Institute of Medical Sciences, Tzu Chi University, Hualien.
Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi.
Clin Spine Surg. 2021 Nov 1;34(9):E514-E521. doi: 10.1097/BSD.0000000000001178.
This study employed a retrospective study design.
This retrospective cohort study aimed to compare the outcomes of anterior cervical discectomy and fusion (ACDF), and those of conservative treatment for patients with cervical angina.
Cervical angina is typically characterized by intolerable and paroxysmal angina-like precordial pain, which is caused by cervical disk degeneration in patients without definitive cardiovascular abnormalities. Diagnosis is either delayed or neglected because of its various clinical manifestations. Whether conservative or surgical treatment is appropriate remains controversial because of the lack of comparative studies.
From 2009 to 2016, 163 patients with cervical angina with advanced chest pain, tightness, or palpitation were retrospectively studied. Twenty-three patients underwent ACDF, and the other 140 patients were treated nonsurgically by medication, physical therapy, collar immobilization, or stellate ganglion block. Japanese Orthopedic Association (JOA) score and 20-point autonomic nervous system (ANS) score were assessed pretreatment and posttreatment. Patients' satisfaction was assessed using the Odom criteria.
The average age of the patients was 50 years, and most of them were females. The average follow-up was 25.5 months. The pretreatment JOA and 20-point ANS scores in the conservative and ACDF groups were 13.3 versus 11.7 (P=0.110) and 13.0 versus 13.3 (P=0.928), respectively. Generalized estimating equation analysis showed that posttreatment JOA and ANS scores at each observation interval improved significantly in the ACDF group (P<0.001). Angina-like symptoms also improved significantly in the ACDF group (P<0.001). During an average 2-year follow-up, good or excellent results were obtained in 78.2% of surgical patients and 35% of nonsurgical patients.
Compared with conservative therapy, surgical treatment with ACDF for cervical angina provided better and more consistent relief from angina-like symptoms and overall sympathetic symptoms.
Level III.
本研究采用回顾性研究设计。
本回顾性队列研究旨在比较颈椎心绞痛患者行前路颈椎间盘切除融合术（ACDF）与保守治疗的疗效。
颈椎心绞痛的特征为无法忍受的阵发性心绞痛样胸痛，由无明确心血管异常的颈椎间盘退变引起。由于其临床表现多样，诊断往往被延迟或忽视。由于缺乏比较研究，对于是采用保守治疗还是手术治疗，目前仍存在争议。
2009 年至 2016 年，我们对 163 例有严重胸痛、紧缩感或心悸的颈椎心绞痛患者进行了回顾性研究。23 例患者接受 ACDF 治疗，其余 140 例患者接受药物、物理治疗、颈托固定或星状神经节阻滞治疗。治疗前后评估日本骨科协会（JOA）评分和 20 分自主神经（ANS）评分。采用 Odom 标准评估患者满意度。
患者平均年龄为 50 岁，大多数为女性。平均随访时间为 25.5 个月。保守治疗和 ACDF 组患者的术前 JOA 和 20 分 ANS 评分分别为 13.3 分和 11.7 分（P=0.110）和 13.0 分和 13.3 分（P=0.928）。广义估计方程分析显示，ACDF 组在每个观察时间点的术后 JOA 和 ANS 评分均显著改善（P<0.001）。ACDF 组的心绞痛样症状也显著改善（P<0.001）。在平均 2 年的随访中，手术组 78.2%的患者和非手术组 35%的患者获得了良好或优秀的结果。
与保守治疗相比，颈椎心绞痛患者行 ACDF 手术治疗可更好、更一致地缓解心绞痛样症状和整体交感神经症状。
III 级。
