Abstract
Since vascular risk factors that predispose to vertebrobasilar ischemia are common findings in elderly, cervical spondylosis—which is also common in such age group—as a cause of vertigo is sometimes considered as a myth. The purpose of this study is to investigate the effect of cervical spondylosis on blood flow velocity of VAs during cervical rotation and to identify the possible association of vertigo with the decreased blood flow velocity through VAs during head rotation in these patients. The incidence of cervical spondylosis was estimated in patients with and without vertigo. Patients with vertigo proved to have spondylosis are further compared with patients having spondylosis but not complaining of vertigo and patients who neither have spondylosis nor complain of vertigo who served as controls. Plain cervical radiography was used to evaluate cervical degenerative changes using cervical degenerative index. Color duplex sonography was used to measure vertebral artery blood flow with the cervical spine in the neutral position then with 60° rotation and 30° extension to measure the opposite vertebral artery. A significantly higher prevalence of cervical spondylosis was found among patients complaining of vertigo than those in non-vertigo group (71.4% vs. 32.9%, respectively). Furthermore, among patients with cervical spondylosis, patients having vertigo showed significantly more evident degenerative changes (P = 0.003). Despite Doppler ultrasound examination with head in neutral position was similar in all groups; cervical spondylosis patients with vertigo had statistically significant lower blood flow parameters with contralateral head rotation in the left and right vertebral arteries than cervical spondylosis patients without vertigo and controls. The decreased vertebral artery blood flow that occurs with cervical rotation can be observed in patients with cervical spondylosis. In patients with high-grade cervical spondylosis with more extensive osteophyte formation, the decreased blood flow becomes prominent and symptomatic presenting as vertigo.
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References
Brandt T (1999) Vertigo: its multisensory syndromes. Springer, New York
Schenk R, Coons L, Bennett S et al (2006) Cervicogenic dizziness: a case report illustrating orthopedic manual and vestibular physical therapy comanagement. J Man Manip Ther 14(3):56–68
Brandt T, Baloh R (2005) Rotational vertebral artery occlusion: a clinical entity or various syndromes? Neurology 65:1156–1157
Nwaorgu O, Onakoya P, Usman M (2003) Cervical vertigo and cervical spondylosis—a need for adequate evaluation. Niger J Med 12:140–144
Olszewski J, Majak J, Pietkiewicz P et al (2006) The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis. Otolaryngol Head Neck Surg 134:680–684
Colledge NR, Barr-Hamilton RM, Lewis SJ et al (1996) Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 313:788–792
Nagashima C (2002) Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J Neurosurg 32:512–521
Sheehan S, Bauer RB, Meyer JS (2003) Vertebral artery compression in cervical spondylosis. Neurology 10:968–986
Morales C, De Marinis A, Labatut G et al (1990) Clinical significance of cervical arthropathy in patients with vertigo. Rev Med Chile 118:657–661
Ofiram E, Garvey TA, Schwender JD et al (2009) Cervical degenerative index: a new quantitative radiographic scoring system for cervical spondylosis with interobserver and intraobserver reliability testing. J Orthop Traumatol 10:21–26
Mitchell JA (2003) Changes in vertebral artery blood flow following normal rotation of the cervical spine. J Manipulative Physiol Ther 26:347–351
Hedera P, Bujdakova J, Traubner P (1993) Blood flow velocities in basilar artery during rotation of the head. Acta Neurol Scand 88:229–233
Petersen B, von Moravic M, Zeller JA et al (1996) Basilar artery blood flow during head rotation in vertebrobasilar ischemia. Acta Neurol Scand 94:294–301
Olszewski J, Zalewski P, Machala W et al (1994) Administration of the cervical torsion test by the examination of Doppler's blood flows in vertebral arteries and basilar artery in patients with degenerative cervical spine changes. Otolaryngol Pol 68:549–555
Bayrak IK, Durmus D, Bayrak AO, Diren B, Canturk F (2009) Effect of cervical spondylosis on vertebral arterial flow and its association with vertigo. Clin Rheumatol 28:59–64
Ozdemir H, Cihangiroglu M, Berilgen S, Bulut S (2005) Effects of cervical rotation on hemodynamics in vertebral arteries. JDMS 21:384–391
Scheel P, Ruge C, Schoning M (2000) Flow velocity and flow volume measurements in the extracranial carotid and vertebral arteries in healthy adults: reference data and the effects of age. Ultrasound Med Biol 26:1261–1266
Jargiello T, Pietura R, Rakowski P, Szczerbo-Trojanowska M, Szajner M, Janczarek M (1998) Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency. Eur J Ultrasound 8:149–155
Landwehr P, Schulte O, Voshage G (2001) Ultrasound examination of carotid and vertebral arteries. Eur Radiol 11:1521–1534
Cloud GC, Markus HS (2003) Diagnosis and management of vertebral artery stenosis. QJM 96:27–54
Strek P, Reron E, Maga P, Modrzejewski M, Szybist N (1998) A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine. Eur Arch Otorhinolaryngol 255:437–440
Vilela M, Goodkin R, Lundin D et al (2005) Rotational vertebrobasilar ischemia: hemodynamic assessment and surgical treatment. Neurosurgery 56:36–43
Shinohara N, Kohno K, Takeda S et al (1998) A case of bow hunter's stroke caused by bilateral vertebral artery occlusive change on head rotation to the right. No Shinkei Geka 26:417–422
Kuether T, Nesbit GM, Clarke WM et al (1997) Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency. Neurosurgery 41:427–433
Owolabi M, Ogah O, Ogunniyi A (2007) Episodic vertigo resulting from vascular risk factors, cervical spondylosis and head rotation: two case reports. Neuropsychiatr Dis Treat 3:675–678
Majak J, Olszewski J, Milonski J et al (2005) Influence of positional blood flow disorders in the vertebral and basilar arteries on the prevalence of vertigo in patients with cervical spondylosis. Pol Merkuriusz Lek 19:398–399
Sullivan HG, Harbison JW, Vines FS et al (2000) Embolic posterior cerebral artery occlusion secondary to spondylotic vertebral artery compression: a case report. J Neurosurg 43:618–622
Marti S, Hegemann S, Von Budingen H et al (2008) Rotational vertebral artery syndrome: 3D kinematics of nystagmus suggest bilateral labyrinthine dysfunction. J Neurol 255:663–667
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Machaly, S.A., Senna, M.K. & Sadek, A.G. Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis. Clin Rheumatol 30, 1527–1534 (2011). https://doi.org/10.1007/s10067-011-1770-x
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DOI: https://doi.org/10.1007/s10067-011-1770-x