Department of Orthopaedic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai 200003, China.
Department of Orthopaedic Surgery, Navy General Hospital, Beijing 100037, China.
Med Hypotheses. 2014 May;82(5):631-5. doi: 10.1016/j.mehy.2014.02.029. Epub 2014 Mar 5.
Sympathetic symptoms associated with cervical disorders, such as vertigo, headache, dizziness, etc., are common clinical disorders bewildering both clinicians and patients. In our clinical practice we observed that sympathetic symptoms associated with cervical disorders were apparently relieved in some patients after undergoing routine anterior cervical decompression and fusion plus posterior longitudinal ligament (PLL) resection. This study was designed to investigate the sympathetic nerve innervations in the cervical PLL and its potential correlation with cervical sympathetic symptoms such as vertigo.
In animal research, cervical PLLs of 9 adult rabbits were harvested and stained with sucrose-phosphate-glyoxylic acid (SPG), which is a specific fluorescence staining method for sympathetic postganglionic fibers. In human research, cervical PLL of 8 patients of cervical spondylosis with sympathetic symptoms were harvested during surgery and stained with SPG. All sections were observed under fluorescence microscope. Sympathetic symptoms were evaluated using the sympathetic symptom 20-point score preoperatively and at 1 week, 2-month, and 6-month postoperatively.
In rabbit specimens, a large number of sympathetic postganglionic fibers were distributed in the cervical PLL of every segment. The density of sympathetic fibers distributed in the intervertebral portion of PLL was more than that in the vertebral portion. Compared with deep layer section, the nerve fibers in the superficial PLL layer section were thicker and more densely populated. Existence of sympathetic postganglionic fibers was also confirmed in human specimens. Those nerve fibers were mostly short and isolated in areatus form, with non-interwoven branches. The mean sympathetic symptoms score decreased significantly from 6.6 ± 2.6 before surgery to 2.0 ± 1.9 at 6 months postoperatively after anterior cervical decompression and fusion with PLL removed.
According to the experimental result and clinical practice, we hypothesized that sympathetic nerve fibers distributed in PLL may represent a pathologic basis of stimulation induced by cervical vertebral degenerative changes and thus are susceptible to being a potential causative factor in cervical spondylosis with sympathetic symptoms.
与颈椎疾病相关的交感症状，如眩晕、头痛、头晕等，是常见的临床疾病，令临床医生和患者都感到困惑。在我们的临床实践中，我们观察到，一些患有与颈椎疾病相关的交感症状的患者，在接受常规前路颈椎减压融合术加后纵韧带（PLL）切除术后，这些交感症状明显缓解。本研究旨在探讨颈椎 PLL 中的交感神经支配及其与眩晕等颈椎交感症状的潜在相关性。
在动物研究中，采集 9 只成年兔的颈椎 PLL 并进行蔗糖-磷酸盐-乙醛酸（SPG）染色，这是一种用于交感节后纤维的特异性荧光染色方法。在人体研究中，采集 8 例伴有交感症状的颈椎病患者的颈椎 PLL，并用 SPG 染色。所有切片均在荧光显微镜下观察。术前及术后 1 周、2 个月、6 个月采用交感症状 20 分评分法评估交感症状。
在兔标本中，每一节段的颈椎 PLL 中都分布着大量的交感节后纤维。在 PLL 的椎间部分分布的交感纤维密度大于椎体部分。与深层切片相比，浅层 PLL 层切片中的神经纤维较粗且分布更密集。在人体标本中也证实了交感节后纤维的存在。这些神经纤维大多呈短孤立的弧形，分支不交织。前路颈椎减压融合术加 PLL 切除术后，平均交感症状评分从术前的 6.6±2.6 显著降至术后 6 个月的 2.0±1.9。
根据实验结果和临床实践，我们假设 PLL 中分布的交感神经纤维可能代表颈椎退行性改变刺激的病理基础，因此易成为交感型颈椎病的潜在致病因素。
