Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo

Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervicalvertigo is an independent entity still remains controversial. In this narrative review, weoutline the basic science and clinical evidence for cervical vertigo according to the currentliterature. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin,including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral arteryvertigo, and migraine-associated cervicogenic vertigo. Proprioceptive cervical vertigo androtational vertebral artery vertigo have survived with time. Barré-Lieou syndrome once wasdiscredited, but it has been resurrected recently by increased scientific evidence. Diagnosisdepends mostly on patients’ subjective feelings, lacking positive signs, specific laboratoryexaminations and clinical trials, and often relies on limited clinical experiences of clinicians.Neurological, vestibular, and psychosomatic disorders must first be excluded before thedizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin.Treatment for cervical vertigo is challenging. Manual therapy is recommended for treatmentof proprioceptive cervical vertigo. Anterior cervical surgery and percutaneous laser discdecompression are effective for the cervical spondylosis patients accompanied with BarréLiéou syndrome. As to rotational vertebral artery vertigo, a rare entity, when the exact area ofthe arterial compression is identified through appropriate tests such as magnetic resonanceangiography (MRA), computed tomography angiography (CTA) or digital subtractionangiography (DSA) decompressive surgery should be the chosen treatment.Key words: Cervical vertigo, dizziness, whiplash injury, neck pain, cervical spondylosis,manual therapy, vestibular rehabilitation, vertebrobasilar insufficiency