Spinal pathologies and management strategies associated with cervical angina (pseudoangina): a systematic review

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  • 1 School of Medicine, University of California, Irvine, California;
  • 2 Keck School of Medicine of USC, Los Angeles, California;
  • 3 College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas;
  • 4 Department of Neurological Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania;
  • 5 Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
  • 6 Department of Neurological Surgery, University of California, San Diego, California
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS CSM = cervical spondylotic myelopathy; ECG = electrocardiogram; ED = emergency department; NSAID = nonsteroidal antiinflammatory drug; OPLL = ossification of the posterior longitudinal ligament; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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Contributor Notes

Correspondence Nolan J. Brown: University of California, Irvine, CA. nolanb@uci.edu.

INCLUDE WHEN CITING Published online December 4, 2020; DOI: 10.3171/2020.7.SPINE20866.

N.J.B. and S.S. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Brodsky AE. Cervical angina. A correlative study with emphasis on the use of coronary arteriography. Spine (Phila Pa 1976). 1985;10(8):699709.

    • Search Google Scholar
    • Export Citation
  • 2

    Nachlas IW. Pseudo-angina pectoris originating in the cervical spine. JAMA. 1934;103:323325.

  • 3

    Davis D. Radicular Syndrome With Emphasis on Chest Pain Stimulating Coronary Disease. Year Book Medical Publishers, Inc.; 1957.

  • 4

    Sussman WI, Makovitch SA, Merchant SH, Phadke J. Cervical angina: an overlooked source of noncardiac chest pain. Neurohospitalist. 2015;5(1):2227.

    • Search Google Scholar
    • Export Citation
  • 5

    Wells P. Cervical angina. Am Fam Physician. 1997;55(6):22622264.

  • 6

    Pope JH, Aufderheide TP, Ruthazer R, Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):11631170.

    • Search Google Scholar
    • Export Citation
  • 7

    Mourad G, Alwin J, Strömberg A, Jaarsma T. Societal costs of non-cardiac chest pain compared with ischemic heart disease—a longitudinal study. BMC Health Serv Res. 2013;13:403.

    • Search Google Scholar
    • Export Citation
  • 8

    Sudo H, Goto R. Cervical angina because of ossification of the posterior longitudinal ligament. Spine J. 2012;12(2):169.

  • 9

    Nakajima H, Uchida K, Kobayashi S, Cervical angina: a seemingly still neglected symptom of cervical spine disorder? Spinal Cord. 2006;44(8):509513.

    • Search Google Scholar
    • Export Citation
  • 10

    Nakae Y, Johkura K, Kudo Y, Kuroiwa Y. Spinal cord infarction with cervical angina. J Neurol Sci. 2013;324(1-2):195196.

  • 11

    Akiyama H, Tamura K, Takatsuka K, Kondo M. Spinal cord tumor appearing as unusual pain. Spine (Phila Pa 1976). 1994;19(12):14101412.

  • 12

    Ito Y, Tanaka N, Fujimoto Y, Cervical angina caused by atlantoaxial instability. J Spinal Disord Tech. 2004;17(5):462465.

  • 13

    Ozgur BM, Marshall LF. Atypical presentation of C-7 radiculopathy. J Neurosurg. 2003;99(2)(suppl):169171.

  • 14

    Tanaka S. Etiological consideration of cervical angina combined with cervical disc herniation. Jpn Orthop J. 1976;19:875877.

  • 15

    LaBan MM, Meerschaert JR, Taylor RS. Breast pain: a symptom of cervical radiculopathy. Arch Phys Med Rehabil. 1979;60(7):315317.

  • 16

    Jones SJ, Miller J-MM. Spurling test. In: StatPearls. April 30, 2019. Accessed August 12, 2020. https://www.ncbi.nlm.nih.gov/books/NBK493152

    • Search Google Scholar
    • Export Citation
  • 17

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264269, W64.

    • Search Google Scholar
    • Export Citation
  • 18

    National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. Centers for Disease Control and National Center for Health Statistics. Accessed August 12, 2020. https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf

    • Search Google Scholar
    • Export Citation
  • 19

    Weiss AJ, Wier LM, Stocks C, Overview of emergency department visits in the United States, 2011: Statistical brief #174. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Accessed August 12, 2020. https://www.ncbi.nlm.nih.gov/books/NBK235856

    • Search Google Scholar
    • Export Citation
  • 20

    Güler N, Bilge M, Eryonucu B, Cirak B. Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia—a case report. Angiology. 2000;51(10):861865.

