Is cervical spondylosis to blame for dizziness?

This is the 4576th article of Da Yi Xiao Hu

As a spine surgeon, I often see patients who come to my clinic with dizziness. After preliminary examination, I consider that they may have cervical spine problems, so I ask them to go to the orthopedics department. However, the first thing these patients say when they sit down is "Doctor, I feel dizzy. Should I see a neurologist or an orthopedic doctor?" Today I will talk to you about the relationship between cervical spondylosis and dizziness.

The main complaint of "dizziness" is also one of the top three reasons for elderly people to visit doctors. We often encounter many patients who come in and say, "Doctor, I feel dizzy," and before our doctor even says anything, he immediately says, "I have cervical spondylosis, I guess it's a flare-up of cervical spondylosis." This shows that the concept of cervical spondylosis causing dizziness has been deeply rooted in people's minds. Dizziness is actually a symptom, not an independent disease. Many diseases can cause the symptom of dizziness.

In terms of the classification of causes, in professional terms, there are vestibular peripheral, vestibular central, and systemic related. In plain words, they are caused by the ears, the brain, and other reasons.

Let’s start with the “ears” which ranks first. In fact, more than half of dizziness is related to the ears, and the dizziness related to the ears is usually very severe, with a feeling of upside down, and is accompanied by obvious nausea and vomiting. The most common disease in this category, which can also be said to be the number one cause of dizziness, is benign paroxysmal positional vertigo, which accounts for 20-30% of dizziness. This name may not be familiar, but it has another famous name - otolithiasis. The dizziness caused by otolithiasis has a characteristic, which is that it is closely related to changes in head position. For example, some patients will feel dizzy when they turn their head to the left, but they are fine in other directions.

Another common vertigo related to the ear is Meniere's disease, which is also a very familiar name. When encountering severe dizziness, some patients will ask us if it is Meniere's disease. A big feature of the vertigo caused by Meniere's disease is that these patients will be accompanied by obvious tinnitus symptoms. Many patients with recurrent attacks will also have hearing loss or even deafness.

Although brain-related vertigo ranks second, it is very harmful. The structure of the brain is very complex. All human activities and senses are controlled by different parts of the brain, among which the cerebellum, brain stem and dizziness are most closely related. Lesions in these parts will cause dizziness. The most common lesions are stroke (cerebral infarction, cerebral hemorrhage), intracranial infection (encephalitis), tumors, etc. They can account for about 10% of the causes of dizziness.

Finally, there is systemic related vertigo, which I refer to as "others". This "other" includes a lot of things, but the proportion of causes is not very high. For example, low blood pressure, low blood sugar (for example, if you don't eat breakfast, you will feel dizzy after a half-day class), anemia, drugs (such as some anti-epileptic drugs, antihypertensive drugs, antipsychotic drugs, etc.), and motion sickness (what we call carsickness and seasickness). There is also a kind of visual vertigo, such as some people will feel dizzy in front of a crowd of people in fast-moving traffic or a fast-moving movie screen. There are also some mental and psychological reasons, etc.

Finally, a small part of systemic related vertigo is caused by cervical spondylosis. Cervical spondylosis has five major symptoms: "sourness, numbness, hardness, pain, and dizziness". Cervical spondylosis can indeed cause dizziness, but it is the rarest symptom of cervical spondylosis. Dizziness can indeed be caused by cervical spondylosis. Dizziness caused by cervical spondylosis probably accounts for less than 10% of the total dizziness. The mechanism of dizziness caused by cervical spondylosis is not clear. There are three main hypotheses: vertebral artery compression, sympathetic nerve stimulation, and proprioceptor stress. In layman's terms, the blood vessels are physically compressed in the neck, or the neck nerves are stimulated to cause blood vessels to contract, and other reasons cause brain ischemia and dizziness symptoms. However, it must be clear that the current diagnosis of cervical vertigo is an exclusionary diagnosis, that is, it is necessary to exclude systemic diseases including cardiac, neurological, neurosurgery, ENT, and mental and psychological diseases, and then combine clinical manifestations and imaging examinations to make the final diagnosis of cervical vertigo.

Since vertigo caused by cervical spondylosis has a long course and develops slowly, it takes several years or even decades of chronic disease development to appear. Therefore, if vertigo occurs, you should not go to the orthopedics department for the first consultation to avoid delaying the disease.

Author: Yu Luchao, Department of Orthopedics, Shanghai Putuo District Central Hospital