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Casado-Sánchez A, Sancio-Fernández D, Seijas-Otero D, Abuín-Porras V, Alonso-Pérez JL, Sosa-Reina MD. Effectiveness of manual therapy in dizziness intensity and cervical range of motion in patients with cervicogenic dizziness: A systematic review. J Bodyw Mov Ther 2025; 42:1141-1147. [PMID: 40325649 DOI: 10.1016/j.jbmt.2025.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 01/20/2025] [Accepted: 03/02/2025] [Indexed: 05/07/2025]
Abstract
Cervicogenic dizziness appears in 35-40 % of patients affected with neck pain. Conservative physical therapy treatment for this pathology is increasingly present in the scientific literature, However, there is limited evidence regarding the long-term effects of manual therapy on dizziness intensity and cervical range of motion (ROM). This research aims to address these gaps by analyzing the existing evidence to determine the efficacy of manual therapy for patients with cervicogenic dizziness. OBJECTIVE To determine the effect of manual therapy in dizziness intensity and cervical range of motion in patients affected with cervicogenic dizziness. MATERIAL AND METHODS A bibliographic search was carried out in the following databases: Pubmed, PEDro, WOS, Scopus and CINAHL from February to March 2022 and an update was carried out during March 2024. Randomized clinical trials were included with a minimum sample of 20 subjects, published in English, conducted on human subjects, with the presence of a group diagnosed with cervicogenic dizziness (CD) that received manual therapy treatment, and required to have a score on the PEDro scale ≥7. For the evaluation of the methodological quality, PEDro scale was used. For risk of bias assessment, the Cochrane RoB 2.0 tool was applied. The main outcomes studied were: dizziness intensity and cervical range of motion (ROM). Pain intensity, frequency of dizziness and functionality were also studied as secondary outcomes. RESULTS After applying the inclusion and exclusion criteria, a total of 8 articles were included for qualitative analysis. The mean score on the PEDro scale was 8.12 points. Most articles reflected a decrease in the intensity of dizziness and an increase in ROM in the short term, describing inconsistencies in the long term. CONCLUSION Scientific evidence supports the effect of manual therapy in patients with cervicogenic dizziness in terms of modifying the intensity of dizziness and cervical ROM, at least in the short term. While short-term benefits are consistent, long-term effects remain uncertain. Further research is recommended to explore lasting outcomes and optimize treatment approaches.
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Affiliation(s)
- Adrián Casado-Sánchez
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Diego Sancio-Fernández
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Daniel Seijas-Otero
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Vanesa Abuín-Porras
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain; Physiotherapy in Motion Research Group, Faculty of Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - José Luis Alonso-Pérez
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain; Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Canary Islands, 38300, Spain
| | - Ma Dolores Sosa-Reina
- Department of Physiotherapy, Faculty of Physical Activity and Sport Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain; Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Canary Islands, 38300, Spain.
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Prakash N, Cleland J, Kalyan HK, Roy A, Jose N, Harikesavan K. Analysis of posture and balance impairments in individuals with chronic nonspecific neck pain-an observational study. Health Sci Rep 2024; 7:e2215. [PMID: 38974326 PMCID: PMC11224027 DOI: 10.1002/hsr2.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/24/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024] Open
Abstract
Background Neck pain is one of the most burdensome chronic musculoskeletal problems globally. Impaired proprioception is associated with Chronic Nonspecific neck pain as the structures of the cervical spine are crucial for proprioception and balance. There is a paucity of literature examining objective measures of balance and postural sway in patients with Nonspecific neck pain. Methods This study was observational and consisted of 126 samples (63 cases and 63 controls who were recruited using convenience sampling. The demographics of the samples were collected and the postural and balance impairment was assessed using Biodex Balance SD. Mean, Median, and SD were obtained and the inferential analysis was done using the Whitney U Test and the level of significance was accepted at p < 0.05. Results The subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts. There are significant differences in the overall static stability index, (p < 0.001). There was a significant difference in static sway index(p = 0.003), and static stability index lateral (p = 0.004). There was no significant difference for static sway index forward and backward (p = 0.550) and lateral sway index (p = 0.711). Conclusion Subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts and there was a significant difference between the static sway and static stability index in forward and backward directions as well as in lateral direction. These findings may help to assess the specific balance parameters and address the underlying causes of balance issues in patients with neck pain and also provide a comprehensive care to the patients. Clinical Trial Registration The trial was registered with CTRI India with registration number: CTRI/2022/07/044222.
