Brown Nolan J, Shahrestani Shane, Lien Brian V, Ransom Seth C, Tafreshi Ali R, Ransom Ryan Chase, Sahyouni Ronald
1School of Medicine, University of California, Irvine, California.
2Keck School of Medicine of USC, Los Angeles, California.
J Neurosurg Spine. 2020 Dec 4;34(3):506-513. doi: 10.3171/2020.7.SPINE20866. Print 2021 Mar 1.
Cervical angina, or pseudoangina pectoris, is a noncardiac syndrome of chest pain that often mimics angina pectoris but is a disease of the spine. Diagnosis of cervical angina can be difficult and is often overlooked, although once identified, it can be successfully managed through conservative therapies and/or a variety of surgical interventions. Ultimately, cervical angina is an important component of the list of differential diagnoses in noncardiac chest pain. In the present study, the authors report the first comprehensive systematic review of the range of cervical and thoracic pathologies associated with cervical angina, as well as the different treatment methods used to manage this condition.
A systematic review was performed according to PRISMA guidelines and using PubMed, Web of Science, and Cochrane databases from database inception to April 29, 2020, to identify studies describing spinal pathologies related to cervical angina. The following Boolean search was performed: ("cervical" OR "thoracic") AND ("angina" OR "chest pain") AND ("herniation" OR "OPLL"). Variables extracted included patient demographics, cervical angina pain location, pathology and duration of symptoms, treatment and/or management method, and posttreatment pain relief.
Upon careful screening, 22 articles published between 1976 and 2020 met the study's inclusion/exclusion criteria, including 5 case series, 12 case reports, and 5 retrospective cohort studies. These studies featured a total of 1100 patients, of which 95 met inclusion criteria (mean patient age 51.7 years, age range 24-86 years; 53.6% male). Collectively, symptom durations ranged from 1.5 days to 90 months. Cervical herniation (72.6%) accounted for the majority of cervical angina cases, and surgical interventions (84.4%) predominated over physical therapy (13.0%) and medical management strategies (9.1%). Every patient assessed at follow-up reported relief from symptoms related to cervical angina.
Cervical angina is a noncardiac syndrome of chest pain associated with a broad range of cervical and thoracic spinal pathologies, the most common of which is cervical disc herniation. Although difficult to diagnose, it can be successfully treated when identified through first-line conservative management or surgical interventions in refractory cases.
颈性心绞痛，即假性心绞痛，是一种胸痛的非心脏综合征，常酷似心绞痛，但却是一种脊柱疾病。颈性心绞痛的诊断可能困难且常被忽视，不过一旦确诊，可通过保守治疗和/或多种手术干预成功处理。最终，颈性心绞痛是非心脏性胸痛鉴别诊断清单中的一个重要组成部分。在本研究中，作者报告了对与颈性心绞痛相关的一系列颈椎和胸椎病变以及用于处理该病症的不同治疗方法的首次全面系统评价。
根据PRISMA指南并使用从数据库建立到2020年4月29日的PubMed、科学网和Cochrane数据库进行系统评价，以识别描述与颈性心绞痛相关的脊柱病变的研究。进行了以下布尔检索：（“颈椎”或“胸椎”）且（“心绞痛”或“胸痛”）且（“椎间盘突出”或“后纵韧带骨化症”）。提取的变量包括患者人口统计学资料、颈性心绞痛疼痛部位、病理及症状持续时间、治疗和/或管理方法以及治疗后疼痛缓解情况。
经仔细筛选，1976年至2020年间发表的22篇文章符合该研究的纳入/排除标准，包括5个病例系列、12个病例报告和5个回顾性队列研究。这些研究共涉及1100例患者，其中95例符合纳入标准（患者平均年龄51.7岁，年龄范围24 - 86岁；男性占53.6%）。总体而言，症状持续时间从1.5天到90个月不等。颈椎间盘突出（72.6%）占颈性心绞痛病例的大多数，手术干预（84.4%）比物理治疗（13.0%）和药物管理策略（9.1%）更为普遍。在随访中评估的每位患者均报告与颈性心绞痛相关的症状得到缓解。
颈性心绞痛是一种与多种颈椎和胸椎脊柱病变相关的非心脏性胸痛综合征，其中最常见的是颈椎间盘突出。尽管难以诊断，但通过一线保守治疗或对难治性病例进行手术干预确诊后可成功治疗。
