Cervical instability can cause vertigo, which is also clinically referred to as sympathetic cervical spondylosis, vertebral artery cervical spondylosis or cervical vertigo.
Since vertigo can be caused by various pathological factors such as vestibular, visual, cardiovascular and cervical spine, the clinical determination of the relationship between cervical instability and vertigo should be based on the correlation between vertigo and cervical spine lesions by first excluding related departments such as otolaryngology, ophthalmology and neurology. Some scholars believe that the stimulation of sympathetic nerve by the unstable displaced segment and the stimulation or compression of vertebral artery are the main causes of vertigo. And the role of cervical proprioceptive dysfunction in the development of cervical vertigo has also received attention.
There are many clinical symptoms of sympathetic cervical spondylosis, which are mainly manifested in the following aspects.
1. Head symptoms: such as dizziness or vertigo, headache or migraine, head sinking, occipital pain, poor sleep, memory loss, difficulty in concentration, etc. Occasionally, people may fall down due to dizziness.
2. Eye, ear, nose and throat symptoms: eye swelling, dryness or tearfulness, vision changes, blurred vision, tinnitus, ear blockage, hearing loss, foreign body sensation in the throat, dry mouth, vocal cord fatigue, etc.
3. Intestinal symptoms: nausea or even vomiting, bloating, diarrhea, indigestion, belching, and foreign body sensation in the throat, etc.
4.Cardiovascular symptoms: palpitations, chest tightness, heart rate changes, arrhythmia, blood pressure changes, etc. The face or a certain limb is sweaty, sweatless, chilly or feverish, sometimes feeling pain, numbness but not according to the distribution of nerve segments or travel.
The most common clinical features of vertebral artery cervical spondylosis are headache, vertigo and visual disturbance.
Vertigo is the most common, and almost every patient has vertigo of varying severity, accompanied by diplopia, nystagmus, tinnitus, deafness, nausea and vomiting. During the attack, patients feel light-headed and unstable, as if they and the surrounding scenery are rotating in a certain direction; some patients also 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 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.
3.Headache It is a kind of vascular headache caused by vasodilatation of the collateral circulation due to insufficient blood supply of the solid vertebral basilar artery, which occurs in episodes and lasts for several minutes or hours, or even days. The pain is persistent and often appears or worsens in the morning, when the head is moving, or when the car is bumpy. The headache is mostly located in the occipital region, top of the occipital region or temporal region, with throbbing pain (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 nausea, vomiting, sweating, salivation, panic, breath-holding, and blood pressure changes and other symptoms of autonomic dysfunction. 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 performance 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 loss, 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. Ischemia of the 3rd, 4th and 6th cerebral nuclei and medial longitudinal capsule can cause diplopia.
4, medullary palsy and other neurological symptoms: such as slurred speech, swallowing disorder, loss of gag reflex, choking, soft palate palsy, hoarseness, tongue extension disorder, oculofacial muscle twitching and facial nerve palsy, etc.
5, sensory disorders There may be facial, perioral, tongue, limbs or hemiplegia numbness, some with pins and needles sensation, ankylosis, and some may have deep sensory disorders.
Cervical instability is mainly caused by the relaxation of local soft tissue ligaments in the cervical spine, and most often by the dysfunction of small vertebral joints and vertebral body misalignment. The criteria for determining cervical instability are: the sum of anterior-posterior displacement of adjacent segments ≥ 3 mm, and/or the sum of angular displacement ≥ 11° on cervical hyperflexion and hyperextension radiographs. The effectiveness of cervical brace braking is an important basis for establishing the diagnosis.
Such patients present with corresponding clinical symptoms or worsening of symptoms when their cervical spine position changes. When the unstable vertebral segment is displaced secondary to spinal stenosis, the nerve roots, spinal cord or anterior central spinal artery may be irritated or compressed, resulting in symptoms of nerve or spinal cord damage; when the vertebral artery or sympathetic nerve is irritated by the displaced vertebral segment, symptoms such as dizziness may occur.
Conservative treatment methods such as cervical braking can usually achieve more satisfactory clinical results; for some patients with recurrent attacks or severe symptoms and poor conservative treatment, surgical treatment can be chosen.
Patients with recurrent symptoms or (and) spinal cord injury are treated surgically if conservative treatment is effective. The surgical procedure is a conventional anterior cervical surgery, with removal of the intervertebral disc and the posterior border of the vertebral body, and either an intervertebral fusion device for fixed fusion or an autologous iliac bone block for intervertebral bone grafting and anterior plate internal fixation. A neck brace is worn for 3 months after surgery or until follow-up radiographs show fusion of the implant.
Conservative treatment should be preferred for patients with milder symptoms or younger age, and the following points need to be noted.
1, develop the habit of daily exercise, swimming, running, climbing, playing badminton, etc. can make the cervical and back muscles get a better exercise, enhance muscle strength and improve the stability of the cervical spine, and relieve the symptoms of cervical instability. If you are too busy to find the time, you can also exercise on your own every day: 20 times each of neck forward flexion, back extension, right and left side, left rotation and right rotation movements. Strength from light to heavy.
2, if you need to work and study in front of the computer for a long time, I suggest you buy a cervical brace for a long time cervical light traction, which has a significant preventive effect on small joint disorders caused by dislocation. However, this should only be used when the symptoms are more obvious when physical exercise is not possible, to relieve the symptoms. Once the symptoms are relieved the first one should be performed.
3, early use of blood relaxation drugs for improving the blood supply to the neck muscles and soft tissues, strengthen the neck muscle ligament function recovery has a very good effect, you can use the traditional black plaster paste, the usual hot compress also has a significant effect, mainly to protect the neck muscles and soft tissues, to avoid strain caused by fatigue and other factors, if you can scraping, physiotherapy, hot compress, cupping and other therapies, the effect will be more obvious.