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Cervical angina caused by atlantoaxial instability

Yoshiyuki Ito1, Nobuhiro Tanaka, Yoshinori Fujimoto

  • 1Department of Orthopaedic Surgery, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. yoito@hiroshima-u.ac.jp

Journal of Spinal Disorders & Techniques
|September 24, 2004
PubMed

Insights

Cervical angina, chest pain mimicking cardiac issues, can stem from atlantoaxial instability. Surgical fusion resolved symptoms, highlighting the importance of cervical spine evaluation for unexplained precordialgia.

Area of Science:

  • Neurology
  • Orthopedics
  • Cardiology

Background:

  • Cervical angina is precordialgia resembling cardiac angina, often caused by cervical spondylosis compressing nerve roots.
  • Compression of the C7 ventral root is the most common etiology for cervical angina.

Observation:

  • A case of cervical angina was attributed to atlantoaxial instability, distinct from typical C7 root compression.
  • The patient presented with significant atlantoaxial instability but minimal C7 root compression.
  • Chest pain was triggered by neck movement and resolved after surgical fusion of the atlantoaxial joint.

Findings:

  • Diagnosis of cervical angina was confirmed, caused by spinal cord compression at the C1-C2 level.
  • The resolution of symptoms post-fusion, without direct C7 decompression, supports atlantoaxial instability as the cause.
  • Potential mechanisms include sympathetic nervous system perturbation or impaired pain modulation pathways.

Implications:

  • Physicians should consider cervical angina in patients with unexplained precordialgia, especially when cardiac evaluations are normal.
  • Evaluation of the cervical spine, particularly for atlantoaxial instability, is crucial for diagnosing this rare condition.
  • Atlantoaxial instability represents a key differential diagnosis for precordialgia.

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