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Cervical angina because of ossification of the posterior longitudinal ligament
The Spine Journal 12 (2012) 169
Cervical angina because of ossification of the posterior longitudinal ligament An 80-year-old man with increasing anterior chest pain was admitted to the emergency department. Electrocardiograms, laboratory investigations, and other examinations ruled out both angina and acute myocardial infarction. Computed tomography of the chest showed no evidence of aortic dissection. He reported a 4-year history of difficulty in performing fine finger movements. Increased deep tendon reflexes were observed in both upper and lower extremities. Computed tomography of the cervical spine revealed ossification of the posterior longitudinal ligament (Figs. 1 and 2). His symptoms gradually improved with rest and by wearing a neck collar. He refused surgical intervention. Cervical spine disorders may often be present with pain in the anterior chest areas, resembling true angina pectoris [1]. It has been sometimes described as cervical angina. Accurate diagnosis requires a strong sense of suspicion in patients with inadequately explained chest pain. The chief complaint is typically intolerable paroxysmal precordialgia induced by neck motion, as with this patient [2].
Fig. 1. Ossification of the posterior longitudinal ligament (OPLL). Sagittal reconstruction computed tomography showing spinal canal stenosis because of OPLL.
References [1] Nakajima H, Uchida K, Kobayashi S, et al. Cervical angina: a seemingly still neglected symptom of cervical spine disorder? Spinal Cord 2006;44:509–13. [2] Ito Y, Tanaka N, Fujimoto Y, et al. Cervical angina caused by atlantoaxial instability. J Spinal Disord Tech 2004;17:462–5.
Hideki Sudo, MD, PhDa Reo Goto, MDb a Department of Advanced Medicine for Spine and Spinal Cord Disorders Hokkaido University Graduate School of Medicine N15-W7, Kita-ku, Sapporo Hokkaido 060-8638, Japan b Department of Orthopaedic Surgery Abashiri-Kosei General Hospital N6-W1, Abashiri Hokkaido 093-0076, Japan
Fig. 2. Axial image. 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2012.01.018
FDA device/drug status: Not applicable. Author disclosures: HS: Nothing to disclose. RG: Nothing to disclose.
Cervical angina because of ossification of the posterior longitudinal ligament An 80-year-old man with increasing anterior chest pain was admitted to the emergency department. Electrocardiograms, laboratory investigations, and other examinations ruled out both angina and acute myocardial infarction. Computed tomography of the chest showed no evidence of aortic dissection. He reported a 4-year history of difficulty in performing fine finger movements. Increased deep tendon reflexes were observed in both upper and lower extremities. Computed tomography of the cervical spine revealed ossification of the posterior longitudinal ligament (Figs. 1 and 2). His symptoms gradually improved with rest and by wearing a neck collar. He refused surgical intervention. Cervical spine disorders may often be present with pain in the anterior chest areas, resembling true angina pectoris [1]. It has been sometimes described as cervical angina. Accurate diagnosis requires a strong sense of suspicion in patients with inadequately explained chest pain. The chief complaint is typically intolerable paroxysmal precordialgia induced by neck motion, as with this patient [2].
Fig. 1. Ossification of the posterior longitudinal ligament (OPLL). Sagittal reconstruction computed tomography showing spinal canal stenosis because of OPLL.
References [1] Nakajima H, Uchida K, Kobayashi S, et al. Cervical angina: a seemingly still neglected symptom of cervical spine disorder? Spinal Cord 2006;44:509–13. [2] Ito Y, Tanaka N, Fujimoto Y, et al. Cervical angina caused by atlantoaxial instability. J Spinal Disord Tech 2004;17:462–5.
Hideki Sudo, MD, PhDa Reo Goto, MDb a Department of Advanced Medicine for Spine and Spinal Cord Disorders Hokkaido University Graduate School of Medicine N15-W7, Kita-ku, Sapporo Hokkaido 060-8638, Japan b Department of Orthopaedic Surgery Abashiri-Kosei General Hospital N6-W1, Abashiri Hokkaido 093-0076, Japan
Fig. 2. Axial image. 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2012.01.018
FDA device/drug status: Not applicable. Author disclosures: HS: Nothing to disclose. RG: Nothing to disclose.