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Objective: To analyze the correlation between TCM syndromes types of cervical vertigo and detection results of transcranial ultrasound cerebral artery blood flow. Methods: Patients with cervical vertigo admitted from May 2021 to May 2023 were selected as the research subjects. According to different TCM syndromes types, they were divided into phlegm-dampness retention group, liver-yang hyperactivity group, liver-kidney yin-deficiency group and qi-blood deficiency group, with 20 cases in each group. 30 patients with healthy physical examination were included in control group, and they were given Doppler ultrasound examination. The Doppler ultrasound features and cerebral artery blood flow changes [peak systolic blood flow velocity (Vs), mean blood flow velocity (Vm), peak diastolic blood flow velocity (Vd) and pulsatility index (PI) of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were analyzed among patients with different TCM syndromes types and control group. Results: Vs values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in phlegm-dampness retention group, liver-kidney yin-deficiency group and qi-blood deficiency group were lower than those in control group(P<0.05). The Vs values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in liver-yang hyperactivity group were higher than those in control group (P<0.05). Comparison of Vs among different TCM syndromes types groups was as follows: liver-yang hyperactivity group> phlegm-dampness retention group> liver-kidney yin-deficiency group > qi-blood deficiency group, and the Vs values of left and right vertebral arteries and basilar artery in phlegm-dampness retention group were significantly higher than those in control group (P<0.05) while the Vm values of left right middle cerebral artery were significantly lower (P<0.05). The Vm values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were higher in liver-yang hyperactivity group than those in control group (P<0. 05), and were lower in liver-kidney yin-deficiency group than those in control group (P<0.05). The Vm values of left and right middle cerebral arteries in qi-blood deficiency group were lower compared with those in control group (P<0.05), and there were no significant differences in Vm values of left and right vertebral arteries and basilar artery compared to control group (P>0.05). Vm comparison of different TCM syndromes types groups was shown as liver-yang hyperactivity group> phlegm-dampness retention group > qi-blood deficiency group > liver-kidney yin-deficiency group. Compared with control group, the Vd values of left and right vertebral arteries and basilar artery in phlegm-dampness retention group were lower (P<0.05) while the Vd values of left and right middle cerebral arteries were higher (P<0.05). The Vd values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were lower in liver-yang hyperactivity group than those in control group (P<0.05). The Vd values of left and right vertebral arteries and middle cerebral artery in liver-kidney yin-deficiency group were lower than those in control group (P<0.05), and there was no difference in basilar artery Vd compared to control group (P>0.05). The Vd values of left and right vertebral arteries in qi-blood deficiency group were lower than those in control group (P<0.05), and there was no significant difference in basilar artery Vd compared with that in control group (P>0.05), and the Vd values of left and right middle cerebral arteries were significantly higher than those in control group (P<0.05). Vd in different TCM syndromes types groups was as follows: qi-blood deficiency group phlegm-dampness retention group> liver-kidney yin-deficien- cy group > liver-yang hyperactivity group. The PI values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in phlegm-dampness retention group and qi-blood deficiency groups were lower than those in control group (P<0.05). The PI values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were higher in liver-yang hyperactivity group and liver-kidney yin-deficiency group than those in control group (P<0.05). Comparison of PI in different TCM syndromes types groups was manifested as liver-yang hyperactivity group liver-kidney yin-deficiency group phlegm-dampness retention group> qi-blood deficiency group. Conclusion: Patients with vertigo of different TCM syndromes types have different degrees of cerebral arterial hemodynamic abnormalities, and there are differences among different groups. Transcranial Doppler ultrasound examination can provide reference value for the TCM syndromes types of vertigo. [ABSTRACT FROM AUTHOR]