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Affiliation(s)
- Nithin Prakash
- Department of Physiotherapy, Manipal College of Health ProfessionsManipal Academy of Higher EducationManipalIndia
| | - Joshua Cleland
- Joshua Cleland, Doctor of Physical Therapy Program, Boston, Department of Rehabilitation Sciences, School of MedicineTufts UniversityBostonMassachusettsUSA
| | - Hemant K. Kalyan
- Department of Orthopedics and Sports MedicineManipal Hospitals BangaloreBangaloreIndia
| | - Ajit Kumar Roy
- Department of NeurologyManipal Hospitals BangaloreBangaloreIndia
| | - Naveen Mathew Jose
- Physical Medicine and RehabilitationManipal Hospitals BangaloreBangaloreIndia
| | - Karvannan Harikesavan
- Department of Physiotherapy, Manipal College of Health ProfessionsManipal Academy of Higher EducationManipalIndia
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Chang TP, Wang Z, Lee XX, Kuo YH, Schubert MC. Risk of Cervical Dizziness in Patients With Cervical Spondylosis. JAMA Otolaryngol Head Neck Surg 2024; 150:93-98. [PMID: 38095893 PMCID: PMC10722389 DOI: 10.1001/jamaoto.2023.3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/14/2023] [Indexed: 12/17/2023]
Abstract
Importance The dizziness associated with cervical spondylosis is a controversial topic given that many experts believe that cervical spondylosis is a common cause of dizziness, whereas others do not believe it exists. Objective To compare the risk of dizziness between patients with cervical spondylosis and matched controls (ie, patients with lumbar spondylosis after propensity score matching [PSM]). Design, Setting, and Participants This cohort study used medical claims data from the National Health Insurance Research Database of Taiwan for patients 60 years or older with cervical or lumbar spondylosis newly diagnosed in any outpatient department between January 1, 2010, and December 31, 2015. Patients diagnosed with cervical spondylosis were included as the study cohort, and those diagnosed with lumbar spondylosis who were matched to the study cohort via PSM were selected as the control cohort. Both cohorts were followed up for 1 year unless they were diagnosed with dizziness, censored by death, or withdrew from the health insurance program. Data analysis was performed from August 9 to September 20, 2022. Main Outcomes and Measures The main outcome was the date of outpatient diagnosis of dizziness. The risks of dizziness were compared between groups. The relative risk and incidence rate difference were calculated. Results A total of 3638 patients with cervical spondylosis (mean [SD] age, 67.9 [7.1] years; 2024 [55.6%] male) and 3638 patients with lumbar spondylosis (mean [SD] age, 68.0 [7.1] years; 2024 [55.6%] male) after PSM were selected as the study and control cohorts, respectively. The patients with cervical spondylosis had higher risk of dizziness than matched controls, with a 1-year relative risk of 1.20 (95% CI, 1.03-1.39). The 1-year incidence of dizziness was 10.2% (95% CI, 9.2%-11.2%) in patients with cervical spondylosis and 8.6% (95% CI, 7.7%-9.5%) in the matched group of lumbar spondylosis. The incidence rate difference between the groups was 1.6% (95% CI, 0.3%-3.0%). Conclusions and Relevance These data support the association between dizziness and cervical spondylosis, but the small difference between groups reveals that dizziness associated with cervical spondylosis is uncommon. Clinicians should be wary of diagnosing a cervical cause for dizziness based on an actual history of cervical spondylosis.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Zheyu Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xin-Xian Lee
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Otolaryngology–Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:1884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
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Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
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Moen U, Magnussen LH, Wilhelmsen KT, Goplen FK, Nordahl SHG, Meldrum D, Knapstad MK. Prevalence and distribution of musculoskeletal pain in patients with dizziness-A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1941. [PMID: 35191148 PMCID: PMC9286866 DOI: 10.1002/pri.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/28/2021] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness. METHODS A comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies. RESULTS Out of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0-10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident. DISCUSSION In the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.
