Effect of total disc replacement on atypical symptoms associated with cervical spondylosis

To determine the efficacy of total disc replacement (TDR) for the treatment of cervical spondylosis associated with atypical symptoms. In this retrospective study, patients with myelopathy and/or radiculopathy related to cervical spondylosis that were treated with TDR were contacted by phone. Atypical symptoms involved in the questionnaire included dizziness, headache, nausea, vomiting, blurred vision, tinnitus, palpitations, hypomnesia, and abdominal discomfort. The severity of each atypical symptom was evaluated separately based on an numerical rating scale. The radiographs and charts before and after the surgery were reviewed. Paired samples t tests were used to compare the severity of the symptoms before and after surgery. Between 2003 and 2010, 73 of 133 patients diagnosed with cervical spondylotic myelopathy and/or radiculopathy treated by TDR experienced atypical symptoms before surgery. The mean follow-up was 34.6 months. There were 47 males and 26 females (mean age 48.9 years). Of the 73 patients, 41 were diagnosed with myelopathy; 13 with radiculopathy; and 19 with mixed-type spondylosis. The incidence of each symptom before surgery was dizziness (46.6 %), tinnitus (41.1 %), facial flushing and sweating (41.1 %), palpitations (39.7 %), headache (35.6 %), hypomnesia (30.1 %), nausea and vomiting (20.5 %), blurred vision (20.5 %), and gastroenterologic discomfort (5.5 %). The severity of the following symptoms improved after surgery: dizziness (p = 0.000, alpha = 0.05), headache (p = 0.000, alpha = 0.05), nausea and vomiting (p = 0.000, alpha = 0.05), blurred vision (p = 0.004, alpha = 0.05), tinnitus (p = 0.000, alpha = 0.05), palpitations (p = 0.000, alpha = 0.05), hypomnesia (p = 0.010, alpha = 0.05), and other symptoms (p = 0.030, alpha = 0.05). The gastroenterologic discomfort did not improve (p = 0.731, alpha = 0.05). TDR may have a positive effect on atypical symptoms associated with cervical spondylotic myelopathy and/or radiculopathy.