Vertigo is an illusion of motion produced by spatial disorientation of the body. Cervicogenic vertigo, as the name suggests, is a syndrome of vertigo caused by cervicogenic factors. It is common in middle-aged and elderly people, and is characterized by vertigo that occurs mainly when the head is moving, such as when the head and neck are flexed and extended back and forth or turned from side to side. Cervicogenic vertigo is very common in clinical practice and has attracted the attention of scholars. As early as 1933, Dekley et al. pointed out that vertigo was related to insufficient blood supply to the vertebrobasilar artery, and in 1957, Denny Brown first proposed “vertebrobasilar insufficiency of blood supply” (VBI). Guo Shishi and Zhao Dinglin believed that stimulation of the vertebral artery must also affect the sympathetic nerve. In May 1984, the National Symposium on Cervical Spondylosis unified cervical spondylosis and made cervical vertigo one of the diagnostic criteria for vertebral artery cervical spondylosis. Several decades ago, Ryan and Cope called cervical disorder with vertigo or dizziness as “cervicogenic vertigo”, but in recent years, with the advancement of clinical research, cervicogenic vertigo has begun to be used more as a disease name than a clinical manifestation of vertebral artery cervical spondylosis, although this name is not clear and has caused a lot of controversy. The name is not clear and has caused a lot of controversy. The vertebral artery starts from the subclavian artery, and before entering the transverse foramen of the cervical spine, the vertebral artery travels between the anterior oblique muscle and the long cervical muscle and then passes through the transverse foramen of the sixth to first cervical vertebrae and travels upward. From the atlantoaxial foramen, the posterior vertebral artery bypasses the lateral atlantoaxial mass, passes through the vertebral artery sulcus on the posterior atlantoaxial arch, arrives below the posterior atlantoaxial membrane forming a siphonlike bend similar to that of the internal carotid artery, and finally crosses the posterior atlanto-occipital membrane and dura mater to enter the skull through the foramen magnum of the occipital bone. Bilateral vertebral arteries converge below the cerebral bridge to form the basilar artery, which previously branches from the vertebral artery to form an anterior spinal artery that descends along the anterior median fissure of the spinal cord.Chen J and Lantz CA found that the vertebral artery adheres to the C1-2 joint capsule by a fascial wrapping that resists a 200 g tearing force. This fascia, in turn, forms a perivascular fibrous sheath (PFS) by binding to the fascia of the C2-6 ventral nerve root and the contact tissue between the C2-6 transverse foramen. Liu Qingyun believes that the anatomical division of the vertebral artery into four segments is of vital importance for diagnosis and differential diagnosis, and affirms that the second and third segments of the vertebral artery are the main sites of cervicogenic vertigo. 1.2 The vertebrobasilar system mainly supplies blood to the brainstem, cerebellum, inferior temporal lobe and medial occipital lobe lateral cortex. While the vestibular system located in the brainstem is very sensitive to ischemia, vertigo is often the first or even the only symptom when the vertebrobasilar artery supply is inadequate. faris believes that unilateral vertebral artery lesions do not necessarily cause symptoms. tool and Tucker, in a cadaveric study, constantly perfused the vertebral artery with water and fresh blood and found a 10% reduction in blood flow when the head was turned to the opposite side less than 45º, which they believe requires Michaeli A. concluded that rotation of the neck to at least 45º is necessary to interfere with carotid blood flow, and therefore rotation to 45º is necessary to check for vertebral artery involvement. Ou Shining et al. found that head tilting was most likely to cause decreased vertebral artery blood flow and clinical symptoms. There has been a difference of opinion in China as to whether obstruction or stenosis of the atlantoaxial segment of the vertebral artery tends to occur ipsilateral or contralateral to the direction of head rotation. In the biomechanical study of the cervical spine, K.R. Dai found that the axial rotation range between C1-C2 is 47º, and when the head is twisted, the contralateral atlanto-axial spine moves forward relative to the cardinal spine, which may lead to stretching and stenosis of the vertebral artery between them, and the contralateral vertebral artery is involved first at 30º of twisting, and the ipsilateral vertebral artery starts to twist at 45º. 1.3 Usually, cervical osteophytes (hyperplasia at the hook vertebral joint, superior articular eminence, transverse foramen, etc.), degenerative disc thinning leading to narrowing of the intervertebral space, vertebral body displacement, fracture or slippage, transverse synovial lesions (fracture or displacement under external force), and soft tissue lesions in the neck can compress and stimulate the vertebral artery and its surrounding nerve plexus, causing morbidity. Feng