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COMMENTARY
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 602-603

Cervical Spondylosis and Atypical Symptoms


Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India

Date of Submission21-Mar-2021
Date of Decision21-Mar-2021
Date of Acceptance21-Mar-2021
Date of Web Publication24-Jun-2021

Correspondence Address:
Dr. Bajaj Jitin
Department of Neurosurgery, 4th Floor, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh 482003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.319240

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How to cite this article:
Jitin B. Cervical Spondylosis and Atypical Symptoms. Neurol India 2021;69:602-3

How to cite this URL:
Jitin B. Cervical Spondylosis and Atypical Symptoms. Neurol India [serial online] 2021 [cited 2021 Jul 28];69:602-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/3/602/319240




Cervical spondylosis is a progressive degenerative disease presenting with axial neck pain, radiculopathy, myelopathy, or their combination. Often, patients may complain of associated headache, vertigo, nausea, vomiting, tinnitus, angina, and palpitation. These symptoms are generally subjective and vary individually. While a surgeon concerns primarily with the typical ones, the atypical symptoms are sometimes quite bothersome to a patient and might affect the quality of life to a significant degree. We congratulate Sharma et al. for bringing out their study on this infrequently discussed subject.[1]

The mechanism of these atypical symptoms is not fully understood and limited to indirect evidence after surgery and few animal experiments.[2],[3] The substrates implicated for the atypical symptoms include irritation or compression of sympathetic fibers in the posterior longitudinal ligament (PLL), perivertebral sympathetic plexus, spinal cord compression, and vertebrobasilar ischemia. The PLL has sympathetic fibers concentrated in the intervertebral portion compared to the vertebral one, which is consistent with the entry of the sinuvertebral nerve.[3] Altered blood flow in the posterior circulation during neck rotation supports the vertebrobasilar ischemia hypothesis, arguing its improvement with cervical fixation.[4] While posterior cervical sympathetic syndrome (Barre-Lieou syndrome) remains attractive in many chiropractic practices, several animal experiments have refuted this entity.[5] As all the treatment options performed for treating spondylosis have shown relief of atypical symptoms, including anterior cervical discectomy and fusion, total disk replacement, or laminoplasty, the spinal cord decompression seems to the most convincing mechanism for their abatement.[2]

Sharma et al. showed a significant decrease in severity and frequency of vertigo, headache, nausea, vomiting, and gastrointestinal discomfort, and amelioration of hypertension.[1] This is the first such Indian study pushing the neuroscience community to explore the non-mechanical aspects of cervical spondylosis, which one often ignores. The findings reverberate with other studies reporting similar results.[2] It would have been intriguing to correlate the atypical symptom improvement with the disease duration, decompression alone versus decompression with fusion, and whether these symptoms recur in a case of adjacent segment degeneration or recurrent myelopathy. The study also proposes long-term follow-up to find the durability of improvement.

Patients with cervical spondylosis are generally of advanced age. Cardiac diseases may be associated, are common, and should be excluded. These may masquerade with similar symptoms of vertigo, headache, tinnitus, and hypertension. Further, exclusion of brain and craniovertebral junction pathologies is also indispensable to avoid any postoperative surprises.

The growing evidence of alleviating atypical symptoms after cervical spondylosis surgeries is encouraging. However, one needs to keep myelopathy and or radiculopathy as the primary indications, and never a patient should undergo surgery solely for atypical symptoms. Patients might consider any improvement in atypical symptoms as an added benefit, maybe for a selected group, and with the possibility of relapse in the future. There might also be few confounding factors responsible for relief from atypical symptoms after surgery, including relief from neck pain, improved lifestyle, and exercise. Only a specific imaging or molecular marker might predict the improvement of atypical symptoms and their degree. More laboratory research and prospective long-term trials may shed more light on this.



 
  References Top

1.
Sharma R, Garg K, Agrawal S, Mishra S, Gurjar HK, Tandon V, et al. Atypical Symptoms of Cervical Spondylosis: Is Anterior Cervical Discectomy and Fusion Useful? -An Institutional Experience. Neurol India 2021;69:595-601.  Back to cited text no. 1
  [Full text]  
2.
Sun Y, Muheremu A, Yan K, Yu J, Zheng S, Tian W. Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy. BMC Surg 2015;15:105.  Back to cited text no. 2
    
3.
Li J, Gu T, Yang H, Liang L, Jiang D, Wang Z, et al. Sympathetic nerve innervation in cervical posterior longitudinal ligament as a potential causative factor in cervical spondylosis with sympathetic symptoms and preliminary evidence. Med Hypotheses 2014;82:631–5.  Back to cited text no. 3
    
4.
Olszewski J, Majak J, Pietkiewicz P, Luszcz C, Repetowski M. The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 2006;134:680–4.  Back to cited text no. 4
    
5.
Foster CA, Jabbour P. Barré-Lieou syndrome and the problem of the obsolete eponym. J Laryngol Otol 2007;121:680–3.  Back to cited text no. 5
    




 

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