ARTICLE
Though there is abundant literature on cervicogenic dizziness, 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. This 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. 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. Broadly, the dizziness incorporates four descriptive symptoms: namely, ‘vertigo’, which is nothing but a false perception of movement of self or surrounding; ‘disequilibrium’ or ‘imbalance’ which is an inability to maintain balance; ‘presyncope’, a sense of losing consciousness; and ‘lightheadedness’, defined as a vague symptom of feeling disconnected from the environment. Dizziness is said to be cervicogenic when it is closely associated with the neck pain, the neck injury, or the neck pathology, after excluding the other causes of dizziness. Though neurologists, neuro-otologists, physicians, and orthopedicians commonly come across patients with presumptive cervicogenic dizziness in clinics, not many would stake the claim. 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. Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by an illusory sensation of motion and disequilibrium due to neck pathology. Current theory suggests that episodes of dizziness are due to disturbed sensory afferents from the neck, leading to a sensory mismatch between cervical, visual and vestibular inputs. The diagnosis is dependent upon the correlating symptoms of disequilibrium and dizziness with neck pain and excluding other vestibular disorders. 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. A number of clinical studies including randomized controlled trials support the efficacy of manual therapy for CGD. The proprioceptive inputs from the neck play an important role in head-eye coordination and postural processes. Neck proprioception provides the necessary information about head movements relative to the trunk. Accordingly, neck muscles, especially in the suboccipital region, are richly endowed with spindles, which have a complex sensory and motor innervation within the muscles. Furthermore, mechanoreceptive nerve endings in the facet joint capsules are also important for proprioception and pain sensation in the cervical spine. The sensory input from the neck participates in perceptual functions and reflex responses, thereby interacting with signals of the vestibular and visual system to stabilize the eyes, the head and posture. With strong connections between cervical receptors and equilibrium function, it is apparent that degenerative or traumatic changes of the spine and problems in the neck muscles could induce distorted sensations and cause symptoms of disequilibrium. To diagnose CGD, masquerading pathologies must be identified and excluded. The list of differential diagnosis may include benign paroxysmal positional vertigo, perilymphatic fistula, labyrinthine concussion, migraine-related vertigo and central or peripheral vestibular dysfunction. Once vestibular and neurovascular pathologies have been ruled out, the diagnosis of CGD should be established by a correlation between dizziness and the cervical spine. Results from clinical studies do show promise for the use of manual approaches in the treatment of Cervicogenic dizziness (CGD). The underlying mechanism for the efficacy of manual therapy includes stimulation of cervical proprioceptors and normalization of the afferent input. It must be emphasized that manual therapies should be applied with great caution in patients with CGD. Ruling out neurovascular aetiologies is of utmost importance before starting the manual therapy to prevent any untoward events in CGD. The dearth in the awareness about the constitute conditions contributes at least partly to many health practitioners avoiding treatment or limiting referrals for treatment. Most of the existing literature discusses the cervicogenic dizziness, in general, and provides guidelines accordingly. However, cervicogenic dizziness can be caused by many conditions of separate pathophysiological backgrounds. Failure to separate these conditions in clinical practice as well as in research studies may have a negative impact and hamper the further understanding of the disease. Sources: https://chiro.org/wordpress/2019/12/approach-to-cervicogenic-dizziness-a-comprehensive-review-of-its-aetiopathology-and-management/ https://chiro.org/wordpress/2019/12/cervicogenic-dizziness/