Shiqing believes that the causes of inadequate blood supply to the vertebral artery are: compression or stimulation of the hyperplastic bones of the hook vertebral joint; stimulation of the vertebral artery or its surrounding nerve plexus by cervical instability bony stenosis of the transverse foramen of the cervical vertebral artery or congenital developmental slenderness. The most common cause of compression of the vertebral artery below C2, as confirmed by Chen Zhongqiang through imaging, is the growth of bone spurs in the hook vertebral joint, mostly at the level of C4-5 and C 5-6. Ischemic vertigo of the vertebral basilar artery caused by cervical spine trauma has also been frequently reported in the literature. According to Martin I, the following factors should be considered: spasmodic contraction of the vertebral artery due to traumatic provocation of the cervical sympathetic nerve; hemodynamic changes; and distortion and displacement of the vertebral artery. 1.4 About the atlanto-occipital, atlanto-axial joint and posterior atlanto-axial bridge The occipital neck is a functional complex formed by the connection between the atlanto-occipital and atlanto-axial joints and the ligaments between them. It provides flexible motion, stability and protection. A variety of clinical diseases can lead to occipitocervical instability, which in turn causes cervical medullary compression and vertebral artery injury. 2, sympathetic nerve dysfunction As early as 1926 Barre and Lieon described a series of symptoms caused by stimulation of the cervical sympathetic nerve, such as vertigo, tinnitus, blurred vision, unsteady walking and abnormal sweating, namely Bar-Lew’s syndrome. marinne (1980) reported that electrical stimulation of the cervical sympathetic nerve in experimental animals could lead to vasospasm of the vertebrobasilar artery, internal carotid artery and internal auditory artery with The sympathetic nerve has been shown to reduce blood flow. Many clinical facts also prove that sympathetic nerve stimulation is one of the causes of vertebrobasilar artery ischemia. For example, stimulation of the patient’s stellate ganglion during surgery can cause transient vertigo and tinnitus, which is indirectly proved by the fact that re-stimulation after infiltration of the stellate ganglion with procaine does not cause episodes. Sun Jingyi used sympathetic nerve stripping around the vertebral artery to treat cervicogenic vertigo, and the excellent treatment rate was 95%. Zeng Bing et al. used the method of closing the cervical sympathetic ganglion to treat sympathetic cervical spondylosis and vertebral artery cervical spondylosis, and achieved an excellent rate of 61.9%. 3. Cervical proprioceptive disorders 3.1 The main proprioceptors are the musculocutaneous and Golgi tendon tissues, joint receptors, and vestibular organs. The maintenance of human posture is related to the following factors: vestibular organs; visual provision of the body in relation to the environment; and the cervical reflex. The lateral vestibular spinal cord bundle may have a facilitative effect on somatic movements, while the medial vestibular spinal cord bundle is associated only with the cervical and upper limb muscles, has an inhibitory effect, and influences alpha and gamma motor neurons through the interneurons, and is involved in the ataxic activity of the head and neck muscles to maintain head postural balance. Arbitrary random movements cannot be separated from the modulation of the sensory system, especially proprioception, inner ear vestibular balance sensation and vision. Therefore, the head is very important for the source of body posture, and the center coordinates the postural response of each muscle group through the integration of information. 3.2 Foreign scholars emphasize the role played by disturbance of proprioceptive afferents in the neck. The proprioceptive information in the neck plays an important role in the control of eye movements and body posture, and the disturbance in the neck causes the cervical proprioceptors to produce erroneous proprioceptive information, whose afferents cause errors in the central nervous analysis of vestibular and visual signals, and spatial orientation is affected, resulting in the sensation of dizziness or instability. The main difference between vertigo caused by this mechanism and vertigo caused by VBI is that it is not accompanied by cerebral ischemic symptoms.Karlberg M believed that postural tracings to evaluate human postural dynamics could be useful as a diagnostic tool for cervicogenic vertigo. He found that in normal subjects, cervical proprioceptors and visual and vestibular affect the subcortical nystagmus electrogram. When the neck is dysfunctional, the nystagmus electrogram is evoked and the malfunction of the cervical proprioceptors can cause vertigo. According to the research of Toruji Morizono, the afferent impulses in the proprioceptors, especially in the neck, are most closely related to balance. This is because the distribution density of the cervical proprioceptors, which are the sensory apparatus for deep perception, is higher than that of the other motor muscles. Physiologically, it is observed