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Affiliation(s)
- Unni Moen
- Western Norway University of Applied SciencesBergenNorway
| | | | | | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular DisordersHaukeland University HospitalBergenNorway
- Department of Otorhinolaryngology & Head and Neck SurgeryHaukeland University HospitalBergenNorway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Dara Meldrum
- The School of Medicine Trinity College DublinThe University of DublinDublinIreland
| | - Mari Kalland Knapstad
- Western Norway University of Applied SciencesBergenNorway
- Norwegian National Advisory Unit on Vestibular DisordersHaukeland University HospitalBergenNorway
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6
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Tardov M, Boldin A, Razumov A. Cervicogenic vertigo. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:50-56. [DOI: 10.17116/jnevro202212212150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Seemungal BM, Agrawal Y, Bisdorff A, Bronstein A, Cullen KE, Goadsby PJ, Lempert T, Kothari S, Lim PB, Magnusson M, Marcus HJ, Strupp M, Whitney SL. The Bárány Society position on 'Cervical Dizziness'. J Vestib Res 2022; 32:487-499. [PMID: 36404562 PMCID: PMC9837683 DOI: 10.3233/ves-220202] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo - spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in "cervical dizziness/vertigo", we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.
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Affiliation(s)
- Barry M. Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexander Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo Bronstein
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Kathleen E. Cullen
- Departments of Biomedical Engineering, Neuroscience, and Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Peter J. Goadsby
- King’s College London, UK & University of California, Los Angeles, USA
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | - Sudhir Kothari
- Department of Neurology, Poona Hospital and Research Centre, Pune, India
| | - Phang Boon Lim
- Cardiology Department, Hammersmith Hospital, Imperial College London, UK
| | - Måns Magnusson
- Department of Otorhinolaryngology and Clinical Sciences, Lund University & Skane University Hospital, Sweden
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, USA
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8
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Micarelli A, Viziano A, Micarelli B, Giulia DF, Alessandrini M. Usefulness of postural sway spectral analysis in the diagnostic route and clinical integration of cervicogenic and vestibular sources of dizziness: A cross-sectional preliminary study. J Vestib Res 2021; 31:353-364. [PMID: 33843709 DOI: 10.3233/ves-190729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients -93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) -with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Di Fulvio Giulia
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
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9
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Yang TH, Xirasagar S, Cheng YF, Kuo NW, Lin HC. Association of Cervical Spondylosis With Peripheral Vertigo: A Case-Control Study. Laryngoscope 2020; 131:E625-E630. [PMID: 32396217 DOI: 10.1002/lary.28715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to assess the association of prior cervical spondylosis (CS) with peripheral vertigo. STUDY DESIGN Case-control study. METHODS Data were retrieved from the Taiwan Longitudinal Health Insurance Database. A total of 2,570 patients who were newly diagnosed with peripheral vertigo were identified. We compared them with a 3:1 ratio of propensity score-matched patients, 7,710 comparison patients from the same dataset. We performed multivariate logistic regressions to estimate the odds ratio for prior CS occurrence among peripheral vertigo patients versus controls. RESULTS Of 10,280 sample patients, 1,739 (16.92%) patients had CS prior to the index date. A significant difference in prior CS between peripheral vertigo patients and controls (19.49% vs. 16.06%, P < .001) was observed. Logistic regression analysis shows that the odds of prior CS was 1.285 for peripheral vertigo patients versus controls (95% confidence interval [CI]: 1.143-1.446) after adjusting for age, sex, urbanization level, monthly income, geographic region, hyperlipidemia, diabetes, coronary heart disease, hypertension, and asthma. Prior CS with myelopathy was not associated with peripheral vertigo. Stratified analysis by age showed that the odds of CS were highest among patients with peripheral vertigo in the 45- to 64-year-old age group (1.442, 95% CI: 1.215-1.712). CONCLUSIONS CS is associated with subsequent peripheral vertigo in the Taiwan population, with higher risk among those aged 45 to 64 years. LEVEL OF EVIDENCE 2b Laryngoscope, 131:E625-E630, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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10
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Chu ECP, Chin WL, Bhaumik A. Cervicogenic dizziness. Oxf Med Case Reports 2019; 2019:476-478. [PMID: 31844531 DOI: 10.1093/omcr/omz115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/23/2019] [Accepted: 10/06/2019] [Indexed: 12/20/2022] Open
Abstract
Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24-year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic & Physiotherapy Center, New York Medical Group, Hong Kong, China
| | - Wui Ling Chin
- New York Chiropractic & Physiotherapy Center, New York Medical Group, Hong Kong, China
| | - Amiya Bhaumik
- Department of Health Science, Lincoln University College, Selangor Darul Ehsan, Malaysia
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11
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Tsutsui H, Kikuchi H, Oguchi H, Nomura K, Ohkubo T. Identification of physical and psychosocial problems based on symptoms in patients with Behçet's disease. Rheumatol Int 2019; 40:81-89. [PMID: 31802209 DOI: 10.1007/s00296-019-04488-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet's disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the "ICF Checklist", and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.
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Affiliation(s)
- Hideyo Tsutsui
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. .,Department of Human Culture, Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo, 164-8530, Japan.
| | - Hirotoshi Kikuchi
- Division of Rheumatology and Allergy, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hiroko Oguchi
- Division of Rheumatology and Allergy, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kyoko Nomura
- Department of Human Culture, Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo, 164-8530, Japan.,Department of Environmental Health Science and Public Health, Akita University G, 1-1-1 Hondo, Akita City, Akita, 010-8543, Japan
| | - Takayoshi Ohkubo
- Department of Human Culture, Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo, 164-8530, Japan
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Micarelli A, Viziano A, Augimeri I, Micarelli B, Capoccia D, Alessandrini M. Diagnostic route of cervicogenic dizziness: usefulness of posturography, objective and subjective testing implementation and their correlation. Disabil Rehabil 2019; 43:1730-1737. [PMID: 31656108 DOI: 10.1080/09638288.2019.1680747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. MATERIALS AND METHODS Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. RESULTS Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. CONCLUSIONS The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements.Implications for rehabilitationUncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation.Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations.Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | | | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Yao M, Tang ZY, Cui XJ, Sun YL, Ye XL, Wang P, Zhong WH, Zhang RC, Li HY, Hu ZJ, Wang WM, Qiao WP, Li J, Gao Y, Shi Q, Wang YJ. Shi-Style Cervical Mobilizations Versus Massage for Cervical Vertigo: A Multicenter, Randomized, Controlled Clinical Trial. J Altern Complement Med 2019; 26:58-66. [PMID: 31580705 DOI: 10.1089/acm.2019.0113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: Large sample and high-quality evidence to evaluate the preliminary safety of the mobilizations and massage for cervical vertigo are not yet available. Thus, the present study aimed to investigate the comparative effectiveness and preliminary safety of Shi-style cervical mobilizations (SCM) compared with traditional massage (TM) in cervical vertigo patients. Design: A prospective, multicenter, open-label, randomized, controlled clinical trial with a 1:1 allocation ratio. Settings: Five academic medical centers. Subjects: A total of 360 adult patients with a diagnosis of cervical vertigo. Interventions: The patients were randomly allocated to either an SCM (n = 180) or TM (n = 180) group. The patients were treated during six sessions over 2 weeks. The primary outcome was the Dizziness Handicap Inventory (DHI) total scale score, and secondary outcomes included the DHI subscales, Chinese version of the Short-Form 36 Health Survey (CSF-36), and adverse events (AEs). Outcomes were assessed in the short term at 2 weeks, 1 month, and 3 months, and in the intermediate term at 6 months after randomization. Results: Significant changes were observed from the baseline in the DHI total scale and subscales at 2 weeks and 1, 3, and 6 months in both groups (all p < 0.05). However, the differences between the two groups were not significant (all p > 0.05). Furthermore, we noted significant changes from the baseline in SF-36 scores at 2 weeks in both groups (all p < 0.05), whereas CSF-36 scores were not significantly higher in the SCM group (all p > 0.05) compared with the TM group. No serious AEs were reported in either of the two groups. Conclusions: No differences in outcomes were detected between the SCM and TM groups in terms of treatment of cervicogenic dizziness. Efficacy trials are required to determine whether the improvement observed for each treatment was causally related to the interventions.
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Affiliation(s)
- Min Yao
- Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhan-Ying Tang
- Rehabilitation Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Jun Cui
- Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue-Li Sun
- Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiu-Lan Ye
- Rehabilitation Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Wang
- Orthopaedics and Traumatology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wei-Hong Zhong
- Rehabilitation Department, Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Rui-Chun Zhang
- Tuina Department, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, Urumqi, China
| | - Hui-Ying Li
- Orthopaedics and Traumatology, First Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Zhi-Jun Hu
- Rehabilitation Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Min Wang
- Orthopaedics and Traumatology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wei-Ping Qiao
- Orthopaedics and Traumatology, First Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jun Li
- Rehabilitation Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Gao
- Rehabilitation Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qi Shi
- Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jun Wang
- Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Shen Y, Zhou Q, Zhu X, Qiu Z, Jia Y, Liu Z, Li S. Vertigo caused by longus colli tendonitis: A case report and literature review. Medicine (Baltimore) 2018; 97:e13130. [PMID: 30407336 PMCID: PMC6250553 DOI: 10.1097/md.0000000000013130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Tendinitis of the longus colli muscle is an aseptic inflammatory process leading to acute posterior neck pain, neck stiffness, and dysphagia or odynophagia. We present a patient exhibiting an infrequent symptom, vertigo. This is the first description of the occurrence of vertigo symptoms caused by longus colli tendinitis. PATIENT CONCERNS A 38-year-old man was diagnosed with vertigo, presenting with a 1-month history of dizziness, palpitations, and numbness in the hands. DIAGNOSIS Longus colli tendinitis. The diagnosis was established using magnetic resonance imaging fat-suppression sequences. INTERVENTIONS Treatment with corticosteroid injections and acupotomy. OUTCOMES The symptoms relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week. LESSONS Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.
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Affiliation(s)
- Yifeng Shen
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Qiaoyin Zhou
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinyue Zhu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Zuyun Qiu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jia
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Zixiang Liu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Shiliang Li
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
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Yang L, Chen J, Yang C, Pang X, Li D, Wu B, Wu Y, Lu X, Xu J, Chen X, Peng B. Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study. World Neurosurg 2018; 119:e686-e693. [PMID: 30092465 DOI: 10.1016/j.wneu.2018.07.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis. METHODS Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically. RESULTS After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P = 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs. CONCLUSIONS Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.
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Affiliation(s)
- Liang Yang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Jindong Chen
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Cheng Yang
- Department of Orthopedics, Changzheng Hospital, Shanghai, China
| | - Xiaodong Pang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Duanming Li
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Bing Wu
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Ye Wu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Xiang Lu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Jinlin Xu
- Department of Spinal Surgery, Laizhou People Hospital, Shandong, China
| | - Xiongsheng Chen
- Department of Orthopedics, Changzheng Hospital, Shanghai, China.
| | - Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.
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Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol 2018; 275:2421-2433. [PMID: 30094486 DOI: 10.1007/s00405-018-5088-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other. METHODS This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers' understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links. RESULTS Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm. CONCLUSIONS So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
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17
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Peng B. Cervical Vertigo: Historical Reviews and Advances. World Neurosurg 2018; 109:347-350. [PMID: 29061460 DOI: 10.1016/j.wneu.2017.10.063] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 01/23/2023]
Abstract
Vertigo is one of the most common presentations in adult patients. Among the various causes of vertigo, so-called cervical vertigo is still a controversial entity. Cervical vertigo was first thought to be due to abnormal input from cervical sympathetic nerves based on the work of Barré and Liéou in 1928. Later studies found that cerebral blood flow is not influenced by sympathetic stimulation. Ryan and Cope in 1955 proposed that abnormal sensory information from the damaged joint receptors of upper cervical regions may be related to pathologies of vertigo of cervical origin. Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in tense neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness. Further studies are needed to illustrate the complex pathophysiologic mechanisms of cervical vertigo and to better understand and manage this perplexing entity.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.
