| Part I1. Groups and initial differential diagnosisObjectives: To investigate the importance of preliminary differential diagnosis fromcervical sympathetic symptoms in outpatient department.Methods：716outpatients were grouped and given appropriate treatments concerning theexistence of BPPV and abnormal neck artery (carotid and vertebral arteries). The incidenceof cervical disease, surgery rates, neurological treatment and the efficiency of surgicaltreatment were evaluated and compared between different groups.Results：(1) In370patients with BPPV (51.68%), the ratio of women, incidence ofcervical spondylosis, cervical spondylosis surgery, improvement rate of postoperativesympathetic nerve symptom were significantly different from control group (P <0.05). Butthere were no significant difference in age and improvement of neurological treatment (P>0.05).(2) In235patients with vascular abnormalities (32.82%), there were significantdifference (P <0.05) in the proportion of women, average age, incidence of cervical disease,improvement of sympathetic nerve symptom postoperatively, compared with the controlgroup. There were no significant difference in the rate of surgery for cervical spondylosisand improvement of neurological treatment (P>0.05).Conclusion：It should be paid more attention to the screening and diagnosis of BPPV infemale patients and abnormal carotid artery in male patients over the age of50. In addition,the effect of surgical treatment for sympathetic symptoms is poor in the patients withBPPV or carotid artery disease.2.Differential diagnosis and treatment of benign paroxysmal positional vertigoObjectives: To investigate the differential diagnosis and treatment for BPPV.Methods：252patients without cervical vascular disease were diagnosed as BPPV. Theywere divided into two groups according to the presence of cervical disease (with or withoutcervical disease group). Cervical spondylosis group were given surgery and someconservative treatment). Non-cervical spondylosis group were given neurological therapy for vertigo. The improvement of sympathetic symptoms after treatment were evaluated andcompared.Results：There was no statistical difference (P>0.05) in age and proportion of womenbetween these two groups. There was better improvement of sympathetic symptoms afterneurological therapy in non-cervical spondylosis group (P <0.05). Between conservativetreatment and surgical treatment, there was no statistical difference of symptomimprovement in cervical spondylosis group (P>0.05).Conclusion：Sympathetic symptoms in BPPV patients can be significantly improved byneurological standard treatment. It shouldn’t be explained as cervical sympatheticsymptoms and the effect of spinal surgical treatment for this is poor.3. Differential diagnosis and treatment of the neck artery anomalousObjectives: To investigate the differential diagnosis and treatment for the neck arteryanomalous.Methods：117patients without BPPV were found the neck artery anomalous. They weredivided into two groups according to the presence of cervical disease (with or withoutcervical disease group). Cervical spondylosis group were given surgery and someconservative treatment). Non-cervical spondylosis group were given therapy either inneurology or vascular surgery. The improvement of sympathetic symptoms after treatmentwere evaluated and compared.Results：There was no statistical difference (P>0.05) in age and proportion of menbetween these two groups. There was better improvement of sympathetic symptoms aftertherapy by neurology or vascular surgery in non-cervical spondylosis group than insurgical treatment (P <0.05).Conclusion：Sympathetic symptoms in patients with neck artery anomalous can besignificantly improved by standard treatment. It shouldn’t be explained as cervicalsympathetic symptoms and the effect of spinal surgical treatment for this is poor.4. Observation of X-Ray in patients with cervical sympathetic symptomsObjectives: To investigate the characteristics of the cervical sympathetic symptoms in X-Ray radiographs.Methods：229patients without BPPV or the neck artery anomalous were divided into twogroups according to the presence of cervical disease (with or without cervical diseasegroup). Plain and flexion-extension radiographs were taken. Cervical curvatureabnormality, instability and so called “foramen arcuale” were measured and then statisticalanalysis was performedResults：There was no statistical difference (P>0.05) in age, proportion of women, ratesof cervical curvature abnormality and instability between these two groups. The rates ofinstability were higher in cervical spondylosis group than non-cervical spondylosis group(P <0.05). The rates of cervical curvature abnormality were beyond60%in both groups.Conclusion：Cervical curvature abnormality and instability may be an important but not anindependent factor that affects the cervical sympathetic symptoms．CSS may be releasedby way of reconstruct or keep the cervical curvature and stability.Part II Development and study on reliability and validit of a New CervicalSympathetic Symptoms Svaluation Questionnaire (CSSEQ)Objectives: To provide an objective，effective and standard tools to evaluate the cervicalsympathetic symptomsMethods：Based on literature reviews, double rounds investigation were performed in bothexperts and patients following the Delphi principle. A new Cervical SympatheticSymptoms Svaluation Questionnaire (CSSEQ) was developed by analysing the result ofthe double rounds consultation. After that, the re-measured reliability, inspected criteriavalidity and discriminatory validity of the new CSSEQ were examined.Results：The new CSSEQ includes10selected items such as“vertigo”. Each item, having aweighting coefficient, can be used to measure the severity of one Sympathetic symptoms.The sum of the whole items scores can be a tool in evaluating the total severity of thesympathetic symptoms which can be divided into three levels: less than35as mild,between35and45as medium and above45as serious. The results of evaluation showed that the new CSSEQ reflects the severity of sympathetic symptoms effectively withpreferable reliability and validityConclusion：The new CSSEQ is worthy of clinical application