Background: Cervical vertigo commonly concurs in patients with neck pain, but the concurrent
mechanism of these 2 symptoms still remains unclear. We previously reported a bidirectional
segmental nerve fiber connection between cervical spinal and sympathetic ganglia, which
provided a hypothesis that this connection between the 2 ganglia may be the anatomic basis for
the concurrence of neck pain and cervical vertigo. However, this concurrent mechanism needs
biochemical and functional evidence.
Objectives: This study aimed to investigate a possible noradrenergic pathway between cervical
spinal and sympathetic ganglia.
Study Design: We performed both clinical and laboratory research. Clinical observation was a
prospective case–control study.
Setting: Clinical study took place in our hospital; laboratory study was in an orthopedic laboratory.
Methods: Cervical lamina block therapy used in patients with cervical vertigo was clinically
evaluated; norepinephrine (NE) expressions in cervical sympathetic ganglia were analyzed using
immunohistochemical staining after electrical stimulation to the cervical spinal ganglia; the
influence of phentolamine local injection to the vertebrobasilar artery flow was experimentally
measured.
Results: Cervical lamina block therapy could significantly shorten the clinical hospital stays
of patients with cervical vertigo (P = 0.000) and improve vertebral artery flow (P < 0.05). NE
expressions in superior cervical sympathetic ganglia (SCG) or inferior cervical sympathetic ganglia
(ICG) increased significantly when ipsilateral C2 to C3 or C6 to C8 spinal ganglia were electrically
stimulated, respectively. Adrenergic receptor block with phentolamine significantly inhibited the
decrease of basilar artery (BA) flow induced by electrical stimulation of the cervical spinal ganglia.
The change range of BA flow caused by stimulations of C2 to C3 and C6 to C8 spinal ganglia was
more than that of C4 and C5.
Limitations: The inpatients observed in this clinical study might be influenced by some factors
including emotion, diet, sleep, and others. The limitations of the laboratory study included animal
species and small sample size.
Conclusions: Adrenergic system could play a part in cervical spinal ganglia altering the
vertebrobasilar artery system. It could provide a neurochemical foundation between neck pain and
vertigo, and that segmental functional connections exist between cervical spinal and sympathetic
ganglia.
The purpose of the present study is to investigate the pathological mechanism of cervical vertigo by studying the nervous connections between cervical spinal ganglia and cervical sympathetic ganglia. Seventy New Zealand rabbits were randomly divided into a superior cervical spine group (C2 and C3), an inferior cervical spine group (C4 through C6), and corresponding control groups. The cervical ganglia of the rabbits in the experimental groups were injected with 4% fluorogold solution, whereas those in the control groups were injected with physiological saline. The rabbits were killed after four days. The sympathetic ganglia were cut, preserved via cryosection, and observed under a microscope. Fluorescence was observed in the ipsilateral superior cervical sympathetic ganglia of the specimens in C2 and C3 into which dye was injected, but not in the inferior cervical ganglia or contralateral superior ganglia. Fluorescence was also observed in the ipsilateral inferior cervical sympathetic ganglia in the C5 and C6 groups, but not in the contralateral inferior cervical sympathetic ganglia or superior ganglia of either side. Injection of fluorogold at C4 produced ipsilateral fluorescence in both the superior and inferior cervical sympathetic ganglia. Nerve fiber connections are present between the cervical spinal ganglia and cervical sympathetic ganglia. These connections are arranged in a segmental distribution.
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