From the Guidelines
There is no established percentage of people with Postural Orthostatic Tachycardia Syndrome (POTS) who have underlying cervical spine issues, and a standard MRI scan can detect cervical spine misalignment, but it may not capture dynamic issues that occur when upright or moving. While some case reports suggest a potential connection between cervical spine abnormalities and POTS symptoms in certain individuals, this is not considered a primary cause for most POTS patients 1. A study published in Anaesthesia in 2004 found that MRI may reveal unsuspected soft tissue injury in approximately 25% of cases, and it is recommended that any patient with a neurological deficit referable to the cervical spine should undergo plain film skeletal survey and MRI 1. However, another study published in Intensive Care Medicine in 2012 recommends MRI if there is a positive neurological examination referable to the spinal cord (myelopathy) 1.
Key Points to Consider
- A standard MRI of the cervical spine can detect significant structural abnormalities, including misalignments, herniated discs, stenosis, or compression of neural structures 1.
- However, an MRI is performed with the patient lying down, so it may not capture dynamic issues that occur when upright or moving.
- If a cervical issue is suspected despite a normal MRI, consulting with a specialist who focuses on the relationship between cervical spine and autonomic dysfunction may be recommended 1.
- Additional tests like upright or flexion-extension MRIs, or manual examination of cervical stability may be considered.
- Most POTS treatment focuses on increasing blood volume, exercise reconditioning, compression garments, and medications that help regulate heart rate and blood pressure rather than cervical interventions.
Recommendations for Practice
- A standard MRI scan should be considered to detect cervical spine misalignment, but it should be interpreted by a senior radiologist who is skilled in musculoskeletal/neuro-radiology 1.
- Patients with POTS should be evaluated for underlying cervical spine issues, but this should not be considered a primary cause for most POTS patients.
- Treatment for POTS should focus on increasing blood volume, exercise reconditioning, compression garments, and medications that help regulate heart rate and blood pressure, rather than cervical interventions.
From the Research
Prevalence of Cervical Spine Issues in POTS Patients
- There is limited research directly addressing the percentage of individuals with Postural Orthostatic Tachycardia Syndrome (POTS) who have underlying cervical spine issues 2, 3.
- However, a study published in 2022 found that spinal misalignment, including cervical kyphosis and thoracic scoliosis, may contribute to the development of POTS symptoms 4.
Detection of Cervical Spine Misalignment using MRI
- Magnetic Resonance Imaging (MRI) can be used to detect cervical spine misalignment and other structural abnormalities in the cervical spine 5.
- A study published in 2022 found that MRI scans can identify Modic changes and endplate abnormalities in the cervical spine, which may be associated with POTS symptoms 5.
- Another study published in 2022 reported a case of a patient with POTS who underwent chiropractic rehabilitation, including cervical and thoracic spinal manipulation, and showed improvement in cervical alignment and resolution of POTS symptoms 4.
Association between Cervical Spine Issues and POTS Symptoms
- Research suggests that cervical spine issues, such as spinal misalignment and structural abnormalities, may contribute to the development of POTS symptoms 6, 4.
- A study published in 2022 found that patients with POTS who received chiropractic rehabilitation, including cervical and thoracic spinal manipulation, reported improvement in symptoms, including neck pain, dizziness, and POTS 4.