Objective: To observe the clinical application value of the treatment of cervical vertigo with acupuncture of "dredging governor vessel". Methods: 296 patients with cervical vertigo who were admitted to Shanghai Traditional Chinese Medicine Hospital from May 2020 to March 2022 were selected, they were divided into study group and control group by the dual color sphere method, each with 148 cases. The study group received acupuncture treatment based on the principle of "dredging governor vessel", and the control group received routine acupuncture treatment. The traditional chinese medicine efficacy, clinical symptom scores [evaluation scale for cervical vertigo (ESCV), visual analog scale (VAS)], arterial blood flow velocity, and hemorheology indexes were compared between the two groups. Results: The total clinical effective rate of the study group was higher than that of the control group (P<0.05). After treatment, the ESCV scores of the study group was higher than that of the control group, while the VAS scores was lower than that of the control group (P<0.05). After treatment, the pulsatility index (PI) of basilar artery (BA) and bilateral cerebral (L, R) vertebral artery (VA) of the study group were lower than those of the control group, and the average blood flow velocity (Vm) was higher than that of the control group (P<0.05). After treatment, the whole blood viscosity high shear (HBV), whole blood viscosity low shear (LBV), hematocrit (HCT), plasma viscosity (PV), erythrocyte aggregation index (AI), whole blood reduced viscosity (RV), erythrocyte rigidity index (IR), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), erythrocyte electrophoresis time (EET) of the study group were lower than those of the control group (P<0.05). Conclusion: The treatment of cervical vertigo with acupuncture of "dredging governor vessel", which can effectively improve the symptoms of pain and vertigo, regulation of cerebral blood flow velocity, and hemorheological indexes. [ABSTRACT FROM AUTHOR]

Objective To explore the curative effect of Quick needling combined with Jingshu Granule on cervical vertigo in patients with blood stasis and qi stagnation pattern. Methods A total of 106 cervical vertigo patients with blood stasis and qi stagnation pattern admitted to the hospital from November 2019 to August 2022 were selected and divided into observation group (n = 53) and control group (n = 53) by random number table method. The control group was treated with Jingshu granule, and the observation group was treated with Quick needling combined with Jingshu granule. The effects of continuous treatment for 8 weeks in both groups were observed. TCM syndrome score, vertigo improvement and clinical efficacy were compared between the two groups. The improvement of inflammatory factors, vasomotor factors and vertebrobasilar hemodynamics in peripheral blood was compared between the two groups. The occurrence of adverse reactions during treatment was recorded and compared between the two groups. Results The TCM syndrome scores of the main and secondary symptoms of the two groups after treatment were lower than before treatment (P < 0.05), and the TCM syndrome scores of the main and secondary symptoms of the observation group after treatment were lower than those of the control group (P < 0.05 ). Dizziness handicap inventory (DHI) scores of both groups after treatment were lower than before treatment (P < 0.05 ), DHI scores of the observation group were lower than that of the control group after treatment (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05 ). After treatment, the tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) and C-reactive protein (CRP) in both groups were lower than before treatment (P < 0.05), and the TNF-a, IL-6 and CRP in the observation group were lower than that of the control group (P < 0.05). Endothelin-1 (ET-1) and 5-hydroxytryptamine (5-HT) after treatment were lower than before treatment, nitric oxide (NO) was higher than before treatment (P < 0.05), ET-1 and 5-HT in observation group after treatment were lower than those of the control group, and NO was higher than that of the control group (P < 0.05 ). The blood flow velocity of left vertebral artery, right vertebral artery and basilar artery in both groups after treatment was higher than before treatment (P < 0.05), and the blood flow velocity of left vertebral artery, right vertebral artery and basilar artery in the observation group after treatment was higher than those of the control group (P < 0.05). There was no obvious adverse reaction in both groups during treatment. Conclusion For the treatment of cervical vertigo patients with blood stasis and qi-stagnation pattern, the combination of Quick needling and Jingshu Granule could enhance clinical efficacy, inhibit the synthesis of inflammatory factors in peripheral blood, improve vasomotor factors and vertebrobasilar hemodynamics, with good safety. It has certain clinical application value. [ABSTRACT FROM AUTHOR]

