Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Int Orthop. 2020 Jun;44(6):1159-1168. doi: 10.1007/s00264-020-04531-y. Epub 2020 Mar 19.
To investigate the effect of C3/4 disc degeneration on cervical spondylosis with dizziness (CSD) and to assess the curative effect of anterior cervical decompression and fusion (ACDF) in patients with CSD.
Four hundred nineteen patients who underwent ACDF for treatment of myelopathy or radiculopathy were divided into dizziness and non-dizziness group. The visual analog scale (VAS) score and Japanese Orthopaedic Association (JOA) score were used to determine the intensity of dizziness and neurological symptoms, respectively. Cervical disc degeneration was evaluated using Miyazaki's classification system. Some parameters were measured using cervical radiographs. The surgical effects on CSD were compared between surgery with and without C3/4 level. Multivariate logistic regression analysis was used to determine the risk factors for CSD.
The pre-operative incidence of CSD was 33.9%. Women were more likely to develop dizziness than men (p < 0.05), CSD was significantly associated with C3/4 disc degeneration (69.7%, p < 0.001), and smokers were more subject to dizziness (p < 0.05). Regression analysis showed that female (OR = 1.611, p = 0.031), smoking (OR = 1.719, p = 0.032), Miyazaki grade of C3/4 ≥ IV (OR = 2.648, p < 0.001), and instability on C3/4 (OR = 1.672, p = 0.024) were risk factors for CSD. Treatment of CSD by ACDF involving C3/4 was more effective than not involving C3/4 (efficacy rate, 73.2% vs 51.7%, p < 0.05).
The CSD is a common clinical manifestation in elderly patients, especially patients with cervical spondylosis at the C3/4 level. Female, smoking, instability on C3/4, and C3/4 Miyazaki grade ≥ IV could be considered significant risk factors for CSD. CSD is more likely to be alleviated by ACDF involving C3/4.
探讨 C3/4 椎间盘退变对伴有头晕的颈椎病（CSD）的影响，并评估前路颈椎减压融合术（ACDF）治疗 CSD 的疗效。
将 419 例行 ACDF 治疗的颈椎病伴或不伴头晕患者分为头晕组和非头晕组。采用视觉模拟评分（VAS）和日本骨科协会（JOA）评分评估头晕和神经症状的严重程度。采用 Miyazaki 分级系统评估颈椎间盘退变情况。颈椎正侧位片测量相关参数。比较 C3/4 节段手术与否对 CSD 的手术疗效。采用多因素 logistic 回归分析 CSD 的危险因素。
术前 CSD 的发生率为 33.9%。女性头晕发生率高于男性（p＜0.05），CSD 与 C3/4 椎间盘退变显著相关（69.7%，p＜0.001），吸烟者更易头晕（p＜0.05）。回归分析显示，女性（OR=1.611，p=0.031）、吸烟（OR=1.719，p=0.032）、C3/4 椎间盘 Miyazaki 分级≥Ⅳ级（OR=2.648，p＜0.001）、C3/4 节段不稳定（OR=1.672，p=0.024）是 CSD 的危险因素。ACDF 治疗 CSD 时累及 C3/4 节段比不涉及 C3/4 节段更有效（有效率 73.2%比 51.7%，p＜0.05）。
CSD 是老年患者，尤其是 C3/4 颈椎病变患者的常见临床表现。女性、吸烟、C3/4 节段不稳定和 C3/4 椎间盘 Miyazaki 分级≥Ⅳ级可视为 CSD 的显著危险因素。累及 C3/4 节段的 ACDF 更有可能缓解 CSD。
