International Journal of Orthopaedic Surgery

REVIEW ARTICLE
Year
: 2021  |  Volume : 29  |  Issue : 1  |  Page : 16--17

Cervical vertigo: A brief review


Kiran Kumar Mukhopadyay1, Rajeev Raman2,  
1 Department of Orthopaedics, NRS Medical College, Kolkata, West Bengal, India
2 Department of Orthopaedics, Joint and Bone Care Hospital, Kolkata, West Bengal, India

Correspondence Address:
Kiran Kumar Mukhopadyay
Department of Orthopaedics, NRS Medical College, 138, Acharya Jagadish Chandra Bose Rd, Sealdah, Raja Bazar, Kolkata 700014, West Bengal.
India

Abstract

Vertigo is a perception of movement either of the environment or of one’s own body, which may be of rotation or swaying. Vertigo or nonvestibular dizziness is one of the most common complaints of the patients, but there are a number of causes for that. Very few literatures are available on vertigo. The purpose of this article was to provide an overview and literature review.



How to cite this article:
Mukhopadyay KK, Raman R. Cervical vertigo: A brief review.Int J Orthop Surg 2021;29:16-17


How to cite this URL:
Mukhopadyay KK, Raman R. Cervical vertigo: A brief review. Int J Orthop Surg [serial online] 2021 [cited 2022 Jan 26 ];29:16-17
Available from: https://www.ijos.in/text.asp?2021/29/1/16/324275


Full Text



 Introduction



Vertigo is a perception of movement either of the environment or of one’s own body, which may be of rotation or swaying. Vertigo or nonvestibular dizziness is one of the most common complaints of the patients, but there are a number of causes for that, for example, otolaryngyeal disturbances, cardiovascular system disorders, benign and positional paroxysmal vertigo (BPPV), of which BPPV is the most common cause.[1]

It is not clear from studies that whether the cervical vertigo is a separate entity or not. It has been seen experimentally that neck afferent assists the coordination of eye, head, and body. It also affects spatial orientation and control of posture. Further, it has been shown that unilateral block of upper dorsal cervical roots causes ataxia but not a linear or rotational vertigo.[2] On the basis of these studies, a certain hypothesis has been postulated for cervical vertigo, which needs to be discussed.

 Hypothesis for Cervical Vertigo



Ryan and Cope[3] first introduced the term “cervical vertigo” in 1955 and accordingly, cervical vertigo was thought to be due to abnormal afferent input from damaged joint receptors in the upper cervical region to the vestibular nucleus. Later on, the said thought was supported by some researchers based on the fact that the upper cervical zygapophyseal joints are densely innervated and the joint capsules of C1 to C3 contain 50% of all cervical proprioceptors.[4],[5] and also there is an abundance of mechanoreceptors in the γ-muscle spindles of the upper cervical muscles.[6]

Ultimately, four different hypotheses explaining the cervical vertigo have been postulated.[7],[8]

Proprioceptive cervical vertigo

Migraine-associated cervical vertigo

Barre–Lieou syndrome

Rotational vertebral artery vertigo

Proprioceptive cervical vertigo

The mechanoreceptor are a critical component of the proprioceptive system. The network of mechanoreceptors in the neck region controls multiple degrees of freedom of movements of joints and via direct neurophysiological connections it gives the central nervous system information about the orientation of the head.[9],[10] Neck mechanoreceptors control the afferent cervical activity in the upper cervical spine, which can be altered by muscular fatigue, degenerative changes, direct trauma, or direct effect of pain. These are the anatomical bases that may explain how cervical vertigo can be caused by upper cervical dysfunction.[11]

Migraine-associated cervicogenic vertigo

In 2013, Yacovino and Hain[4] postulated that migraine could be a link between cervical pain and cervicogenic vertigo. Selby and Lance[12] found one-third of people with migraine experience vertigo.

Barré–Liéou syndrome

1926, Barré[13] noted that sympathetic nerve fibers are stimulated by pathological changes in cervical spine, which play a role in modifying the blood flow of the vertebral artery. He, later along with Liéou, defined the Barré–Liéou syndrome, including vertigo, tinnitus, headache, blurred vision, dilated pupils, nausea, vomiting, and so on. They postulated that the sympathetic plexus surrounding the vertebral arteries could be stimulated by cervical degenerative disease and this stimulation could contribute to reflexive vasoconstriction of vertebrobasilar system, thus accounting for the aforementioned symptoms.[14]

Rotational vertebral artery vertigo (Bowhunter’s syndrome)

If there is sufficient collateral circulation, there would not be any symptoms, but symptoms may occur if there is an insufficient terminal vessel. The vascular supply to the vestibulocochlear organ is by the end artery, which makes this organ more susceptible to vertebrobasilar insufficiency (VBI).[15]

 Diagnosis



It is difficult to diagnose cervical vertigo, and it can be made only after ruling out other potential causes for vertigo.[7],[16] For diagnosing cervical vertigo neck pain, pain must be there and its absence rules out cervical vertigo. Benign paroxysmal positional vertigo (BPPV) is often misdiagnosed as cervical vertigo, a Dix-Hallpike test for the patients with vertigo is necessary to confirm it.[17]

 Conclusion



It is still a matter of debate whether cervical vertigo is a myth or reality. The four different hypotheses have been postulated to explain cervical vertigo viz. proprioceptive cervical vertigo, Barré–Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. Management is also challenging for cervical vertigo. For proprioceptive cervical vertigo, manual therapy is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors’ contribution

KKM was involved in study design, analysis of data, review, and final preparation of the manuscript. RR helped in study design and preparation of manuscript.

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