Objectives: The concrete mechanism underlying the pathogenesis of cervical vertigo has not been well illustrated. This study aims to determine the diagnostic and potential therapeutic values of the neurotransmitter neuropeptide Y (NPY) in cervical vertigo. Methods: Sixty male rabbits were randomly divided into five groups: the blank control, superior cervical sympathetic ganglia (SCSG) stimulation, SCSG sham-operated control (ganglion exposure and electrode placement in SCSG), inferior cervical sympathetic ganglia (ICSG) stimulation, and ICSG sham-operated control (ganglion exposure and electrode placement in ICSG) groups. Electrical stimulation at 30.0 Hz and 10.0 V for 5 min was delivered to expose SCSG or ICSG. Immunochemistry was conducted to determine the expression levels of NPY in all cervical spinal ganglia (C1–C8) dissected immediately after electrical stimulation. Results: According to the immunohistochemical results, the blank control group only had few NPY-positive cells and was not significantly different with the sham-operated group. However, after SCSG stimulation, more NPY-positive cells in C2, C3, C4, and C5 were observed (C2 and C3 were the most evident). After ICSG stimulation, more NPY-positive cells were found in C6, C7, and C8, particularly in C6 and C7. Conclusions: The low expression of NPY in all cervical ganglia (C1–C8) can be enhanced by electrical stimulation, whereas the expression of NPY in the cervical sympathetic ganglia was not affected by mechanical stimulation. This study provided new insights into the possible relationship between the neurotransmitter NPY and the pathogenesis of cervical vertigo.

This article aims to evaluate the treatment effect of micro acupotomy and stellate ganglion stimulation on cervical vertigo. 90 patients with cervical vertigo were randomly divided into two groups, observation group and control group, with 45 cases in each group. The observation group was given micro acupotomy and stellate ganglion stimulation and the control group was given regular acupuncture treatment. The two groups were treated for 2 w. The therapeutic effect and evaluation of symptoms and functions of cervical vertigo score of the two groups of patients after treatment were observed. The mean blood flow levels of vertebrobasilar artery, right vertebral artery and left vertebral artery before and after treatment were observed. The results show that there were significant differences in mean changes of vertigo symptoms and functional scores between the two groups of patients (p<0.01) and the improvement of the observation group was larger than that of the control group (p<0.05); there was significant difference in the speeds of the blood flow of the vertebral-basal artery between the two groups before and after treatment (p<0.05) and the improvement of the observation group was larger than that of the control group (p<0.05). By comparison, the clinical effects of the two groups were statistically different (p<0.05), no side effects occurred in the two groups of patients. Micro acupotomy combined with stellate ganglion stimulation is effective in treating cervical vertigo. [ABSTRACT FROM AUTHOR]

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Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P

This paper introduces Professor WANG Haidong 's approach to treat cervical vertigo with needle knife based on the holism of body- qi -spirit. Professor WANG Haidong , considering the etiology and pathogenesis of cervical vertigo, starting from the holism of body- qi -spirit, based on the anatomical structure, employs the "seven-neck points" technique to improve local blood supply and address the physical issue; guided by the Jingjin theory, he utilizes the "knot releasing technique" to disperse knots and relax sinews, thereby regulating qi . In addition, he uses the "bone puncturing technique at governor vessel" to uplift yang - qi and nourish the brain, thereby nurturing the spirit.

Objective: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA)., Methods: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months., Results: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively ( t =12.97, P <0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively ( t =11.83, P <0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively ( t =-15.96, P <0.05)., Conclusion: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.

