I. Overview The cervical spine is the most active spinal segment in the human body, which is prone to strain, and degenerative changes in the cervical spine occur with age and accumulation of injuries, especially in the C4-5 and C5-6 vertebral segments, which are a frequent vertebral segment. Because cervical degeneration includes posteriorly protruding discs, hooked vertebral joints or vertebral spurs, and vertebral subluxations, they can compress the vertebral artery or stimulate the sympathetic plexus around the vertebral artery, causing spasm of the vertebral artery and narrowing of the lumen, resulting in insufficient blood supply to the vertebrobasilar artery and causing a series of clinical symptoms. Under normal conditions, the left and right vertebral arteries of the basilar artery can regulate each other’s blood flow to cope with the compression caused by cervical spine activities, so that blood flow can be supplied to brain tissue normally. For example, when the head is turned to the left, the left vertebral artery becomes twisted or twisted to make the lumen narrower and the blood flow decreases, then the right vertebral artery automatically adjusts to compensate for this with a compensatory increase in blood flow, which does not cause ischemia in the brain tissue. If the right vertebral artery is narrowed due to stiffness or compression and stimulation by bone spurs, it will lead to a series of manifestations of basilar artery ischemia, resulting in vertebral artery cervical spondylosis. Vertebral artery cervical spondylosis is a syndrome in which the vertebral artery is stimulated or compressed by various mechanical and dynamic factors, resulting in narrowing and folding of the vessel and causing inadequate blood supply to the vertebrobasilar artery as the main symptom. Vertebral artery cervical spondylosis is a common disease among middle-aged and elderly people. About 70% of patients with cervical spondylosis have vertebral artery involvement, and more than 50% of people over the age of 50 with dizziness and headaches are related to vertebrobasilar artery involvement caused by cervical spondylosis. In clinical practice, there are also diagnoses such as “cervical vertigo” and “vertebral artery compression syndrome”, also known as “cervical migraine”. The most common clinical features of vertebral artery cervical spondylosis are headache, vertigo and visual disturbance. With the change of modern lifestyle, long-term ambulatory workers, those who work and play games in front of a sedentary computer, and those who sleep, read and write with incorrect posture can cause strain on the muscles of the neck, resulting in muscle ligament spasm over time, traction on the cervical spine deformation, affecting blood vessels and nerves and various manifestations of cervical spondylosis. Patients with cervical spondylosis can be seen in all age groups clinically, and the youngest I have seen is only 8 years old. More than half of the young patients with headache and dizziness have no abnormalities on cranial CT, and the cervical spine film suggests cervical spondylosis manifestations such as straightening of the cervical curve or even retroflexion, osteophytes and ligament calcification. In cervical spondylosis, head and facial symptoms are more common, and migraine is the most common, with one side of migraine accounting for about 70% and both sides of pain accounting for 10%, indicating that both sides of the vertebral artery have lesions. Secondly, ear symptoms, such as tinnitus, hearing loss and ear vertigo, also account for about 70% of the cases. Once again, visual impairment accounts for about 40%. Those affecting pronunciation account for about 20%. Clinical manifestations 1, vertigo is the most common, almost every patient has vertigo of varying severity, accompanied by diplopia, nystagmus, tinnitus, deafness, nausea, vomiting and other symptoms. During the attack, patients feel light-headed and unstable, as if they and the surrounding scenery are rotating in a certain direction; some patients feel that they and the ground are moving, tilting and swaying. Vertigo or dizziness often occurs when the head is moved, such as when the head is tilted upward, when the head is suddenly turned or when the head is repeatedly turned from side to side, and in serious cases, fainting or coma may occur. Some patients can only turn their heads to one side, and turning their heads to the opposite side can easily lead to an attack, and turning to the opposite side again can reduce the symptoms; some patients also complain of an attack when they look at the blackboard while taking notes with their heads down. In short, the activity of the head and neck and the change of posture induce or aggravate the vertigo is an important feature of this disease. 2. Sudden collapse is a symptom unique to this type. Some of them occur when the vertigo is intense or when the neck is active. Patients may suddenly feel numbness and weakness of limbs and fall down, but they are clear-minded and can get up by themselves. This symptom is associated with sudden head movement or posture change. Some people think it is due to ischemia of the medulla oblongata, and some people think it is due to sudden ischemia at the intersection of vertebral bodies. 3.Headache It is a kind of vascular headache caused by the dilatation of blood vessels in the collateral circulation due to insufficient blood supply to the vertebrobasilar artery, which occurs in episodes and lasts for several minutes or hours, or even days. The pain is persistent and tends to appear or worsen in the morning, during head movement, or during bumpy rides. The headache is usually located in the occipital region, top of the occipital region or temporal region, and is throbbing (pulsating pain), burning pain or swelling pain, which may radiate to the back of the ear, face, teeth, top of the occipital region, and even to the orbital region and the root of the nose. During the attack, there may be symptoms of autonomic dysfunction such as nausea, vomiting, sweating, salivation, panic, breath-holding, and changes in blood pressure. In individual cases, there is pain, numbness, tingling or foreign body sensation in the face, hard palate, tongue and pharynx during the attack. Therefore, it is similar to the manifestation of migraine, and some people call it cervical migraine. 4. Ocular symptoms such as visual fog, flash in front of the eyes, dark spots, transient dark haze, temporary visual field defects, vision loss, diplopia, hallucinations and blindness, etc. These ocular symptoms are mainly caused by ischemia of the posterior cerebral artery. Visual impairment is mainly caused by ischemia in the visual center of the occipital lobe of the brain, so it can be called cortical visual impairment. Ischemia of the 3rd, 4th, and 6th cerebral nuclei and medial longitudinal capsule can cause diplopia. In addition, because the vertebral artery is connected to the internal carotid artery system by the posterior communicating artery, it can reflexively cause retinal artery spasm and result in ocular pain and changes in the vascular tone of the fundus. Dilatation of the fundus venosus and thinning of the arteries are common during episodes, especially during neck hyperextension. Individual patients may develop vasospastic retinitis. Signs and symptoms such as blepharospasm, conjunctival congestion, corneal hypersensitivity leading to ulceration, lacrimal gland secretion disorder, retrobulbar optic neuritis, proptosis, glaucoma, and Horner’s sign have also been reported in some patients. 5, medullary paralysis and other cerebral neurological symptoms such as slurred speech, swallowing disorder, loss of gag reflex, choking, soft palate paralysis, hoarseness, tongue extension disorder, oculofacial muscle twitching and facial nerve paralysis, etc. 6, sensory disorders There may be facial, perioral, tongue, limbs or hemiplegia numbness, some with pins and needles, anthrax sensation, some may have deep sensory disorders. From the above manifestations, it can be seen that the symptoms of this disease are many and mixed, but the diagnosis can still be made based on physical examination, x-ray and cerebral hemogram. Since vertigo is serious during the attack and falls are easy to occur, it is appropriate to rest on the back during the attack, and the pillow should be lowered to reduce the movement of the cervical spine. In addition, it is especially important to prevent new injuries caused by sudden falls.