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18
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Stulin ID, Tardov MV, Kunelskaya NL, Agasarov LG, Boldin AV. Cervical vertigo: a neurologist's point of view. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:97-102. [DOI: 10.17116/jnevro20181183197-102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Tardov MV, Kunel'skaya NL, Baybakova EV, Chugunova MA, Yanushkina ES, Nikitkina YY, Klyasov AV, Zaoeva ZO. [Cervical vertigo from the perspective of an otorhinolaryngologist]. Vestn Otorinolaringol 2017; 82:72-76. [PMID: 28980603 DOI: 10.17116/otorino201782472-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
At present, the skeptical attitude toward the term 'cervical vertigo' (CV) predominates in the ENT-community. Such point of view is attributable to the absence of specific CV symptoms and well-defined diagnostic criteria. The present literature review was designed to consider the results of the clinical observations and experimental investigations obtained during the past 150 years that give evidence of the possibility to regard cervical vertigo as a separate nosological entity. The characteristic signs of this condition are analyzed and systematized. Four CV variants are currently distinguished. The principles of diagnostics and treatment of cervical vertigo are discussed and general concept of CV is formulated.
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Affiliation(s)
- M V Tardov
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - N L Kunel'skaya
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152; N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia, 117997
| | - E V Baybakova
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - M A Chugunova
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - E S Yanushkina
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - Ya Yu Nikitkina
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - A V Klyasov
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
| | - Z O Zaoeva
- State-financed Healthcare Institution of Moscow 'L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology', Moscow Health Department, Moscow, Russia, 117152
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Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother 2017; 7:12. [PMID: 29340206 PMCID: PMC5759906 DOI: 10.1186/s40945-017-0040-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/04/2017] [Indexed: 12/21/2022] Open
Abstract
Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.
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Affiliation(s)
- Alexander S. Reiley
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Frank M. Vickory
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Sarah E. Funderburg
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Rachel A. Cesario
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Richard A. Clendaniel
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
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Yang L, Yang C, Pang X, Li D, Yang H, Zhang X, Yang Y, Peng B. Mechanoreceptors in Diseased Cervical Intervertebral Disc and Vertigo. Spine (Phila Pa 1976) 2017; 42:540-546. [PMID: 27438387 DOI: 10.1097/brs.0000000000001801] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We collected the samples of cervical intervertebral discs from patients with vertigo to examine the distribution and types of mechanoreceptors in diseased cervical disc. OBJECTIVE The aim of this study was to determine whether mechanoreceptors are distributed more abundantly in cervical discs from patients with cervical spondylosis, and whether they are related to vertigo. SUMMARY OF BACKGROUND DATA Previous limited studies have found that normal cervical intervertebral discs are supplied with mechanoreceptors that have been considered responsible for proprioceptive functions. Several clinical studies have indicated that the patients with cervical spondylosis manifested significantly impaired postural control and subjective balance disturbance. METHODS We collected 77 samples of cervical discs from 62 cervical spondylosis patients without vertigo, 61 samples from 54 patients with vertigo, and 40 control samples from 8 cadaveric donors to investigate distribution of mechanoreceptors containing neurofilament (NF200) and S-100 protein immunoreactive nerve endings. RESULTS The immunohistochemical investigation revealed that the most frequently encountered mechanoreceptors were the Ruffini corpuscles in all groups of cervical disc samples. They were obviously increased in the number and deeply ingrown into inner annulus fibrosus and even into nucleus pulposus in the diseased cervical discs from patients with vertigo in comparison with the discs from patients without vertigo and control discs. Only three Golgi endings were seen in the three samples from patients with vertigo. No Pacinian corpuscles were found in any samples of cervical discs. CONCLUSION The diseased cervical discs from patients with vertigo had more abundant distribution of Ruffini corpuscles than other discs. A positive association between the increased number and ingrowth of Ruffini corpuscles in the diseased cervical disc and the incidence of vertigo in the patients with cervical spondylosis was found, which may indicate a key role of Ruffini corpuscles in the pathogenesis of vertigo of cervical origin. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Liang Yang
- Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- Department of Orthopedics, Pingjin Hospital, Logistics College of Armed Police Forces, Tianjin, China
