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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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.

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.

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