Vertigo, don't think it's cervical spondylosis

The current classification standard of cervical spondylosis was formed by the consensus of experts at the 2nd National Symposium on Cervical Spondylosis held in Qingdao in 1992. It has been 25 years since then. It can be divided into six types: cervical type, nerve root type, spinal cord type, vertebral artery type, sympathetic nerve type and esophageal compression type. Although more and more scholars believe that the terms "vertebral artery type cervical spondylosis" and "sympathetic type cervical spondylosis" are not scientific, they have not reached a consensus and have been used up to now，Among them, the existence of cervical spondylosis of vertebral artery type (cervical vertigo) is more controversial, and it is inseparable from vertigo in the field of neurology.

So where does vertigo come from? What is the cross-cutting relationship between cervical vertigo and cervical vertigo?

Most people experience dizziness at least once in their lifetime. In other words, nearly a third of outpatients complain of dizziness.

However, it is rarely known that vertigo is a positional illusion caused by the human body's obstacles to spatial positioning. It is only a common symptom of many diseases, not a disease.

This kind of symptom is common in Meniere's disease, otolithiasis, vestibular paroxysmal disease, vestibular migraine and other vertigo diseases. Therefore, we can see these patients in otolaryngology, orthopaedics, general medicine and neurology. Most of them can be relieved in a short time after receiving appropriate treatment.

（The World in the Eyes of Patients with Vertigo Attack）

Cervical spine is an important junction between human body and brain. It contains many structures that may be related to dizziness, such as carotid artery, vertebral artery, carotid sinus, deep sensory conduction tract, sympathetic plexus, etc. Therefore, head movement can aggravate the symptoms of vertigo when it occurs, so that patients subjectively believe that vertigo is caused by cervical spine.

However, among many types of cervical spondylosis, only the vertebral artery type, cervical vertigo, may present vertigo symptoms.

Many patients were diagnosed as having cervical vertigo by many non-specialists in China after they underwent cervical spine MRI, cranial MRI, cervical vascular ultrasound, TCD and even DSA examination in a single position. There is a huge misunderstanding.

（Cervical vertebra is an important junction between human body and brain）

People who call cervical vertigo "a common clinical disease" on the Internet are emerging in an endless stream, but they do not know that the probability of cervical vertigo is about the same as that of the mid-five million lottery tickets.

At present, the most common theories that non-specialist doctors rely on to diagnose cervical vertigo in China mainly include two kinds: sympathetic nerve hypothesis and vascular hypothesis. What are these two theories? Is it credible?

Also known as Barre-Lieou syndrome.

The theory was first put forward by Barre and Lieou in 1928. It specifically refers to the cervical vertebral hyperosteogeny which stimulates the sympathetic plexus surrounding the vertebral artery. After sympathetic stimulation, the vertebral artery contraction or local compression of the vertebral artery leads to posterior circulation ischemia and hypoxia, resulting in clinical vertigo attacks.

However, it is regrettable that later studies have failed to prove the existence of sympathetic nerve or vascular changes, so this theory has been eliminated by foreign academia.

（Nerve plexus compression by cervical osteoporosis）

Also known as Bow Hunter syndrome (BHS), also known as Rotational vertebral artery occlusion syndrome (RVAOS), refers to the rotation of the vertebral artery compression resulting in a significant decrease in posterior circulation blood supply, transient symptoms.

（Vertebral artery torsion after neck rotation）

Its diagnostic criteria are extremely strict and the following conditions must be met:

1）Normal angiogram at median head；

2）Posterior cervical angiography did show compression and interruption of blood flow.；

3）TCD monitors the blood vessels after vertebral artery, such as basilar artery or posterior cerebral artery. The blood flow before and after cervical rotation is normal, the blood flow after cervical rotation is interrupted, and the blood flow interruption lasts until the head position is restored to the median compression relief. The blood flow recovery is about 10% more than that of the basal blood flow；

4）Emphasis is laid on the clinical symptoms consistent with neck rotation and interruption of blood flow: no symptoms before neck rotation, symptoms after neck rotation, symptoms continue until the head position recovers to the median, symptoms disappear when blood flow recovers.；

5）It is emphasized that clinical symptoms should include other brain stem cerebellar symptoms besides dizziness, such as decreased consciousness, blurred vision, vague speech, falls, numbness of limbs and material resources, etc.

How many such patients are there? According to such diagnostic criteria, a total of 21 patients were collected from 8 centers in Korea for three consecutive years, i.e. less than one in each center in a year, so it was known that such cases were rare.

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