that the centripetal fibers of the spindle of the neck muscles are transmitting the information of position. If the muscle spindle of the posterior cervical muscle is stretched when stimulated, this misinformation is transmitted to the center, and together with the absence of changes in the semi-regular canal afferents, as a result, the center confirms that the body is tilted back, while there is no change in the aspect of the head, and to correct this posture, the center instructs the body to tilt forward. Therefore, the afferent impulses of cervical proprioceptors are of great relevance. Holtman-S study found that hypertonicity of deep neck muscles did not cause pathological cervical nystagmus, and cervical nystagmus is not a diagnostic criterion for cervical proprioceptive vertigo. Zhang Qinxiu suggested that cerebral ischemia can be manifested as abnormal horizontal optokinetic nystagmus, and nystagmus can be used as an adjunctive indicator of cerebral ischemic vertigo.Brand T. found that unilateral dorsal anesthesia of the superior cervical nerve root caused ataxia and nystagmus in animals, but only ataxia without nystagmus in humans.Janet L. found that vibration-induced changes in cervical proprioceptive input caused head position Janet L. found that vibration-induced changes in proprioceptive input to the neck caused perceptual changes in head position and the illusion of visual target displacement. Other factors Inflammatory diseases of the upper cervical spine, tumors, subclavian steal syndrome, and suprathoracic port syndrome can all cause cervicogenic vertigo. Second, auxiliary examination 1, Dai Liyan believes that power radiography can not only find the abnormal increase of relative displacement between vertebrae and abnormal mobility of spine, but also make quantitative assessment of the degree of spinal instability, so it is the main means and basis for diagnosing spinal instability. When the atlanto-dental spacing is greater than 3 mm in adults and 4 mm in children, it indicates forward subluxation or subluxation of the atlanto-axial vertebrae, and if it is greater than 5 mm, it can be diagnosed as a rupture of the transverse ligament, and when the sum of the two lateral blocks of the atlanto-axial vertebrae are displaced outward by a distance greater than 6.9 mm, it can also indicate a rupture of the transverse ligament. Zhang Zuolun believed that when the difference between the dentate and both sides of the block gap is greater than 3mm, it has clinical value in diagnosing atlantoaxial rotational subluxation and pointed out that the deviation of the dentate axis and the unequal gap between both sides of the dentate can only be used as a reference basis for diagnosis, while the misalignment of the atlantoaxial surface can be used as the main feature for diagnosis. After investigation, Ma Kui-yun believed that the normal group of dentition generally had no deviation or deviation below 0.49 mm; dentition deviation above 0.5 mm, especially above 1.0 mm should be considered as atlantoaxial subluxation. Fielding et al. pointed out that an anterior atlanto-axial gap >3 mm suggested transverse ligament injury. Han Min believes that CT imaging is more valuable in diagnosing atlanto-axial subluxation and atlanto-occipital dislocation. 2. ENG (nystagmography) examination reflects the functional status of the vestibular, cerebellar and other central systems. When one vertebral artery is blocked on one side and the other vertebral artery cannot compensate for it, there will be insufficient blood supply to the corresponding part and corresponding ENG changes, thus providing a basis for the diagnosis of vertigo. Gu Shenwei et al. concluded that brainstem auditory evoked potentials have important diagnostic value for the diagnosis of brainstem ischemia. Xu Jiangtao et al. analyzed the results of brainstem auditory evoked potential (BAEP) neck-turn test in patients with vertebrobasilar artery insufficiency (VBI) and concluded that the neck-turn test could improve the positive rate of BAEP for the diagnosis of VBI. Luo Yu compared four methods of examination for insufficient blood supply to the vertebrobasilar artery, including nystagmography, brainstem auditory evoked potential, transient reflex, and single photon emission computed tomography, and concluded that all four methods are ideal non-invasive examinations that reflect the pathophysiological basis of the disease from different anatomical pathways and play complementary roles. The value of transcranial Doppler ultrasonography (TCD) as a diagnostic method for transient ischemic vertigo of the vertebrobasilar artery has been appropriately evaluated and has been more widely used in clinical practice in recent years. By clinical testing of TCD-R, TCD-HV, and TCD-B, Li Ching-Tian and Zhong Nai-Chuan et al. concluded that TCD examination is useful for the differential diagnosis of vertigo due to ischemic cerebrovascular disease. Blood rheology examination has been used for cervicogenic vertigo for a short time, but some scholars have found a positive correlation between its index and vertigo symptoms and considered it as one of the main causes for the development of cervicogenic vertigo.