Vertigo in Patients with Degenerative Cervical Myelopathy

Abstract

(1) Background: Cervical vertigo (CV) represents a controversial entity, with a prevalence ranging from reported high frequency to negation of CV existence. (2) Objectives: To assess the prevalence and cause of vertigo in patients with a manifest form of severe cervical spondylosis-degenerative cervical myelopathy (DCM) with special focus on CV. (3) Methods: The study included 38 DCM patients. The presence and character of vertigo were explored with a dedicated questionnaire. The cervical torsion test was used to verify the role of neck proprioceptors, and ultrasound examinations of vertebral arteries to assess the role of arteriosclerotic stenotic changes as hypothetical mechanisms of CV. All patients with vertigo underwent a detailed diagnostic work-up to investigate the cause of vertigo. (4) Results: Symptoms of vertigo were described by 18 patients (47%). Causes of vertigo included: orthostatic dizziness in eight (22%), hypertension in five (14%), benign paroxysmal positional vertigo in four (11%) and psychogenic dizziness in one patient (3%). No patient responded positively to the cervical torsion test or showed significant stenosis of vertebral arteries. (5) Conclusions: Despite the high prevalence of vertigo in patients with DCM, the aetiology in all cases could be attributed to causes outside cervical spine and related nerve structures, thus confirming the assumption that CV is over-diagnosed.

Keywords: cervical dizziness; cervical torsion test; cervical vertigo; degenerative cervical myelopathy; degenerative cervical spinal cord compression.

Figure 1

Patient with severe cervical spinal cord compression. (A) Sagittal T2-MRI sequence shows a level of maximal compression—C5/6 (arrow); (B) Compression ratio: anterior–posterior diameter (solid line double arrow) divided by the transverse diameter (dashed line double arrow) of the spinal cord on the axial T2 MRI image (taken at the level of maximum spinal cord compression; the result is 0.37 in this patient).

Figure 2

Cervical torsion test. (A) Subject seated in a rigid but fully rotatable chair, head fixed. (B) The subject´s trunk passively turned 70 degrees to the right, with the head still, then returned to centre. (C) Turning the trunk 70 degrees to the left, then returned to centre.