title: Cervical angina caused by atlantoaxial instability.
abstract: Cervical angina is defined as a paroxysmal precordialgia that resembles true cardiac angina caused by cervical spondylosis. Cervical angina most commonly results from compression of the C7 ventral root. We present here a case of cervical angina caused by atlantoaxial instability. This case had marked atlantoaxial instability but no flexibility of the middle to lower levels of the cervical spine. Although there was mild C7 root compression on the radiologic findings, the chest pain was induced by neck motion, and the precordialgia disappeared after posterior atlantoaxial fusion without C7 root decompression. Therefore, we diagnosed this case as cervical angina caused by spinal cord compression at the C1-C2 level. It was speculated that a perturbation of the sympathetic nervous system or a hypofunction of the pain suppression pathway in the posterior horn of the spinal cord caused the pectoralgia. Although cervical angina is a rare disease, physicians should be aware of it; if there are no abnormal findings on cardiac examinations for angina pectoris, they should examine the cervical spine. Cervical angina due to atlantoaxial instability is one of the differential diagnoses of precordialgia.
authors.affiliation: Department 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
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ito
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yasunaga
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishida
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
mesh_terms: D000344:Afferent Pathways / Q000473:pathology / Q000503:physiopathology; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D004525:Efferent Pathways / Q000503:physiopathology; D005260:Female; D005728:Ganglia, Sympathetic / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology