Cervical Disc Issues Do Not Directly Cause Systemic Hypotension (Low Blood Pressure)
Cervical disc pathology does not cause systemic hypotension; however, cervical disc herniation can cause cerebrospinal fluid (CSF) leakage leading to intracranial hypotension, which is an entirely different condition referring to low CSF pressure, not low blood pressure.
Understanding the Distinction
The term "hypotension" in the context of cervical spine pathology refers to intracranial hypotension (low CSF pressure), not systemic arterial hypotension (low blood pressure). These are fundamentally different conditions:
Intracranial Hypotension from Cervical Disc Pathology
Cervical disc herniation can penetrate the dural sac, creating a CSF leak that results in spontaneous intracranial hypotension (SIH), characterized by orthostatic headaches that worsen when upright and improve when lying down 1, 2.
The mechanism involves direct dural breach from degenerative cervical spine pathology, particularly calcified disc protrusions and osteophytes that can penetrate the thecal sac 1.
Classic presentation includes orthostatic headaches accompanied by MRI findings of pachymeningeal enhancement, subdural collections, and anterior epidural CSF collections at the level of disc pathology 1, 2.
This condition can lead to serious complications including bilateral subdural hematomas and, in severe cases, obtundation from brain sagging 3, 2.
The Opposite Relationship: Hypertension and Cervical Spondylosis
Interestingly, the evidence suggests cervical spine pathology may be associated with elevated blood pressure, not low blood pressure:
Cervical spondylosis has been linked to hypertension through stimulation of sympathetic nerve fibers in pathologically degenerative discs, producing sympathetic excitation and potentially causing secondary hypertension 4.
Two case reports demonstrated resolution of hypertension following anterior cervical discectomy and fusion for cervical spondylosis, suggesting cervical pathology may contribute to elevated blood pressure through sympathetic arousal 4.
Clinical Implications for Blood Pressure Management
During Cervical Spine Surgery
Hypotension during cervical spine surgery is dangerous and can cause anterior cord syndrome through hypoperfusion of the anterior spinal artery 5.
Maintain systolic blood pressure >110 mmHg during and after cervical spine procedures to prevent secondary spinal cord injury 6.
Patients with pre-existing hypertension may require higher MAP to maintain adequate spinal cord perfusion, with evidence showing better neurological recovery in patients with higher preoperative mean arterial pressure 7.
Important Caveats
Do not confuse intracranial hypotension with systemic hypotension when evaluating patients with cervical disc disease and headaches 3.
Look for orthostatic headache patterns (worse upright, better lying down) as the key distinguishing feature of CSF leak-related intracranial hypotension 3, 1.
MRI of the cervical spine may show epidural fluid collections at the level of disc pathology, indicating CSF leak rather than systemic blood pressure issues 1, 2.
Treatment for CSF leak-related intracranial hypotension involves epidural blood patch or surgical repair of the dural defect, not blood pressure management 1, 3.