Objective: To observe the clinical effect of nape seven needles combined with pressing moxibustion for cervical vertigo (CV)., Methods: A total of 70 patients with CV were randomized into an observation group and a control group, 35 cases in each group. In the observation group, nape seven needles combined with pressing moxibustion was delivered, once a day, 6 times a week, for consecutive 2 weeks. In the control group, betahistine hydrochloride tablet and aceclofenac dispersible tablet were given orally, for 2 weeks and 3 days respectively. Before and after treatment, the evaluation scale for cervical vertigo (ESCV) score was observed, the plasma levels of neuropeptide Y (NPY), endothelin-1 (ET-1) and calcitonin gene related peptide (CGRP) were detected, the hemorheologic and hemodynamic indexes were measured, and the clinical efficacy was evaluated after treatment in the two groups., Results: After treatment, the scores of dizziness, daily life and work ability, psychological and social adaptability, and headache, as well as the total scores of ESCV were increased compared with those before treatment ( P <0.01, P <0.05) in the two groups, and the score and total score of neck and shoulder pain of ESCV was increased compared with that before treatment ( P <0.01) in the observation group; each sub-item score and total score of ESCV in the observation group were higher than those in the control group ( P <0.01, P <0.05). After treatment, the plasma levels of NPY and ET-1 were decreased compared with those before treatment ( P <0.01), while the plasma levels of CGRP were increased compared with those before treatment ( P <0.01, P <0.05) in the two groups; the plasma levels of NPY and ET-1 in the observation group were lower than those in the control group ( P <0.01), the plasma level of CGRP in the observation group was higher than that in the control group ( P <0.01). After treatment, the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity were decreased compared with those before treatment ( P <0.01, P <0.05), the mean velocity of basilar artery (BA), left vertebral artery (LVA) and right vertebral artery (RVA) were increased compared with those before treatment ( P <0.05) in the two groups; the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity in the observation group were lower than those in the control group ( P <0.01), and the mean velocity of BA, LVA and RVA in the observation group were higher than those in the control group ( P <0.05). The total effective rate in the observation group was 91.4% (32/35), which was superior to 71.4% (25/35) in the control group ( P <0.05)., Conclusion: Nape seven needles combined with pressing moxibustion can effectively alleviate the clinical symptoms, and improve the hemorheology and hemodynamics in CV patients.

Objectives The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness. Material and Methods Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R–) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded. Results Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R– group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed. Conclusions Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms. Int J Occup Med Environ Health. 2019;32(5):723–33

Objective: To study the distribution of sympathetic nerves of the ligamentum flavum (LF), confirm its existence by histological observation and nuclear magnetic resonance spectroscopy, and analyze the relationship between sympathetic nerve fibers and the biomechanical structure of the LF. Methods: Randomly controlled scientific research selected 15 cases of posterior surgery in the affiliated hospital of Qingdao University from January 2013 to December 2019. The average age was 67.5 ± 14.5 years old, eight males and seven females. The LF specimens (completely separated fresh tissue) of different segments (C3‐7) were taken during the operation. Two pages of LF specimens on the left and right sides of the same segment are randomly allocated by the pairing method for formalin fixation and cryopreservation in liquid nitrogen. LF specimens extracted from seven other adult cadaver specimens (average age at death of about 56.8 ± 4.0 years, three males and four females) were used as a control group; together with formalin‐ fixed specimens obtained during surgery, 3D slices were given layer by layer. The distribution of sympathetic nerves in different parts of the LF was analyzed by glyoxylic acid‐induced biological monoamine fluorescent technique (SPG) and hematoxylin–eosin (HE) staining. Fifteen liquid nitrogen storage specimens were divided into the back of the LF and the spinal canal through frozen sections, and were analyzed by nuclear magnetic resonance spectroscopy‐hydrogen spectrum (1H ‐NMR) for neurotransmitters and neurometabolites. Results: There were type C sympathetic nerve fibers in the LF, which were divided into linear shape (α) and wave shape (β). Experimental group (χ2 = 1.705, P > 0.05) and control group (χ2 = 0.879, P > 0.05) can detect no difference in fluorescence units. Nerve fiber transmitter metabolites choline (Cho), creator (Cr), γ‐aminobutyric acid (GABA) also indicate that the sympathetic nerve is present in the LF. LF sympathetic nerve fibers were mainly distributed in the proximal spinal canal surface, nerve fibers on the medial belt (area II) were fewer than the lateral belt (area I) (W = 210, P < 0.05). The 1HNMR spectrum of LF spinal canal PG / Cho (t = 8.721, P < 0.05), GABA (t = 16.01, P < 0.05) value increased, lactic acid (Lac) / Cr (t = 4.213, P < 0.05), Cho / Cr (t = 2.402, P < 0.05) value decreased, indicating that nerve fibers are actively metabolized on the surface of the spinal canal, mainly distributed in tube surface. βtype fibers were more often distributed around microvessels. A small amount of α type fibers went next to the vascular structures, while α type fibers and β type fibers go cross within LF. Two patients with vertebral artery dissection had no recurrence of sympathetic symptoms within a total of 12 follow‐ups 2 years after discharge. Conclusions: There are many sympathetic nerve fibers distributed on LF, and their distribution may be correlated with histological and mechanical characteristics of LF. It may also be the anatomical basis of cervical vertigo. [ABSTRACT FROM AUTHOR]

