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Neck Pain and Dizziness

Neck pain and dizziness can be problematic and significantly impact one’s function and quality of life.  What is the association between neck pain and dizziness? What is cervical vertigo?  What are the treatment options for neck pain and dizziness?  Which treatment options for neck pain and dizziness should you avoid?  Let’s dig in.

The Balance System

Our body’s balancing system is compromised of three separate systems that work closely together to keep the body in balance: the eyes, inner ear, and upper cervical spine. The upper cervical spine contains and processes information about your position in space and communicates this information to your eyes and inner ears via nerves.  There is a constant highway of electrical signals between the cervical spine, inner ear, and eyes that keep us upright, make us aware of our position, and enable us to walk, move and run. This balancing system requires the inner ear, eyes, and cervical spine to be operational at a high level so that vital information can be exchanged and processed between the three systems (1).

When there is a weak link in the balancing system, the communication between the eyes, inner ears, and cervical spine can be compromised and dizziness may occur.  Injuries to the neck can wreak havoc on this complex and delicate system.  Facet joints in the cervical spine play a big role in the balancing system in addition to providing support to the spine.   They have a  rich supply of pain and positional fibers. Cervical facets can be injured as a result of trauma, degeneration or surgery and can be a major source of neck and headache pain (2).

What Is Cervical Vertigo? (Neck Dizziness)

Cervical vertigo is a medical condition in which dizziness originates from the neck and is characterized by the presence of imbalance, unsteadiness, disorientation, neck pain and limited range of motion (3)   The dizziness can be closely related to changes in the position of the neck.

To better understand the connection between neck pain and dizziness please click on the video below

Can Cervical Neck Pain Cause Dizziness?

Yes!  The balance system is a complex and delicate system that requires the inner ear, eyes, and cervical spine to be fully functional and operate at a high level so that vital information can be exchanged and processed.  Injury to the cervical facets, discs, and ligaments can cause pain and interrupt or compromise this complex and delicate balance system (4).  Neck pain can indeed cause dizziness and regrettably, this is poorly understood and missed by many providers.   Patients often continue to suffer from dizziness or are put through extensive inner ear and eye tests without any investigation of their neck pain and its relationship to their dizziness.

Atlantoaxial Instability (AAI)

Instability simply means that bones move around too much, usually due to damaged ligaments. In the spine, this can cause nerves to get banged into and joints to get damaged. In the craniocervical junction, instability can cause the upper cervical spinal nerves to get irritated, leading to headaches. In addition, the C0-C1 and C1-C2 facet joints can also get damaged. In addition, there are other nerves that exit the skull here that can get irritated, like the vagus nerve, which can cause rapid heart rate. What’s the Difference Between CCI and AAI? CCI refers to instability in any part of the craniocervical junction…

Read More About Atlantoaxial Instability (AAI)

Cervical Medullary Syndrome

Cervical Medullary Syndrome is a clinical condition that occurs as a result of inflammation, deformity, or compression of the lower part of the brain. Symptoms can be extensive with fluctuating severity based upon the extent of the underlying injury. For example, mild irritation of the brainstem may cause only mild, intermittent symptoms. The upper cervical spine and brain are complex with multiple structures.  These structures reside within the skull and protective confines of the cervical spine.  Neither expands to accommodate inflammation, injury, and disease.  Rather the delicate tissues of the brain and spinal cord are irritated or compressed.   The 4 major conditions that cause cervical medullary syndrome are… 

Read More About Cervical Medullary Syndrome

Cervical Radiculopathy

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.

Read More About Cervical Radiculopathy

Chiari Malformation

Chiari Malformation Is a medical condition where a part of the brain at the back of the skull abnormally descends through an opening in the skull. It is named after Dr. Hans Chiari who was an Austrian pathologist who in the late 1880’s studied deformities of the brain.The brain is a large structure divided into different parts that reside within the skull. Important parts of the brain called the Cerebellum and Brainstem sit at the base of the skull. The Foramen Magnum is a large hole at the base of the skull that allows the brain to join the spinal canal. The Cerebellum…

Read More About Chiari Malformation

Craniocervical Instability

Craniocervical Instability is a medical condition characterized by injury and instability of the ligaments that hold your head onto the neck. Common symptoms of Cranial Cervical Instability include a painful, heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, dizziness, and chronic fatigue.CCI or neck ligament laxity treatment options depend upon the severity of the instability and clinical symptoms. When appropriate, conservative care should always be the first-line treatment. Craniocervical Instability Surgery is often recommended when conservative care fails. This involves a fusion of the head to the neck which is a major surgery that is associated with significant risks and complications…

Read More About Craniocervical Instability

Ehlers-Danlos Syndrome (EDS)

Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it.  EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity.   It most commonly affects the skin, joints, and blood vessels.  Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…

Read More About Ehlers-Danlos Syndrome (EDS)

Facet Joint Syndrome

Injury or inflammation of the cervical facet can led to neck, shoulder and headache pain – called “cervical facet syndrome.” Cervical facet syndrome largely involves a joint in the posterior aspect of the cervical spine. It functions to provide stability and guide motion. cervical facet joint injection for cervical facet syndrome Cervical facet pain is common in patients who have sustained a whiplash injury, trauma to the neck or undergone cervical fusion. Physical examination is typically significant for restriction in range of motion along with pain. Each joint has a distinct referral pattern illustrated below. The Centeno-Schultz Clinic are experts at diagnosing and treating cervical facet dysfunction. Injury to the joint is not commonly detected by conventional radiographic studies.