| | - Cheng Yang
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Xiaodong Pang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Duanming Li
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Hong Yang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Xinwu Zhang
- Department of Pathology, General Hospital of Armed Police Force, Beijing, China
| | - Yi Yang
- Department of Pathology, 304th Hospital, Beijing, China
| | - Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
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Zuo J, Han J, Qiu S, Luan F, Zhu X, Gao H, Chen A. Neural reflex pathway between cervical spinal and sympathetic ganglia in rabbits: implication for pathogenesis of cervical vertigo. Spine J 2014; 14:1005-9. [PMID: 24291360 DOI: 10.1016/j.spinee.2013.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/25/2013] [Accepted: 11/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A functional association between cervix and vertigo has been observed in patients with cervical vertigo, implicating correlation between cervical spinal and sympathetic ganglia. However, it is unclear where there is an anatomic connection between those two groups of ganglia. PURPOSE This study aimed to investigate the existence of the neural connections between cervical spinal and sympathetic ganglia. STUDY DESIGN/SETTING FluoroGold staining patterns in cervical spinal and sympathetic ganglia were evaluated using FluoroGold retrograde tracing in New Zealand rabbits. METHODS New Zealand rabbits were randomly divided into superior cervical spinal ganglion injection groups, inferior cervical spinal ganglion injection groups, superior cervical sympathetic ganglion injection group, and inferior cervical sympathetic ganglion injection group. Four percent FluoroGold solution was injected into these ganglia. Distribution of FluoroGold in cervical spinal and sympathetic ganglia was observed under a microscope. RESULTS When FluoroGold solution was injected into C2 and C3 superior cervical spinal ganglia or C5-C6 inferior cervical spinal ganglia, fluorescence was only observed in the ipsilateral superior or inferior cervical sympathetic ganglia, respectively. When FluoroGold solution was injected into superior or inferior cervical sympathetic ganglia, fluorescence was found mainly in the ipsilateral C3-C4 superior or C5-C8 inferior spinal ganglia. No fluorescence was observed in contralateral ganglia of experimental animals and all ganglia of matched control animals injected with physiological saline. CONCLUSIONS Bidirectional nerve fiber connections between cervical spinal and sympathetic ganglia were observed, and these connections are arranged in a segmental distribution. This observation may provide a possible neuroanatomic basis for the pathogenesis of cervical vertigo.
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Affiliation(s)
- Jinliang Zuo
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China.
| | - Jianlong Han
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Siqiang Qiu
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Fanghai Luan
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Xinwei Zhu
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Haoyuan Gao
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Anmin Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, Hubei Province 430030, China
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Asama Y, Goto F, Tsutsumi T, Ogawa K. Objective evaluation of neck muscle tension and static balance in patients with chronic dizziness. Acta Otolaryngol 2012; 132:1168-71. [PMID: 22831284 DOI: 10.3109/00016489.2012.699197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Increase in the average value of bilateral neck muscle tension (ANT) indicates the increase in neck muscle tension to stabilize static posture resulting from vestibular compensation. Asymmetry of neck muscle tension was closely related to postural imbalance. OBJECTIVE Patients with dizziness often complain of neck symptoms with stiff neck. This study was conducted to clarify the pathophysiological mechanism of neck symptoms in patients with dizziness. METHODS We objectively measured bilateral trapezius muscle tension in patients with chronic dizziness and determined its relationship with static postural perturbation. The study included 26 patients with chronic dizziness caused by unilateral vestibular deficit and 24 healthy controls. The tension of bilateral trapezius muscles was objectively measured using a neck muscle tension meter. ANT and the ratio (right/left) of the bilateral neck muscle tension (RNT) were calculated. Static posturography was performed to measure total length of path (LNG). RESULTS ANT was negatively correlated to LNG under the eyes closed (EC) condition only in the case of the patients (r = -0.44, p < 0.05). In the case of both the controls and the patients with a unilateral vestibular deficit, RNT was positively correlated to LNG under the EC condition.
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Yacovino DA. WITHDRAWN: Vértigo cervical: mitos, realidades y evidencia científica. Neurologia 2012:S0213-4853(12)00211-3. [PMID: 22981375 DOI: 10.1016/j.nrl.2012.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/07/2012] [Accepted: 06/27/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- D A Yacovino
- Sección de Neurootología, Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina; Chicago Dizziness and Hearing, Chicago, EE. UU.
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