to evaluate the cervicalsympathetic symptoms.Part III Early outcome and analysis of treatment based on grading system forsympathetic symptoms in cervical degenerationObjectives: To investigate and discuss the appropriate treatment based on grading systemin treating sympathetic symptoms in cervical degeneration.Methods：A prospective study was performed on166patients with radiographic cervicaldegeneration and complains of sympathetic symptoms. The patients were divided into3groups (S0、S1、S2) according to the sympathetic symptoms evaluated by the New CervicalSympathetic Symptoms Svaluation Questionnaire (CSSEQ). Cervical stability andinstability showed in the dynamic slice were recorded as P0, P1respectively. Treatmentincluding both drugs for promoting blood circulation and manipulation, collar support oreven anterior discectomy and fusion surgery were given in different groups.Clinical andradiologic evaluations were taken and compared at baseline (pre-operation), post-treatment(post-operation) and final follow-up. Sympathetic symptoms and mental state in all thepatients were evaluated by the CSSEQ and the anxiety disorders scoring system (SAS)respectively. CSSEQ, Japanese Orthopedic Association (JOA), the Short Form-36HealthSurvey (SF-36) scoring system, and SAS were used used to assessment effects in patientsunderwent operation.Results: All the patients were followed up for6-24months (mean16.5months). Asignificant difference was observed regarding CSSEQ, SF-36, SAS and JOA scores beforetreatment (pre-operation), after treatment (post-operation) and final follow-up (p＜0.05).Conclusions: Sympathetic symptoms in patients with cervical degeneration can bemanaged successfully by the treatment based on grading system with promising earlyoutcomes. Part IV Effect and analysis of anterior decompression in treating cervical spondylosiscompanied by sympathetic symptoms1. Role of Posterior longitudinal ligament in treating cervical vertigo by anteriordecompression and fusionObjectives: To investigate the effect of anterior decompression and fusion with posteriorlongitudinal ligament resected in the treatment of cervical vertigo.Methods： A retrospective study was performed on35patients underwent anteriordecompression and fusion in2-levels for cervical vertigo. The patients were divided intotwo groups (ACCF, ACDF) according to whether the posterior longitudinal ligament at thearea of decompression was resected. The general conditions and clinical evaluations of thetwo groups were taken and compared at baseline,2month post-operation and finalfollow-up.Results: There was no significant difference in the general conditions between both groups(P>0.05). In each group, the vertigo scores is significant different between before surgeryand2month after surgery/at the final follow-up (p＜0.05).There was no significantdifference of the vertigo scores between both groups before surgery and2month aftersurgery (P>0.05). However, the vertigo scores and the subjective satisfactory rate inACDF group are significantly different from ACCF group at the final follow-up (p＜0.05)Conclusion： The posterior longitudinal ligament may play a significance role inpathological procedure of cervical vertigo, and it is ideal to remove the posteriorlongitudinal ligament at the area of decompression for a satisfactory and persistent effect2. Analysis of anterior discectomy and fusion for treating cervical spondylosiscompanied by sympathetic symptomsObjectives: To investigate surgical results of anterior discectomy and fusion in treatingcervical spondylosis companied by sympathetic symptoms.Methods：A retrospective study was performed on46patients with cervical spondylosismyelopathy or myelopathy and radiculopathy companied by sympathetic symptoms. Allthe compression levels underwent anterior discectomy and fusion surgery with posteriorlongitudinal ligament (PLL) resected at the area of decompression. Clinical and radiologic evaluations were taken and compared at baseline, one week post-operation and finalfollow-up. Neurological status was evaluated by Japanese Orthopedic Association (JOA)scores and sympathetic symptoms were evaluated with sympathetic symptoms20-pointscoring system. Antero-posterior, lateral and extension-flextion radiographs were used toevaluate the radiologic outcomes.Results: A significant difference was observed regarding sympathetic symptoms scoresand JOA scores before surgery and one week after surgery/at the final follow-up (p＜0.05). The subjective satisfactory rate was84.78%at the final follow-up.Conclusion：Cervical spondylosis companied by sympathetic symptoms can be managedsuccessfully by the anterior discectomy and fusion with resection of PLL at the area ofdecompression.3. Total disc replacement versus fusion for sympathetic symptoms in single levelcervical degenerative disc disease: a prospective randomized and controlled study.Objectives: To evaluate the clinical effectiveness of TDR in treating sympatheticsymptoms in single level cervical degenerative disc disease (DDD).Methods：A prospective randomized and controlled study was performed.32patients withsympathetic symptoms and compression in single level were enrolled and divided into twogroups at random: study group (17patients, receiving TDR, using a Discover prosthesis)and control group (15patients, receiving ACDF, using a Zero-p implant). The posteriorlongitudinal ligament (PLL) at the decompression level was resected before prosthesisimplanted in both groups. Clinical and radiologic evaluations were obtained preoperativelyafter6month and at the final postoperative follow-up.Results: In each group, a significant difference was observed regarding CSSEQscores,JOA scores, SF-36-MCS and SF-36-PCS scores between before surgery and oneweek after surgery/at the final follow-up (p＜0.05).There was no significant difference ofthe above scores between both groups (P>0.05). However, the range of motion (ROM) inthe treated segment was well preserved in the TDR group.Conclusion：TDR could relieve sympathetic symptoms in single level cervical DDD successfully with the same early results following as ACDF while preserving cervical spinesegmental motion. |
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