided by those studies was not convincing enough to drive a consensus about the mechanism of atypical symptoms in patients with cervical spondylosis.
...

In the present study, patients who received TDR and ACDF experienced significantly alleviated symptoms compared with that of before the surgery, this is in accordance with the previous studies.[21,22] However, patients in the double-door laminoplasty group have also reported significantly alleviated symptoms after the surgery, and the degree of symptom severity alleviation was not significantly different in the laminoplasty group than TDR and ACDF groups.



Considering that the only thing in common with all the 3 surgeries is the decompression of dura and spinal cord, we assume that the stimulation on dura and the spinal cord and the spinal meninges might be responsible for the atypical symptoms in patients with cervical spondylosis.

...
 

pattismith

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another study from Beijin, from orthopedic surgery department this time, april 2018


[Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms].
https://forums.phoenixrising.me/#fragment-related-labLinks
H Liu


Abstract

OBJECTIVE:To investigate the clinical effectiveness of polytheretherketone (PEEK) cages assisted anterior cervical discetomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms.

METHODS:Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The following criteria were used for assessing radiographic success of fusion:
(1) endplate obliterated with no lucent lines;
(2) obliteration of disc space by bony trabeculae;
(3) less than 2°of intervertebral motion or 2 mm of motion between the spinous processes at the operated segment on flexion-extension lateral radiographs.

The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia and gastroenterological discomfort were scored by 20-point system preoperatively, 2 months postoperatively and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed.

RESULTS:They were followed up for at least one year. The mean follow-up was 15.6 months. Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In two patients delayed union and bony fusion were achieved at the end of 9 and 11 months. Pseudoarthosis was found in 1 case but the patient had no symptoms. The score of sympathetic symptoms before surgery, 2 months after surgery and at the final follow-up were 8.4±1.0,2.2±0.3,and 2.4±0.3, respectively. There were 22 excellent cases, 15 good cases, 1 fair case and 1 bad case in terms of RR. Good to excellent results were attained in 95% of theses patients. The sympathetic symptoms improved in all the patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered one week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within one month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared two days after surgery. CONCLUSION:Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement and general satisfaction with the surgical procedure depend not only on obtaining successful decompression and radiographic fusion but also on patient selection.