The concrete mechanism underlying the pathogenesis of cervical vertigo has not been well illustrated. This study aims to determine the diagnostic and potential therapeutic values of the neurotransmitter neuropeptide Y (NPY) in cervical vertigo. Sixty male rabbits were randomly divided into five groups: the blank control, superior cervical sympathetic ganglia (SCSG) stimulation, SCSG sham-operated control (ganglion exposure and electrode placement in SCSG), inferior cervical sympathetic ganglia (ICSG) stimulation, and ICSG sham-operated control (ganglion exposure and electrode placement in ICSG) groups. Electrical stimulation at 30.0 Hz and 10.0 V for 5 min was delivered to expose SCSG or ICSG. Immunochemistry was conducted to determine the expression levels of NPY in all cervical spinal ganglia (C1–C8) dissected immediately after electrical stimulation. According to the immunohistochemical results, the blank control group only had few NPY-positive cells and was not significantly different with the sham-operated group. However, after SCSG stimulation, more NPY-positive cells in C2, C3, C4, and C5 were observed (C2 and C3 were the most evident). After ICSG stimulation, more NPY-positive cells were found in C6, C7, and C8, particularly in C6 and C7. The low expression of NPY in all cervical ganglia (C1–C8) can be enhanced by electrical stimulation, whereas the expression of NPY in the cervical sympathetic ganglia was not affected by mechanical stimulation. This study provided new insights into the possible relationship between the neurotransmitter NPY and the pathogenesis of cervical vertigo. [ABSTRACT FROM AUTHOR]

Good short- and mid-term clinical efficacy of percutaneous cervical nucleoplasty (PCN) for cervical degenerative diseases (CDD) with neck pain has been reported. However, few studies have assessed its long-term influence in patients with both neck pain and cervical vertigo. This study aimed to evaluate the curative efficacy of PCN for CDD with neck pain and cervical vertigo with minimum of 6 years of follow-up. Inpatients who underwent PCN for CDD with neck pain and cervical vertigo between April 2010 and March 2013 were enrolled. Clinical outcomes were assessed using the Cervical Vertigo Evaluation Scale (CVES); greater CVES scores reflected less impairment. Additional open surgeries were recorded. Among 40 patients, 100% completed the 1-year short-term and 3-year mid-term follow-up (FU); 85% completed the 6-year long-term FU. Clinical effective rates were 67.5%, 67.5%, and 52.94% at short-, mid-, and long-term FU, respectively. CVES scores were greater than the preoperative CVES scores at all FU timepoints (P < 0.01). However, the CVES score was lower at the final FU than at the 3-year FU (P < 0.05). The neck pain score significantly decreased over time and was lower than the cervical vertigo score at the final FU (P > 0.05). Reoperation rates were 1/40 (2.50%) and 3/34 (8.82%) at mid- and long-term FU, respectively. PCN in patients with CDD neck pain and cervical vertigo showed satisfactory clinical efficacy at short- and mid-term FU, and it was fair at long-term FU. Thus, PCN could be a complementary operation for CDD. [ABSTRACT FROM AUTHOR]

