<p>Anterior Cervical Surgery for the Treatment of Cervicogenic Headache Caused by Cervical Spondylosis</p>

Abstract

Study Design Retrospective study. Objective To report the efficacy of anterior cervical surgery for the relief of cervicogenic headache (CEH) caused by cervical spondylosis. Methods From January 2014 to December 2016, a total of 166 cases of cervical radiculopathy and/or myelopathy received anterior cervical decompression and fusion (ACDF) in our institution, among which 50 cases (mean age 44.7 years) were accompanied by CEH and followed up at 3, 6, 12, and 24 months postoperatively, respectively. Neck pain and headache scores according to neck disability index (NDI) were documented for all patients at regular intervals. The results measured at different follow-up time point were compared statistically. Results All 50 patients reported neck pain and headache at the same time before surgery. The average NDIs for neck pain before and after surgery were 2.86 (95% CI: 2.7–3.0) preoperatively, 0.98 (95% CI: 0.8–1.1) at 3 months, 0.68 (95% CI: 0.5–0.9) at 6 months, 0.62 (95% CI: 0.5–0.8) at 12 months, and 0.60 (95% CI: 0.4–0.8) at 24 months postoperatively, respectively. The average NDIs for CEH before and after surgery were 2.32 (95% CI: 2.2–2.5) preoperatively, 0.62 (95% CI: 0.5–0.8) at 3 months, 0.60 (95% CI: 0.4–0.8) at 6 months, 0.56 (95% CI: 0.4–0.7) at 12 months, and 0.50 (95% CI: 0.3–0.7) at 24 months postoperatively, respectively. The neck pain and headache improved in all cases and the NDI score of neck pain or headache at each follow-up point after surgery was significantly different from that before surgery (P <0.001). The simple correlation analysis between neck pain and headache was performed, and the Pearson coefficient r was 0.71, indicating a positive correlation between neck pain NDI and headache NDI. No serious surgical complications were found. Conclusion Our study suggests that patients with cervical spondylosis complicated with CEH are always accompanied by neck pain. ACDF can not only relieve neck pain but also improve the accompanying CEH.

Anterior cervical decompression and fusion surgery for cervicogenic headache: A multicenter prospective cohort study

“…This study has also shown that CEH in patients with cervical radiculopathy and/or myelopathy significantly improved or disappeared after ACDF, which was consistent with previous studies ( 6 , 17 , 22 ). To the best of our knowledge, to date, no large-scale, prospective, multicenter study has examined the efficacy of ACDF to relieve CEH diagnosed based on the ICHD-3 beta version.…”

“…It has long been considered a referred pain caused by pathological changes in the upper cervical nerves (C1–C3) ( 2 ). However, as we all know, cervical spondylosis occurs mostly in the lower cervical spine (C4–C7) and rarely in the upper cervical spine ( 5 , 6 ). In reality, Diener et al ( 7 ) and later Persson et al ( 8 ) identified the role of the lower cervical spine as a potential source of CEHs in the early 21st century.…”

“…According to the previous literature, the prevalence of headaches associated with cervical spondylosis ranges from 86 to 88%, and the prevalence of severe headache is about 52% ( 5 , 9 ). However, according to a retrospective study ( 6 ) and a small sample prospective study ( 17 ), the incidence rate of cervical spondylosis patients with CEH (based on ICHD-3 beta version) was only 21.4% (15/70) and 30% (50/166). Therefore, it is difficult to exclude the interference of headache from other causes and determine whether anterior cervical surgery is helpful to improve CEH associated with cervical spondylosis.…”

“…Recently, a retrospective study found that anterior lower cervical discectomy can also relieve the accompanying CEH based on the criteria of the ICHD-3 beta version ( 6 ). So far, there is a lack of large sample and prospective study to investigate the effect of anterior cervical decompression and fusion (ACDF) surgery on CEH associated with cervical spondylosis.…”

Intervertebral disc approach versus nerve root approach in the treatment of cervical spondylotic radiculopathy: a cohort study

“…Some studies have also shown that after cervical disc degeneration, in ammatory factors can be released to sensitize surrounding mechanoreceptors and cause dizziness. Previous case reports have shown that some patients with cervical spondylosis may experience relief of headache and dizziness after cervical laminectomy 25 , and cervical dizziness caused by cervical disc herniation can be signi cantly improved after disc replacement 26 .In addition, studies have shown that physical traction therapy can also improve dizziness symptoms in patients with cervical spondylosis 27 , which all suggest that the relief of dizziness symptoms is related to the reduction of cervical disc pressure and pressure around nerve roots. Combined with the results of this study, the dizziness symptoms of most patients are a persistent drowsiness in the head, which may be accompanied by mental depression and poor sleep quality.…”