Degenerative pathological irritations to cervical PLL may play a role in presenting sympathetic symptoms.

The mechanism of cervical vertigo remains unknown. Stimulation of arterial vertebralis caused by osteophyte of the Luschka joint or segmental instability of the cervical spine was considered to be a potential factor contributing to it. Years of studies found that the ischemia of the vertebral artery is not directly correlated with the clinical symptoms of vertigo, and can not be used to explain cervical vertigo as a sole reason. As proven by clinical practical experience, the routine anterior cervical decompression and fusion (ACDF) procedure, in which the degenerative disc and posterior longitudinal ligament (PLL) were often removed, shows positive results for elimination of the sympathetic symptoms. In this article, we hypothesize that: (1) there are sympathetic nerve postganglionic fibers distributed in the PLL or discs; (2) pathological changes secondary to degeneration of the intervertebral disc may cause irritation of sympathetic nerve fibers in PLL or discs, leading to sympathetic symptoms via certain pathways; (3) removal of the PLL or stabilization of the segment which decreases the irritation to PLL will help to eliminate the sympathetic symptoms.