Cervical Spine Issues in POTS Patients
There is no established percentage of POTS patients with underlying cervical spine pathology in the current medical literature, and cervical spine disorders are not recognized as a primary causative mechanism of POTS in clinical guidelines.
Current Understanding of POTS Pathophysiology
The established pathophysiologic mechanisms of POTS include 1, 2:
- Partial autonomic neuropathy (neuropathic POTS)
- Hypovolemia (hypovolemic POTS)
- Hyperadrenergic state (primary hyperadrenergic POTS)
- Possible autoimmune etiologies (emerging evidence) 1
Vascular laxity and peripheral neuropathy are theorized mechanisms in patients with hypermobile Ehlers-Danlos syndrome (hEDS) who develop POTS, but cervical spine pathology is not mentioned as a contributing factor 1.
Association Data Available
The only quantifiable association data relates to hEDS/hypermobility spectrum disorders (HSDs), not cervical spine issues specifically 1:
- In a survey of 616 hEDS/HSDs patients, 37.5% reported a diagnosis of POTS 1
- In a prospective study of 139 patients with mast cell activation syndrome (MCAS) and refractory GI symptoms, 25.2% had POTS 1
- Patients with hEDS/HSDs and concomitant POTS were more likely to have fibromyalgia, IBS, and dysmotility 1
Single Case Report Evidence
One case report from 2024 describes a 27-year-old woman with both cervicogenic dizziness from upper cervical instability (C1 lateral instability) AND POTS diagnosed via tilt table testing 3. This represents an isolated case of co-occurrence, not evidence of causation or prevalence.
Critical Clinical Distinction
Cervical spine pathology and POTS are distinct clinical entities that may occasionally co-exist but should not be conflated 3:
- Cervical spine disorders can cause cervicogenic dizziness through mechanical dysfunction 4, 3
- POTS causes orthostatic intolerance through autonomic dysfunction 1, 2
- Both can present with dizziness, but the mechanisms are fundamentally different
Diagnostic Pitfalls to Avoid
Do not attribute POTS symptoms to cervical spine pathology without proper autonomic testing 1:
- Abnormal cervical spine imaging findings are common in asymptomatic patients 4
- MRI has 90.6% sensitivity and 95.4% specificity for detecting cervical pathology, but this does not establish causation for POTS symptoms 4
- Tilt table testing remains the gold standard for POTS diagnosis 3, 5
Clinical Recommendation
Testing for cervical spine pathology should be targeted to patients presenting with specific cervical or radicular symptoms, not routinely performed in all POTS patients 1. The guideline explicitly states that universal testing for associated conditions in all patients with one diagnosis is not supported by current evidence 1.