    • Search Google Scholar
    • Export Citation
  • 21

    Booth RE Jr, Rothman RH. Cervical angina. Spine (Phila Pa 1976). 1976;1(1):2832.

  • 22

    Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. National Institute of Health Care Excellence. March 24, 2010. Accessed August 12, 2020. http://guidance.nice.org.uk/CG95/NICEGuidance/pdf/English

    • Search Google Scholar
    • Export Citation
  • 23

    Kato K, Yabuki S, Otani K, Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher. Fukushima J Med Sci. 2016;62(1):6467.

    • Search Google Scholar
    • Export Citation
  • 24

    Baranto A, Börjesson M, Danielsson B, Acute chest pain in a top soccer player due to thoracic disc herniation. Spine (Phila Pa 1976). 2009;34(10):E359E362.

    • Search Google Scholar
    • Export Citation
  • 25

    Freccero D, Donovan DJ. Adjacent segment degeneration at T1–T2 presenting as chest pain: case report. Spine (Phila Pa 1976). 2005;30(21):E655E657.

    • Search Google Scholar
    • Export Citation
  • 26

    Senturk S, Guzel A, Guzel E. Atypical clinical presentation of idiophatic thoracic spinal cord herniation. Spine (Phila Pa 1976). 2008;33(14):E474E477.

    • Search Google Scholar
    • Export Citation
  • 27

    Mellion LR, Ladeira C. The herniated thoracic disc: a review of literature. J Man Manip Ther. 2001;9(3):154163.

  • 28

    Mitchell LC, Schafermeyer RW. Herniated cervical disk presenting as ischemic chest pain. Am J Emerg Med. 1991;9(5):457460.

  • 29

    Htay MNN, Ni H, Moe S. Cervical spondylosis mimicking cardiac angina. J Case Rep Images Med. 2019;5:100050Z09MH2019.

  • 30

    Cheshire WP Jr. Spinal cord infarction mimicking angina pectoris. Mayo Clin Proc. 2000;75(11):11971199.

  • 31

    Gadour M, Rajbhandari SM, Tesfaye S. Cervical spine infection presenting as angina. Hosp Med. 1999;60(3):217218.

  • 32

    Eleraky MA, Apostolides PJ, Dickman CA, Sonntag VK. Herniated thoracic discs mimic cardiac disease: three case reports. Acta Neurochir (Wien). 1998;140(7):643646.

    • Search Google Scholar
    • Export Citation
  • 33

    Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine (Phila Pa 1976). 1994;19(9):10871091.

    • Search Google Scholar
    • Export Citation
  • 34

    Grgic V. Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment C6-C7: a case report. Article in Croatian. Lijec Vjesn. 2008;130(9-10):234236.

    • Search Google Scholar
    • Export Citation
  • 35

    Iwasa M. Clinical analysis of angina pectoris and angina-like pain—with special reference to ECG during attack, “cervical spondylosis” and selective coronary arteriography. Jpn Circ J. 1976;40(10):11911203.

    • Search Google Scholar
    • Export Citation
  • 36

    Constant J. The diagnosis of nonanginal chest pain. Keio J Med. 1990;39(3):187192.

  • 37

    Jain RS, Sharma JK. Cervical angina: an unnoticed cause of noncardiac chest pain. Indian J Clin Pract. 2020;30(9):836838.

  • 38

    Hammad WAE. Pseudo-angina syndrome. A prospective diagnostic study. Al-Azhar Assiut Med J. 2015;13(1)(Suppl 2):912.

  • 39

    Tominaga T, Nishimura R, Fujita H, Acute anterior chest and back pain due to cervical disc herniation without radiculopathy: a case report. Case Rep Imag Surg. 2019;2:13.

    • Search Google Scholar
    • Export Citation
  • 40

    Yeung MC, Hagen NA. Cervical disc herniation presenting with chest wall pain. Can J Neurolog Sci. 1993;20(1):5961.

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