CSM and Dizziness
Dizziness and Cervical Spine Degeneration
Dr Tim Lavin
Dizziness is a common symptom experienced by lots of patients. Vertigo is a particular form of dizziness, where people experience a feeling that the world is moving, though they are still. Vertigo is triggered by a disturbance in the balance centres of the brain or the inner ear.
Some doctors believe this is coincidence, whereas others consider the cervical spine disease to be the cause.
This latter group have coined the term “cervicogenic vertigo”; cervico (Cervical Spine) genic (Generated) vertigo (dizziness).
Vertigo and dizziness have many different causes, but they are often experienced by patients with problems in their cervical spine. Whether or not this is the direct cause of their dizziness symptoms is controversial.
How might cervical spine degeneration cause dizziness?
We know the balance centres of the brain rely on information from the nerves in your neck. It is thought that if this information is disrupted by joint disease, nerve irritation (cervical root C1 and C2) or muscle injury, then dizziness can occur, but this hard to prove definitively.
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The concept of vertebrobasilar insufficiency has been disputed in recent times, for if a significant reduction in blood flow occurs (e.g. sudden artery occlusion in conditions such as vertebral dissection), it would not just cause vertigo but other problems such as difficulty walking and double vision. Therefore, if vertigo occurs in isolation then reduced blood flow from the cervical spine is unlikely to be the cause.
So, does Cervicogenic Vertigo really exist?
Chronic pain and dizziness are commonly experienced by patients with cervical spine disease. This can be distressing. Some patients have noted that their dizzy symptoms can be improved by cervical physiotherapy, effective pain control and psychological intervention.
Not infrequently, patients with cervical spine disease will have a different, coexisting condition causing their vertigo and dizziness. The most common causes include benign positional paroxysmal vertigo, acute labyrinthitis, drug side effects and Migraine. It is important these conditions are considered by your doctor as their treatment is different from cervical spine disease. Amongst these, vestibular migraine, a form of Migraine is most commonly misdiagnosed as cervicogenic vertigo. This condition causes neck pain, headache and vertigo. Interestingly the vertigo can persistent without headache, but importantly these symptoms can respond to anti-migraine medications.
Summary
- Dizziness is a common symptom amongst people with cervical spine disease
- This is often caused by a different condition
- Some feel that dizziness can be due to disease of the cervical spine, although this is far from proven at this stage
- Diagnosis of the correct cause is important in order to offer tailored treatments
Biography - Dr Tim Lavin
Dr. Tim Lavin MBBS MRCP (Neurology) is a a Specialist Registrar in Neurology at Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust. A graduate from Newcastle University Medical School in 2006, he completed his initial training in the North West of England and New Zealand before taking up his appointment as a Neurology Specialist Trainee in 2011.
Further Reading
Migraine Headaches (Patient.co.uk)
Reference
Clinical Characteristics of Cervicogenic-Related Dizziness and Vertigo Dario A. Yacovino, MD1 Timothy C. Hain, MD2. Seminars in Neurology Vol. 33 No. 3 2013
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