Li Yongchao, Peng Baogan
Postgraduate Training Base of General Hospital of Armed Police Force of Liaoning Medical University, Beijing; Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing 100039, China.
Pain Physician. 2015 Jul-Aug;18(4):E583-95.
Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervical vertigo is an independent entity still remains controversial. In this narrative review, we outline the basic science and clinical evidence for cervical vertigo according to the current literature. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. Proprioceptive cervical vertigo and rotational vertebral artery vertigo have survived with time. Barré-Lieou syndrome once was discredited, but it has been resurrected recently by increased scientific evidence. Diagnosis depends mostly on patients' subjective feelings, lacking positive signs, specific laboratory examinations and clinical trials, and often relies on limited clinical experiences of clinicians. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. Treatment for cervical vertigo is challenging. Manual therapy is recommended for treatment of proprioceptive cervical vertigo. Anterior cervical surgery and percutaneous laser disc decompression are effective for the cervical spondylosis patients accompanied with Barré-Liéou syndrome. As to rotational vertebral artery vertigo, a rare entity, when the exact area of the arterial compression is identified through appropriate tests such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) or digital subtraction angiography (DSA) decompressive surgery should be the chosen treatment.
颈性眩晕的特点是由颈椎引起的眩晕。然而，颈性眩晕是否为一个独立的疾病实体仍存在争议。在这篇叙述性综述中，我们根据当前文献概述了颈性眩晕的基础科学和临床证据。到目前为止，有4种不同的假说来解释颈椎源性眩晕，包括本体感觉性颈性眩晕、巴雷-利厄综合征、旋转椎动脉性眩晕和偏头痛相关性颈源性眩晕。本体感觉性颈性眩晕和旋转椎动脉性眩晕随着时间的推移留存了下来。巴雷-利厄综合征曾一度被否定，但最近随着科学证据的增加又重新受到关注。诊断主要依赖于患者的主观感受，缺乏阳性体征、特定的实验室检查和临床试验，且常常依赖于临床医生有限的临床经验。在将颈痛综合征中的头晕和不稳归因于颈椎起源之前，必须首先排除神经、前庭和心身疾病。颈性眩晕的治疗具有挑战性。推荐手法治疗用于本体感觉性颈性眩晕的治疗。前路颈椎手术和经皮激光椎间盘减压术对伴有巴雷-利厄综合征的颈椎病患者有效。对于旋转椎动脉性眩晕这种罕见的疾病，当通过磁共振血管造影（MRA）、计算机断层血管造影（CTA）或数字减影血管造影（DSA）等适当检查确定动脉受压的确切部位时，减压手术应作为首选治疗方法。