Read More About Facet Joint Syndrome

TMJ

The temporomandibular joint (TMJ) is the joint connection between your jaw and your skull. If you run your fingers along either side of your jaw line toward your ears, you can actually feel where the jaw bone ends and the skull bone begins. If you open and close your mouth, the difference between the two is dramatic as the jaw bone moves, thanks to the TMJ joint, while the skull bone remains stable. The TMJ and any of its surrounding structures can become painful and inflamed, and this can become so bad that it can prevent patients from even being able to move their jaw bone to chew.

Read More About TMJ
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Treatment Options for Neck Pain and Dizziness

Identifying and addressing the source of the upper neck pain is key to reducing the pain and eliminating the dizziness.  Neck muscles, ligaments, and cervical facets can cause neck pain and dizziness. Treatment options for neck pain and accompanying dizziness include trigger point injections without steroids, physical therapy, and massage.  When conservative treatment options fail, cervical facet injections have been demonstrated to be effective (5).

The Centeno-Schultz Clinic has extensive experience in the treatment of neck pain and dizziness with PRP and bone marrow-derived stem cells (6).  This is a highly-skilled, complex procedure that your local doctor or orthopedic specialist cannot perform. Click on the video below to watch the procedure.

Can a Pinched Nerve in Your Neck Cause Dizziness?

Yes!  A pinched or irritated nerve in the neck can compromise the complex and delicate balance system.  The inner ear, eyes, and neck must all be functioning at a high level so that vital information can be transmitted and processed.  A pinched nerve can wreak havoc on this system with resultant dizziness and neck pain.

Treatments to Avoid for Neck and Dizziness

Steroid injections

Steroids have a significant number of side effects which include increased risk of bone death (avascular necrosis), weaken tendons (7), and killing off a percentage of the local healing stem cells (8).

Radiofrequency Ablation

Radiofrequency ablation is a nerve destruction procedure that damages an important nerve to the facet joint and can cause atrophy of the supporting muscles (9).

Cervical Fusion

Cervical fusion is a surgical procedure where two or more cervical vertebrae are bolted together with hardware and or bone.  There are significant complications associated with cervical fusion which include, infection, failure to fuse, and adjacent segment disease (10).

In Conclusion

The balance system is compromised for three principles systems:  the inner ear, the eyes, and the cervical spine. The three systems transmit, share, and process critical information constantly which allows us to be upright and to function. All three systems must be functional at a high level and communicate with each other.  Injury to the neck can compromise this delicate and complex system and result in dizziness.  Cervical facet joints are a common site of injury and can cause dizziness.  Neck pain and dizziness are common and need to be part of any dizziness evaluation.  Treatment options to avoid include surgery, radiofrequency ablation, and steroids. Platelet-rich plasma is an effective treatment option for neck pain and dizziness.

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References

1.Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther. 2009;39(5):364-77.DOI: 10.2519/jospt.2009.2834

2. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash-associated disorders: an evidence-based approach. J Am Acad Orthop Surg. 2007;15(10):596-606.

3. Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017;7:12. doi: 10.1186/s40945-017-0040-x

4. Peng B. Cervical Vertigo: Historical Reviews and Advances. World Neurosurg. 2018;109:347-50.DOI: 10.1016/j.wneu.2017.10.063

5. Hahn T, Halatsch ME, Wirtz C, Klessinger S. Response to Cervical Medial Branch Blocks In Patients with Cervicogenic Vertigo. Pain Physician. 2018;21(3):285-94.

6. Cameron JA, Thielen KM (2017) Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results. Spine Res. Vol. 3 No. 2:10 doi: 10.21767/2471-8173.100030

7. .Zhang J, Keenan C, Wang JH. The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-10.DOI: 10.1002/jor.22193

8. Zhang J, Keenan C, Wang JH. The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-10.DOI: 10.1002/jor.22193

9. Dreyfuss P, Stout A, Aprill C, Pollei S, Johnson B, Bogduk N. The significance of multifidus atrophy after successful radiofrequency neurotomy for low back pain. PM R. 2009;1(8):719-22.DOI: 10.1016/j.pmrj.2009.05.014

10.Kong L, Cao J, Wang L, Shen Y. Prevalence of adjacent segment disease following cervical spine surgery: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2016;95(27):e4171. doi: 10.1097/MD.0000000000004171

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