Vertigo in patients with cervical spine dysfunction

Abstract

IntroductionThe term "dysfunction" as used in manual medicine terminology is defined as a reversible, functional restriction of motion of an individual spinal segment or as a peripheral articular malfunction presenting with hypomobility. The appearance of dysfunctions of the upper cervical spine can be the cause of localised or pseudoradicular pain as well as the cause of vertigo and impaired hearing via disturbances of the proprioception from the neck. The significance of dysfunctions of the upper cervical spine as one cause of vertigo and impaired hearing has been commonly discussed in ENT and neurology literature [5, 9-14, 20, 22-26]. Commentators in the field of manual medicine limit the influence of dysfunctions of the cervical spine as a cause of vertigo to upper cervical spine segments [8,16,27,28]. Dysfunctions below the motion segAbstract To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff [4]. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population.

Reduction of Cervical Dystonia After an Extended Course of Chiropractic Manipulation: A Case Report

“…Some studies suggest that CMT can have a positive clinical effect in vestibular dysfunction. 32,33 While vestibular dysfunction has been reported in some patients with CD, this case had no objective testing prior to manipulative intervention. So, it is impossible to know if vestibular dysfunction and its modification through CMT played a role in the reduction of dystonia seen in this case.…”

Postural dynamics: Clinical and empirical implications

“…For example, the central nervous system is greatly influenced by somatosensory input, and consequently alteration of mechanoreceptive input caused by joint dysfunction has the potential to promote numerous symptoms (ie, vertigo, dizziness, imbalance, or ataxia) that could mimic lesions of the cerebellum, vestibular nuclei, cerebral cortex, and basal ganglia. [77][78][79][80][81] Likewise, the region of reversibility can be affected (restricted) by loss of action capabilities produced by the changes in the biomechanical properties of the person (eg, loss of strength or flexibility). 82 The person's skill level, that is, the ability to perform a particular behavior, may also influence this region, particularly when the task is novel or difficult (eg, the biomechanical and esthetic constraints placed on gymnasts are often very difficult to meet and tend to limit the number of viable behavioral strategies).…”

Vestibulospinale Reaktionen bei der zervikogenen Gleichgewichtsstörung

“…Für den manualtherapeutisch tätigen HNO-Arzt stellen nun die funktionellen Störungen der oberen Halswirbelsäule die häufigste Ursache solcher unklaren Schwindelbeschwerden dar. So geben Galm et al [8] bei "Schwindelpatienten", die zuvor beim HNO-Arzt und beim Neurologen waren, eine Störung der oberen Halswirbelsäu-le in 62% an. Demgegenüber wird von Hamann [9] die "Verursachung von Schwindelbeschwerden durch Erkrankungen der HWS" verneint.…”