Objectives: Large sample and high-quality evidence to evaluate the preliminary safety of the mobilizations and massage for cervical vertigo are not yet available. Thus, the present study aimed to investigate the comparative effectiveness and preliminary safety of Shi-style cervical mobilizations (SCM) compared with traditional massage (TM) in cervical vertigo patients. Design: A prospective, multicenter, open-label, randomized, controlled clinical trial with a 1:1 allocation ratio. Settings: Five academic medical centers. Subjects: A total of 360 adult patients with a diagnosis of cervical vertigo. Interventions: The patients were randomly allocated to either an SCM (n = 180) or TM (n = 180) group. The patients were treated during six sessions over 2 weeks. The primary outcome was the Dizziness Handicap Inventory (DHI) total scale score, and secondary outcomes included the DHI subscales, Chinese version of the Short-Form 36 Health Survey (CSF-36), and adverse events (AEs). Outcomes were assessed in the short term at 2 weeks, 1 month, and 3 months, and in the intermediate term at 6 months after randomization. Results: Significant changes were observed from the baseline in the DHI total scale and subscales at 2 weeks and 1, 3, and 6 months in both groups (all p < 0.05). However, the differences between the two groups were not significant (all p > 0.05). Furthermore, we noted significant changes from the baseline in SF-36 scores at 2 weeks in both groups (all p < 0.05), whereas CSF-36 scores were not significantly higher in the SCM group (all p > 0.05) compared with the TM group. No serious AEs were reported in either of the two groups. Conclusions: No differences in outcomes were detected between the SCM and TM groups in terms of treatment of cervicogenic dizziness. Efficacy trials are required to determine whether the improvement observed for each treatment was causally related to the interventions. [ABSTRACT FROM AUTHOR]

Abstract Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3D-trunk-excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.

Objectives: The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness.Material and Methods: Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R-) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded.Results: Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R- group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed.Conclusions: Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms. Int J Occup Med Environ Health. 2019;32(5):723-33. [ABSTRACT FROM AUTHOR]

Objective: To use a unique, 41‐question survey to identify patient features distinguishing cervical vertigo from vestibular causes of vertigo and vestibular migraine. Methods: In this study, a unique, 41‐question survey was administered to 48 patients diagnosed with cervical vertigo (n = 16), migraine (n = 16), and vestibular vertigo (eg, unilateral vestibular paresis, Meniere's disease) (n = 16) to test the hypothesis that a set of distinct symptoms can characterize cervical vertigo. Responses between the three diagnostic groups were compared to identify questions which differentiated patients based on their symptoms. Results: Eight questions were successful in differentiating vestibular vertigo from migraine and cervical vertigo. Symptoms endorsed by subjects with cervical vertigo overlapped substantially with subjects with well‐established vestibular disturbances as well as symptoms of subjects with migraine. Twenty‐seven percent of cervical vertigo subjects reported having true vertigo, 50% having headache, and 94% having neck pain. Conclusion: Lacking knowledge of neck disturbance, the symptoms we elicited in our questionnaire suggest that cervical vertigo subjects may resemble migraine subjects who also have evidence of neck injury. Whether or not subjects with "cervical vertigo" also overlap with other diagnoses defined by a combination of symptoms and exclusion of objective findings such as chronic subjective dizziness and other variants of psychogenic dizziness remain to be established. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Background: Vertigo or giddiness is a common symptom seen in patients attending ENT OPD. Vestibular and neurological pathologies being the known common causes. Cervical spondylosis is being established as a common condition leading to vertigo. Our aim is to evaluate the significance of cervical spondylosis as a cause in patients with vertigo. Methods: Hundred patients of either sex, between the age group of 23-64 years, with vertigo were evaluated with complete history and clinical examination followed by PTA and impedance audiometry. All common causes of vertigo were ruled out and these patients were screened with digital x-ray cervical spine in lateral view to rule out cervical spondylosis. The results were analysed statistically using Chi square test and inference was drawn. Results: Out of 100 (100%) patients evaluated, 58 (58%) were female patients and 42 (42%) male patients. Cervical spondylosis was found to be present in 47 (47%) patients. Conclusions: Cervical spondylosis was found as a common finding in patients with vertigo. It can be ruled out easily using a simple investigation of cervical spine x-ray, in patients where other commoner causes cannot be established. [ABSTRACT FROM AUTHOR]

