Differential Diagnosis

The patient presents with bulging disc osteophytes at the C5-6 and C6-7 levels, mild congenitally narrowing osseous spinal canal accentuated and mild to moderate at the C6-7 level, and vertigo when looking to the left. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Cervicogenic vertigo: This condition is caused by cervical spine disorders, such as herniated discs or osteophytes, which can irritate or compress nerves and blood vessels, leading to vertigo. The patient's symptoms of vertigo when looking to the left and the presence of bulging disc osteophytes at the C5-6 and C6-7 levels support this diagnosis.

• Other Likely Diagnoses

  • Cervical spondylosis: This condition involves wear and tear on the discs and joints in the neck, which can lead to vertigo, especially when turning the head. The patient's age and the presence of osteophytes suggest cervical spondylosis as a possible diagnosis.
  • Herniated disc: A herniated disc at the C5-6 or C6-7 level could compress or irritate nearby nerves, leading to vertigo and other symptoms.
  • Spinal stenosis: The mild congenitally narrowing osseous spinal canal and accentuation at the C6-7 level could contribute to spinal stenosis, which may cause vertigo, especially when the patient looks to the left.

• Do Not Miss Diagnoses

  • Vertebral artery dissection: Although less likely, vertebral artery dissection is a potentially life-threatening condition that can cause vertigo. The patient's symptoms of vertigo when looking to the left could be related to a dissection, especially if there is a history of trauma or neck manipulation.
  • Multiple sclerosis: This condition can cause vertigo, among other symptoms, and should be considered in the differential diagnosis, especially if there are other neurological symptoms present.

• Rare Diagnoses

  • Chiari malformation: A rare condition where the cerebellum extends into the spinal canal, which can cause vertigo, especially when looking up or to the side.
  • Craniocervical junction anomalies: Abnormalities in the junction between the skull and cervical spine, such as atlantoaxial subluxation, can cause vertigo and other symptoms.
  • Cervical spine infection or tumor: Although rare, infections or tumors in the cervical spine can cause vertigo and other neurological symptoms, and should be considered in the differential diagnosis if other symptoms are present.