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

Spinal Cord (2006) 44, 509513& 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00www.nature.com/scOriginal ArticleCervical angina: a seemingly still neglected symptom of cervical spine

disorder?H Nakajima*,1, K Uchida1, S Kobayashi1, Y Kokubo1, T Yayama1, R Sato1, T Inukai1, T Godfrey1 and H Baba11Division of Orthopaedics and Rehabilitation Medicine, Department of Surgery, School of Medicine,

University of Fukui, Fukui, JapanDesign: A review of 10 surgical cases with symptoms of cervical angina.

Objective: To stress the importance of symptoms of cervical angina in patients with cervical

spine disorders.Setting: Fukui University Hospital, Japan.Results: A total of 10 patients complaining of symptoms of cervical angina were admitted with

a tentative diagnosis of coronary artery disease. Pain relief was achieved by anterior surgical

decompression in all patients.Conclusion: We stress that physicians should be aware of the symptoms of cervical angina and

that surgical intervention often leads to complete relief of symptoms.Spinal Cord (2006) 44, 509513. doi:10.1038/sj.sc.3101888; published online 6 December 2005Keywords: cervical angina; cervical spondylosis; ossication of the posterior longitudinal

ligament; surgeryIntroductionCervical spine disorders may often be present with pain

in the upper anterior chest and scapular areas,

resembling true angina pectoris.13 Anterior chest pain

associated with cervical intervertebral disc diseases,

ossied posterior longitudinal ligament (OPLL), or

other spinal disorders, has been sometimes described

as cervical angina3,4 and appears to be relatively

unknown clinical syndrome. Prompt and accurate

diagnosis requires a strong sense of suspicion in patients

with inadequately explained chest pain. Jacobs5 suggested that C6 and C7 nerve roots are the most

frequently involved and the pain is possibly mediated

via the medial and lateral pectoral nerves. Spine

specialists should be well aware of this presentation

in their routine clinical examinations but, unfortunately

and in fact, a number of patients still appear to be

diagnosed as coronary artery disease, and thus undergo

unnecessary examinations and medications.In the present short communication, we describe 10

surgical cases in whom cervical spine disorders were

misdiagnosed over long periods. We emphasize the

importance of these clinical symptoms in the diagnosis

of cervical spine disorders.Patients and methodsBetween 1991 and 2004, a total of 706 patients underwent cervical spine surgeries because of neurological

symptoms and signs, such as myelopathy (n 314),

myeloradiculopathy (n 162), radiculopathy (n 198),

or so-called discopathy (n 32). Reviewing the...