Cervicogenic vertigo is also called cervical vertigo, as the name suggests, the vertigo is related to the neck, and usually occurs when the neck is moving, especially when the neck is twisted or flexed excessively, and sometimes it can also occur with slight activities, such as when lying in bed or getting up, or even when turning over at night. At that time, the patient will suddenly feel dizzy, or even feel “heart flip”, vomit or even sweat profusely, and dare not move with eyes closed. In mild cases, it will heal in seconds, but in severe cases, it can last for several days or longer.
The majority of patients are middle-aged and elderly, while adolescents are rare, and there is no significant relationship between the sexes. The disease can affect people in any occupation, but it is more common in occupations where the neck is often fixed in one position, such as accountants, sewers, car drivers, or workers who have to look at computer screens frequently.
The onset, development and aggravation of most vertigo are directly related to the change of neck activity, especially when the head is suddenly turned or the neck is rotated, and turning to one side can easily cause the attack, while turning to the opposite side can relieve the symptoms. In severe cases, it can even produce sudden collapse. The patient is often in a certain position, and when the head and neck are turned, he suddenly feels dizzy and headache, and then both lower limbs become weak and fall to the ground. During the attack, there is no impairment of consciousness and the patient can get up by himself after falling.
Mechanism of vertigo caused by cervical spondylosis
Recent research findings suggest that the mechanism of vertigo caused by cervical spondylosis is due to the narrowing of the vertebral artery, which supplies blood flow to the brain, due to compression of the vertebral artery by cervical spine osteophytes, and/or abnormal constriction of the vertebral artery due to stimulation of the vertebral artery by abnormal movement of the cervical space (cervical segmental instability). Both causes can cause ischemia in the brain, which can lead to episodes of vertigo. It is now believed that cervical segmental instability plays a major role in the development of cervical vertigo.
Cervical segmental instability is when abnormal activity occurs between two adjacent vertebrae. Normal vertebrae are connected by intervertebral discs, which are equivalent to a joint and allow the vertebrae to move within normal limits, so people can turn their heads, lower their heads and tilt their heads, but they are not allowed to move abnormally between the vertebrae.
Like a bearing, it can rotate, but it cannot bounce up and down. When a disc degenerates or a disc prolapses, the movement between the vertebrae is out of the normal range, just as when a bearing component wears out and the bearing not only rotates but also oscillates. The abnormal activity may then stimulate the sympathetic nerves on the vertebral arteries that travel on both sides of the vertebral body, and the excitation of the nerves causes extensive spasms in the vertebral arteries and even the arteries in the brain, as well as the arteries responsible for balancing the sensory organs, resulting in cerebral ischemia and a series of symptoms such as transient dizziness, malignancy, panic, and chest tightness.
How to diagnose cervicogenic vertigo?
The question about the diagnosis of cervical vertigo of cervical origin is a matter to be studied. Sometimes the diagnosis is quite difficult. We know that although most vertigo is caused by cervical spondylosis, vertigo symptoms are not unique to vertebral artery type cervical spondylosis, but many diseases such as otolaryngology, neurology and ophthalmology can also present vertigo symptoms, such as otogenic vertigo, cerebral vertigo, ophthalmogenic vertigo, traumatic vertigo, vertigo caused by somatic diseases and neurological disorders.
In addition, ischemia in any other segment of the vertebral artery can also cause these symptoms, and many symptoms can be easily confused with other diseases, so it is difficult to diagnose vertebral artery cervical spondylosis.
To confirm the diagnosis clinically, we should pay attention to whether the patient is accompanied by common general symptoms of cervical spondylosis such as neck pain and limitation of neck movement, whether there is intervertebral segmental instability, vertebral osteophytes, deformation of intervertebral foramina, small deformation of vertebral joints and other changes or whether there is cervical deformity on X-ray; secondly, we should pay attention to differential diagnosis. Because of the similarity between this type of cervical spondylosis and other vertigo diseases such as Meniere’s disease, it is sometimes necessary to conduct specialized examinations such as ear vestibular function tests and hearing tests in order to differentiate the diagnosis. When diagnosing this type of cervical spondylosis in the elderly, factors such as vascular elasticity and vascular sclerosis should also be considered.
If necessary, vertebral arteriography is required. The main signs of vertebral arteriography are vertebral artery stenosis, where the vertebral artery loses its original form in the diseased segment, is thinner than the adjacent segment, and may be displaced; or the site of compression is bent, tortuous, or obstructed. Vertebral artery angiography is useful for surgical localization and surgical approach selection. In addition, more satisfactory images of the vertebral artery can be obtained with digital subtraction angiography.
Treatment of cervicogenic vertigo
Conservative treatment: take medication to improve the blood supply to the brain, such as 1 tablet of Cipro every night. Braking the neck and wearing a neck brace to reduce abnormal intervertebral movement. With systematic treatment part of it can be relieved or not attacked.
Surgery: Although most vertebral artery cervical spondylosis can be relieved or cured with systematic conservative treatment, surgery is considered for those with the following conditions.
1.Cervical vertigo or sudden collapse symptoms that have not been treated by non-surgical treatment;
2.The site, degree and extent of vertebral artery compression have been clearly identified by selective vertebral arteriography;
3, the symptoms are mainly caused by the displacement of the affected vertebral artery, although conservative treatment to alleviate, but the disease recurrence, the affected vertebrae long-term instability, seriously affect normal life and workers;
4.Vertebral artery angiography, CT or MRI examination found that the vertebral artery in the transverse foramen is significantly impaired due to compression by factors such as bone redundancy and serious symptoms;
5.Vertebral arteriogram examination found that the proximal part of the vertebral artery due to anatomical abnormalities leading to obvious curvature of the vertebral artery, blood flow obstruction and serious symptoms.
The mechanism of surgical treatment is to release the pressure-causing factors of the cervical medulla, restore the tension of the ligaments around the cervical spine, stabilize the affected vertebrae, avoid stimulation and compression of the vertebral artery, and improve the blood supply to the brain.
In conclusion, although the mechanism of cervical vertigo and the mechanism of surgical treatment are not clear yet, according to the observation of the effect of surgical treatment in a large number of patients with vertigo cervical spondylosis, it is believed that most of the symptoms of cervical vertigo are not caused by the compression of a single vertebral artery, and it is a good idea to release the compressive factors of the cervical medulla, restore the tension of the ligaments around the cervical spine, stabilize the affected vertebrae, and perform anterior decompression, disc removal and bone graft fusion for this type of cervical spondylosis. Anterior decompression, disc removal and bone graft fusion are effective methods for this type of cervical spondylosis.