Cervical spondylosis: a common finding in vertigo patients

INTRODUCTION

Vertigo is one of the most common complaints encountered in ENT OPD. It is perceived as swaying or rotational movement either of one’s own body or of the environment, or both.^1,2 Different causes of vertigo include those arising from disturbances of the ear; central nervous system (CNS); cardiovascular system; and benign positional paroxysmal vertigo (BPPV).³

Cervical pathologies as a cause for vertigo was first described in 1858 by Claude Bernard.⁴ Cervical spondylosis develops in 25-50% of people, by the age of 50 and in at least 70% of elderly population by the age of 75 years.⁵

The aim of our study was to evaluate the clinical importance and significance of cervical spondylosis as a cause of vertigo.

METHODS

A prospective descriptive study was conducted on 100 patients with complaints of vertigo attending ENT outpatient department at Bapuji hospital and Chigateri district hospital, teaching hospitals attached to J.J.M. Medical College, Davangere. After obtaining Ethical Committee clearance, the study was conducted during the period of January 2017 to April 2018.

After thorough history and ENT examination, PTA and impedance audiometry was performed to rule out any auditory pathology. Those patients with no specific cause for vertigo and were willing to participate were included into the study after taking informed and written consent. These patients were later screened with a digital X-ray of cervical spine in lateral view and an orthopaedic opinion and in some, neurological opinion was taken (Figure 1). All the data was recorded in a proforma.

Patients with vertigo after ruling out vestibular and neurological causes, between 23 to 64 years of age of either sex were included. While, patients with vestibular and neurological causes were excluded from the study.

Statistical analysis

Qualitative data was represented in the form of frequency and percentage. Association between qualitative variables was assessed by Chi square test. A p value of less than 0.05 was considered statistically significant. Statistical analysis was done with IBM SPSS Version 22 for windows.

RESULTS

A study was done on 100 (100%) patients, after ruling out vestibular and neurological causes of vertigo by doing thorough ENT examination and pure tone audiometry.

The patients of age group 23-64 years, of either sex were studied. Mean age being 40.34 years. Most of the patients 59 (59%), were between 30-49 years of age (Table 1).

Amongst 100 (100%) patients in our study, 58 (58%) were female patients and 42 (42%) male patients.

Out of 100 (100%) patients, 47 (47%) patients had cervical spine degenerative changes and 53 (53%) patients had normal X-ray cervical spine.

The patients with vertigo in age group 50-59 years were found to have highest incidence of cervical spondylosis (Table 2).

Cervical spondylosis was present in 28 (48.28%) out of total 58 (100%) females and in 19 (45.24%) out of total 42 (100%) males. This was compared and found to be statistically insignificant (Table 3).

NS: not significant.

Amongst 100 (100%) patients, 47 (47%) patients had cervical spondylosis. Vertigo in these patients could be attributed to the cervical spine pathologies.

DISCUSSION

Ryan and Cope first termed “cervical vertigo”, the condition of combined symptoms of neck disorders and vertigo (1955). Dizziness due to cervicogenic causes was theorized to be a result of abnormal afferent input to vestibular nuclei from damaged receptors in the cervical spine.⁶

Schenk et al attributed three mechanisms to the cause of cervicogenic dizziness: irritation of the cervical sympathetic nervous system, vertebral artery compression due to mechanical stress or stenosis, and functional disorders in C0 to C3 involving proprioceptors.⁷

While clinical evaluation, it is necessary to rule out neurologic, vestibular, and psychosomatic disorders before a disorder of the craniovertebral junction is to be looked for.⁸ In our study we have included patients with vertigo, after exclusion of these causes.

A condition worth mentioning here, is an ischemia caused by compression of cervical sympathetic nerves leading to dizziness is seen in a rare syndrome, called Barre-Lieou syndrome, which presents with symptoms of head or neck pain, tinnitus, vertigo, blurred vision, dilated pupils, nausea or vomiting.⁹

Mazloumi et al conducted a study on evaluation of patients with vertigo secondary to cervical spondylosis, where the mean age group was 62.5 years.¹⁰ In a study by Karlberg et al, it was 37 years.¹¹ The mean age of patients in our study was 40.3 years, with 59 (59%) patients (maximum) in 30-49 years age group.

In our study, male patients were 42 (42%) and female patients 58 (58%). With no significant difference found in incidence of cervical changes in male and female groups.

Karlberg et al found that in patients with dizziness of suspected cervical origin physiotherapy reduces neck pain, dizziness and also improves postural performance. Hence, they concluded that, although other diagnoses are common for patients with dizziness, neck disorders should also be considered.¹¹

Rieke et al found the prevalence of vertigo, dizziness, or feelings of imbalance in patients with cervical spine abnormalities to be greater than that found in the general population.¹² Similarly our study showed presence of cervical spondylosis in 47 (47%) patients with vertigo (Significant), which was not attributable to any other causes.

Limitations of study

The limitations of our study are its sample size.

CONCLUSION

Cervical spondylosis as a cause for vertigo can be easily ruled out, even with simple and less expensive investigation like digital X-ray of cervical spine lateral view, as it is easily available. Early diagnosis will definitely help in effective treatment. Thus, preventing progression of episodes of vertigo, by treating cervical spondylosis early.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Wrisley D, Sparto P, Whitney S, Furman J. Cervicogenic dizziness: A review of diagnosis and treatment. J Orthop Sports Phys Ther. 2000;30:755-66.
2. 2. Strupp M, Brandt T. Diagnosis and treatment of vertigo and Dizziness. Dtsch Arztebl Int. 2008;105:173-80.
3. 3. Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician. 2015;18:583-95.
4. 4. Owolabi MO, Ogah OS, Ogunniyi A. Episodic vertigo resulting from vascular risk factors, cervical spondylosis and head rotation: Two case reports. Neuropsychiatric Disease and Treatment. 2007:3(5).
5. 5. Nwaorgu OG, Onakaoya PA, Usman MA. Cervical vertigo and cervical spondylosis–a need for adequate evaluation. Niger J Med. 2003;12(3):140-4.
6. 6. Ryan M, Cope S. Cervical and Otolith Vertigo. J Laryngol Otol. 1959;73:113-20.
7. 7. Schenk R, Coons L, Bennett S, Huijbregts P. Cervicogenic dizziness: a case report illustrating orthopaedic manual and vestibular physical therapy comanagement. Journal of Manual & Manipulative Therapy. 2006;14(3):56-68.
8. 8. Brandt T. Cervical Vertigo- reality or fiction? Audiol Neurootol. 1996;1(4):187-96.
9. 9. Pearce JMS. Barré-Liéou syndrome. J Neurol Neurosurg Psychiatry. 2004;75:319.
10. 10. Mazloumi M, Samini F. Evaluation of the results of surgical and medical treatment in 16 patients with vertigo secondary to cervical spondylosis. MJIRI, 2006;20(2):66-8.
11. 11. Karlberg M, Magnusson M, Malmstrfim EM, Melander A, Moritz U. Postural and Symptomatic Improvement After Physiotherapy in Patients With Dizziness of Suspected Cervical Origin. Arch Phys Med Rehabil. 1996;77:874-82.
12. 12. Rieke, Clara C. Symptoms of imbalance associated with cervical spine pathology. Independent Studies and Capstones. 2008: 293.