Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study
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ORIGINAL PAPER
Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study Yu-Yang Yi 1 & Hao-Wei Xu 1 & Shu-Bao Zhang 1 & Tao Hu 1 & Shan-Jin Wang 1 & De-Sheng Wu 1 Received: 6 January 2020 / Accepted: 4 March 2020 # SICOT aisbl 2020
Abstract Purpose 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. Method 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. Results 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). Conclusion 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. Keywords Dizziness . Cervical spondylosis . Smoking . Cervical instability . Cervical disc degeneration . Anterior cervical decompression and fusion
Introduction Dizziness has become one of the most common manifestation in adult patients [1] and can be classified into four categories according to the patient’s history: vertigo, disequilibrium, presyncope, or lightheadedness [2]. Dizziness reportedly affects about 15% to > 20% of adults yearly according to large population-based studies [3]. Among all causes of dizziness, cervical spondylosis is the most common and controversial Yu-Yang Yi and Hao-Wei Xu are co-first authors. * Shan-Jin Wang [email protected] 1
Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
cause of cervicogenic dizziness [2, 4, 5]. However, the relationship between dizziness and cervical spondylosis remains unclear. Few head-to-head studies of the specific types of cervical disc degeneration that contribute t
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