From the Guidelines
Cervical spondylosis can cause dizziness, vertigo, and tinnitus in some patients, particularly when degenerative changes in the cervical spine compress blood vessels or nerves that supply the brain and inner ear, as supported by the most recent study 1. The symptoms occur due to compression of the vertebral arteries, which run through the cervical vertebrae and supply blood to the brain stem and inner ear, reducing blood flow and causing vestibular symptoms. Additionally, irritation of the cervical sympathetic nerves can disrupt the autonomic nervous system's regulation of inner ear function. According to the study 1, various bedside tests have been developed and validated to assist in triaging patients to one of several defined “dizziness syndromes,” which helps in clinical decision making, including the need for subsequent imaging. Some of the key points to consider in the diagnosis and management of cervical spondylosis-related dizziness, vertigo, and tinnitus include:
- The clinical detection of associated neurologic symptoms is important in triaging these patients, as noted in the study 1.
- The positivity rate of head CT in the emergency department in all patients presenting with these complaints is very low, approximately 2%, with the most common positive findings including ischemic stroke, neoplasm, and hemorrhage 1.
- Treatment typically includes conservative approaches such as physical therapy focusing on gentle neck exercises, posture correction, and possibly anti-inflammatory medications like ibuprofen or naproxen for pain and inflammation.
- In more severe cases, muscle relaxants like cyclobenzaprine may help, and patients should avoid sudden neck movements and maintain proper ergonomics during daily activities.
- If symptoms persist or worsen, further evaluation with imaging studies like MRI may be necessary to rule out other causes and determine if more advanced interventions such as epidural injections or surgery might be beneficial, as suggested by the study 1.
From the Research
Cervical Spondylosis and Its Effects
- Cervical spondylosis can cause vertigo, as studies have shown that cervical spine spondylotic changes are known to induce vertigo 2.
- The mechanism by which cervical vertigo is induced is debatable, but it is believed that distortions in transmitting information to the brain due to spine damage can cause vertigo 3.
- Cervical spondylosis can also cause tinnitus, as changes in blood flow in the vertebral and basilar arteries can lead to hearing loss and tinnitus 3.
- Dizziness is also a common symptom associated with cervical spondylosis, with a 1-year relative risk of 1.20 compared to matched controls with lumbar spondylosis 4.
Diagnosis and Treatment
- Diagnosis of cervical vertigo depends mostly on patients' subjective feelings, lacking positive signs, specific laboratory examinations, and clinical trials 5.
- Treatment for cervical vertigo is challenging, but manual therapy is recommended for treatment of proprioceptive cervical vertigo 5.
- Anterior cervical surgery and percutaneous laser disc decompression are effective for cervical spondylosis patients accompanied with Barré-Liéou syndrome 5.
- A multidisciplinary approach is advocated for the management of cervical vertigo, including collaboration between balneologists and ENT specialists 3.
Pathogenesis
- The pathogenesis of cervical vertigo is believed to involve the stimulation of the dura mater and spinal cord, which can cause atypical symptoms such as vertigo, headache, and tinnitus 6.
- The stimulation of sympathetic nerves in the posterior longitudinal ligament is also believed to play a role in the pathogenesis of cervical vertigo 6.
- The exact mechanism of cervical vertigo is still not fully understood and requires further research 5, 2, 3, 4, 6.