Can your neck pain make everywhere "spinny"

While the influence of neck position on equilibrium  has been known and documented since 1800s, it is often difficult to assume any relationship in situations of neck pain or stiffness associated with dizziness. 

That was until 1955 when Ryan & Cope described a syndrome of disequilibrium and disorientation in patients with many different diagnoses of neck pathology including cervical spondylosis, cervical trauma, and cervical arthritis. They labelled this syndrome cervical vertigo. 

A flurry of publications on cervical vertigo was to follow. The argument for the existence of this diagnosis was premised on the fact that Proprioceptive input from the neck participates in the coordination of eye, head, and body posture as well as spatial orientation. 

However, the interesting fact is that true spinning vertigo is rarely associated with this disease,making some worker to suggest alternative diagnosis of cervicogenic dizziness for this condition. 

Also interesting is the fact that  while some entities previously defined as cervical vertigo have survived the test of time and may be found in the literature today for example  rotational vertebral artery syndrome, post-traumatic cervical vertigo, and cervicogenic proprioceptive vertigo, others such as cervical sympathetic syndrome (Barré-Lieou syndrome), have been discredited. 

It was also subsequently elaborated that since neck contains mechanisms directly involved in balance control (neck afferents), cardiovascular control (carotid bodies), and purely vascular structures (carotid and vertebral arteries), and since neck movements are also invariably associated with head movements, then perhaps experiencing unsteadiness or vertigo associated with neck movements could be due to a disorder in vestibular, visual, vascular, neurovascular, or cervicoproprioceptive mechanisms.

The interesting aspect of this exposition is that currently there is no consensus concerning how one diagnoses cervical vertigo, and the literature is replete with poorly carried out studies as well as studies containing strange suggestions regarding mechanism or treatment.

As such the publications on "cervical vertigo" has plummeted in the last half decade. 

         

References:

1. J Neurol Neurosurg Psychiatry 2001;71:8-12 doi:10.1136/jnnp.71.1.8

2. Neurologia. 2012 Sep 13. pii: S0213-4853(12)00211-3. doi: 10.1016/j.nrl.2012.06.013

3. Cervicogenic Dizziness. http://vestibular.org/cervicogenic-dizziness

4. Cervical Vertigo. http://www.dizziness-and-balance.com/disorders/central/cervical/cervical.html 

Will HNS replace CPAP in OSAS?

Obstructive sleep apnoea syndrome (OSAS) is characterized by repeated episodes of pharyngeal obstruction during sleep, including airway collapse or narrowing resulting in recurrent airflow cessation. 

Identified risk factors include obesity, male sex, Craniofacial and upper airway anomalies, increasing age, and alcohol consumption. 

Traditional  approach to treating OSAS focused on weight reduction (occasionally easy to prescribe, but hard to comply with), removal of obstructive airway lesions (adenotonsillectomy), palatal implants, mandibular advancement surgery (for retrognathia), our own UPPP (uvulopalatopharyngoplasty)  and of course the popular (GPs) option - the CPAP. The interesting fact is compliance rate with CPAP is just about 40-60% (can you stand mask and tubes coming between you and your spouse while on bed?). 

Recent interest in OSAS focuses on genioglossus muscle as therapeutic target, for simple reason: if you get the tongue out of the way, the oropharyngeal airway blockage is removed. 

Devices that stimulate this muscle directly were demonstrated to improve disease severity in OSAS sufferers. However, the interesting aspect is that such direct stimulation would often arouse the patient!!!

This led to the choice of targeted electrical stimulation of the hypoglossal nerve which is directly motor to the genioglossus fibers, with little or no sensory innervation. 

The Hypoglossal Nerve Stimulation (HNS) system is currently undergoing trials in several countries and may be the next interesting toy for treatment of OSAS, though its current cost puts it far beyond the reach of all but very endowed OSAS cases with mild to moderate ( not severe) OSAS. Maybe for severe OSAS, we are stuck with CPAP for some time to come!!!

References:

1. Health Policy Advisory Committee on Technology - Technology Brief: hypoglossal nerve stimulation for sleep apnoea. http://health.qld.gov.au/healthpact/docs/briefs/WP097.pdf

2. Cure Opin Pulm Med. 2011;17(6):419-424