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Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study

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Abstract

Purpose

To investigate the effect of C3/4 disc degeneration on cervical spondylosis with dizziness (CSD) and to assess the curative effect of anterior cervical decompression and fusion (ACDF) in patients with CSD.

Method

Four hundred nineteen patients who underwent ACDF for treatment of myelopathy or radiculopathy were divided into dizziness and non-dizziness group. The visual analog scale (VAS) score and Japanese Orthopaedic Association (JOA) score were used to determine the intensity of dizziness and neurological symptoms, respectively. Cervical disc degeneration was evaluated using Miyazaki’s classification system. Some parameters were measured using cervical radiographs. The surgical effects on CSD were compared between surgery with and without C3/4 level. Multivariate logistic regression analysis was used to determine the risk factors for CSD.

Results

The pre-operative incidence of CSD was 33.9%. Women were more likely to develop dizziness than men (p < 0.05), CSD was significantly associated with C3/4 disc degeneration (69.7%, p < 0.001), and smokers were more subject to dizziness (p < 0.05). Regression analysis showed that female (OR = 1.611, p = 0.031), smoking (OR = 1.719, p = 0.032), Miyazaki grade of C3/4 ≥ IV (OR = 2.648, p < 0.001), and instability on C3/4 (OR = 1.672, p = 0.024) were risk factors for CSD. Treatment of CSD by ACDF involving C3/4 was more effective than not involving C3/4 (efficacy rate, 73.2% vs 51.7%, p < 0.05).

Conclusion

The CSD is a common clinical manifestation in elderly patients, especially patients with cervical spondylosis at the C3/4 level. Female, smoking, instability on C3/4, and C3/4 Miyazaki grade ≥ IV could be considered significant risk factors for CSD. CSD is more likely to be alleviated by ACDF involving C3/4.

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Funding

This work was funded by the National Natural Science Foundation of China (81572181). This work was also funded by a Municipal Human Resources Development Program for Outstanding Young Talents in Medical and Health Sciences in Shanghai (2017YQ070) and funded by the Key Discipline Construction Project of Pudong Health Bureau of Shanghai (PWZxk2017-08).

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  1. Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    Yu-Yang Yi, Hao-Wei Xu, Shu-Bao Zhang, Tao Hu, Shan-Jin Wang & De-Sheng Wu

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Contributions

SJW initiated the idea and did the data analysis; YYY and HWX wrote the assay. SBZ supervised and reviewed the manuscript. TH and DSW supervised the study. DSW gathered the data and helped with the data analysis. All authors read and approved the final manuscript.

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Correspondence to Shan-Jin Wang.

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Yu-Yang Yi and Hao-Wei Xu are co-first authors.

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Yi, YY., Xu, HW., Zhang, SB. et al. Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study. International Orthopaedics (SICOT) 44, 1159–1168 (2020). https://doi.org/10.1007/s00264-020-04531-y

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