Cervical spondylotic internal jugular venous compression syndrome.

Jia‐Yue Ding,Da Zhou,Jing‐Yuan Ya,Li‐Qun Pan,Xun‐Ming Ji,Ran Meng,Cheng Liu,Feng Yan,Yu‐Chuan Ding,Chun‐Qiu Fan

doi:10.1111/cns.13148

Jia‐Yue Ding, Da Zhou + Show 8 more

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https://doi.org/10.1111/cns.13148

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Abstract

AimsThis study aimed to identify the clinical profiles of cervical spondylosis‐related internal jugular vein stenosis (IJVS) comprehensively.MethodsA total of 46 patients, who were diagnosed as IJVS induced by cervical spondylotic compression were recruited. The clinical manifestations and imaging features of IJVS were presented particularly in this study.ResultsVascular stenosis was present in 69 out of the 92 internal jugular veins, in which, 50.7% (35/69) of the stenotic vessels were compressed by the transverse process of C1, and 44.9% (31/69) by the transverse process of C1 combined with the styloid process. The transverse process of C1 compression was more common in unilateral IJVS (69.6% vs 41.3%, P = 0.027) while the transverse process of C1 combined with the styloid process compression had a higher propensity to occur in bilateral IJVS (52.2% vs 30.4%, P = 0.087). A representative case underwent the resection of the elongated left lateral mass of C1 and styloid process. His symptoms were ameliorated obviously at 6‐month follow‐up.ConclusionsThis study proposes cervical spondylotic internal jugular venous compression syndrome as a brand‐new cervical spondylotic subtype. A better understanding of this disease entity can be of great relevance to clinicians in making a proper diagnosis.

Highlights

Cervical spondylosis is a commonly encountered degenerative dis‐ order of the cervical spine
We aimed to identify the clinical profiles of cervical spondylosis‐related internal jugular vein (IJV) stenosis (IJVS) in attempt to gain a deeper understanding of the negative impact of cervical spondylotic IJV compression syn‐ drome on central nervous system (CNS)
Traditional cervical spondylosis including radiculopathy, myelopathy, axial neck pain and vertebral artery insufficiency has been frequently reported in the literature, studies focusing on cervi‐ cal spondylosis‐induced venous outflow disturbance are still lack‐ ing

Summary

Introduction

Cervical spondylosis is a commonly encountered degenerative dis‐ order of the cervical spine. The pathophysiological changes following cervical spondylosis may contribute to a pleth‐ ora of clinical manifestations, such as cervical radiculopathy, cer‐ vical myelopathy, axial neck or shoulder pain, and vertebral artery insufficiency. The spinal cord, nerve roots, and vertebral arteries, whereas, in our clinical practice, we have noticed that a subset of patients with unex‐ plained nonfocal neurological dysfunctions display cerebral venous outflow disturbance in relation to the atlas (C1) compression of the superior segment of the internal jugular vein (IJV).[1]. Our study group dis‐ covered that some nonfocal neurological symptoms like headache, head noise, tinnitus, and visual impairment are tightly correlated to unilateral or bilateral IJVS, and balloon dilation with stenting in the stenotic segment may be a promising option to overcome non‐ immunogenic and nonextrinsic compression IJVS‐induced jugular venous outflow impairment.[11]. Symptomatic IJVS should be viewed as a pathological disorder, which deserves more attention from clini‐ cians due to the limited realization and the disabling or long‐lasting neurological symptoms that cannot be explained by other known diseases.[13]

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