title: Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis.
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.
authors: Rheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. shmach_237@hotmail.com
authors: Shereen A
authors: SA
authors: Machaly
authors: Mohammed K
authors: MK
authors: Senna
authors: Ahmed G
authors: AG
authors: Sadek
references: Clin Rheumatol. 2009 Jan;28(1):59-64
references: 18688672
references: Otolaryngol Pol. 1994;48(6):549-55
references: 7870428
references: Eur J Ultrasound. 1998 Dec;8(3):149-56
references: 9971893
references: Neurology. 2005 Oct 25;65(8):1156-7
references: 16247039
references: Acta Neurol Scand. 1996 Oct;94(4):294-301
references: 8937543
references: Eur Radiol. 2001;11(9):1521-34
references: 11511873
references: QJM. 2003 Jan;96(1):27-54
references: 12509646
references: Neurosurgery. 2005;56(1):36-43; discussion 43-5
references: 15617584
references: BMJ. 1996 Sep 28;313(7060):788-92
references: 8842072
references: Eur Arch Otorhinolaryngol. 1998;255(9):437-40
references: 9833209
references: Ultrasound Med Biol. 2000 Oct;26(8):1261-6
references: 11120363
references: No Shinkei Geka. 1998 May;26(5):417-22
references: 9621355
references: J Neurol. 2008 May;255(5):663-7
references: 18274804
references: Rev Med Chil. 1990 Jun;118(6):657-61
references: 1775787
references: Neuropsychiatr Dis Treat. 2007;3(5):675-8
references: 19300597
references: J Orthop Traumatol. 2009 Mar;10(1):21-6
references: 19384631
references: Otolaryngol Head Neck Surg. 2006 Apr;134(4):680-4
references: 16564396
references: Niger J Med. 2003 Jul-Sep;12(3):140-4
references: 14737984
references: Acta Neurol Scand. 1993 Sep;88(3):229-33
references: 7903016
references: J Neurosurg. 1975 Nov;43(5):618-22
references: 1181394
references: J Neurosurg. 1970 May;32(5):512-21
references: 5438093
references: Pol Merkur Lekarski. 2005 Sep;19(111):398-9
references: 16358884
references: J Manipulative Physiol Ther. 2003 Jul-Aug;26(6):347-51
references: 12902962
references: Neurosurgery. 1997 Aug;41(2):427-32; discussion 432-3
references: 9257311