Les vertiges cervicaux ont une réalité mais ce ne sont pas de vrais vertiges

Abstract

Past controversies about the contribution of cervical spine to vertigo mainly resulted from confusion between vertigo and dizziness, and dogmatic belief that spine could not contribute to such conditions. In fact, whereas cervical disorders cannot induce vertigo with nystagmus (which are only explained by ENT or neurological disorders) they can conversely contribute to induce dizziness, through two main mechanisms: (1) impingement of vertebral artery during extremes or brisk cervical rotations (bow-hunter syndrome), especially in patients with loops of vertebral artery or arcuate foramen (ossification of atlo-occiptal ligament on the posterior aspect of axis, making an osseous arch around the vertebral artery). Marked sagittal C1-C2 instability can also reduce flow in vertebral arteries; (2) various abnormal proprioceptive inputs from cervical discs, uncus, zygapophyseal joints, muscles and ligaments or fascias, like the occipito-cervical membrane, can also foster dizziness. Patients with dizziness of putative cervical origin must first be examined by an ENT physician, and neurologist could also be asked to check for alternative explanations before classifying the dizziness as arising partly from the cervical spine and related structures. This possibility should not be denied, moreover as some spine surgery can induce a marked improvement of those dizziness in properly selected patients.