Purpose: Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other.Methods: This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers’ understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links.Results: Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm.Conclusions: So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness. [ABSTRACT FROM AUTHOR]

Cervical vertigo has long been a controversial entity, which is general ly accepted in practice by the medical com munity. We present the sum mary of contemporary knowledge of the scientific bio graphy of cervical vertigo, pos sible etiology, dia gnosis and treatment. This disorder is overdia g - nosed and there is still no laboratory or clinical test to confirm the dia gnosis, while none of the pos sible theories provide fully convinc ing evidence of a cervical mechanism. Appropriate management is difficult and mostly empirical. [ABSTRACT FROM AUTHOR]

Vertigo is one of the most common presentations in adult patients. Among the various causes of vertigo, so-called cervical vertigo is still a controversial entity. Cervical vertigo was first thought to be due to abnormal input from cervical sympathetic nerves based on the work of Barré and Liéou in 1928. Later studies found that cerebral blood flow is not influenced by sympathetic stimulation. Ryan and Cope in 1955 proposed that abnormal sensory information from the damaged joint receptors of upper cervical regions may be related to pathologies of vertigo of cervical origin. Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in tense neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness. Further studies are needed to illustrate the complex pathophysiologic mechanisms of cervical vertigo and to better understand and manage this perplexing entity. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Case series. BACKGROUND: Although growing recognition of cervicogenic dizziness (CGD) is emerging, there is still no gold standard for the diagnosis of CGD. The purpose of this case series is to describe the clinical decision making utilized in the management of 7 patients presenting with CGD. CASE DESCRIPTION: Patients presenting with neck pain and accompanying subjective symptoms, including dizziness, unsteadiness, light-headedness, and visual disturbance, were selected. Clinical evidence of a temporal relationship between neck pain and dizziness, with or without sensorimotor disturbances, was assessed. Clinical decision making followed a 4-step process, informed by the current available best evidence. Outcome measures included the numeric rating scale for dizziness and neck pain, the Dizziness Handicap Inventory, Patient-Specific Functional Scale, and global rating of change. OUTCOMES: Seven patients (mean age, 57 years; range, 31-86 years; 7 female) completed physical therapy management at an average of 13 sessions (range, 8-30 sessions) over a mean of 7 weeks. Clinically meaningful improvements were observed in the numeric rating scale for dizziness (mean difference, 5.7; 95% confidence interval [CI]: 4.0, 7.5), neck pain (mean difference, 5.4; 95% CI: 3.8, 7.1), and the Dizziness Handicap Inventory (mean difference, 32.6; 95% CI: 12.9, 52.2) at discontinuation. Patients also demonstrated overall satisfaction via the Patient-Specific Functional Scale (mean difference, 9) and global rating of change (mean, +6). DISCUSSION: This case series describes the physical therapist decision making, management, and outcomes in patients with CGD. Further investigation is warranted to develop a valid clinical decision-making guideline to inform management of patients with CGD. LEVEL OF EVIDENCE: Diagnosis, therapy, level 4. [ABSTRACT FROM AUTHOR]

Background: The primate ocular motor system is designed to acquire peripheral targets of interest by coordinating visual, vestibular, and neck muscle activation signals. The vestibulo-ocular reflex (VOR) is greatly reduced at the onset of large eye-head (gaze) saccades and resumes before the end of the saccades to stabilize eye-in-orbit and ensure accurate target acquisition. Previous studies have relied on manipulating head movements in normal individuals to study VOR suppression and gaze kinematics. We sought to determine if reduced head-on-trunk movement alters VOR suppression and gaze accuracy similar to experiments involving normal subjects and if intentionally increasing head and neck movement affects these dynamics. Methods: We measured head and gaze movements using magnetic search coil oculography in eight patients with cervical soft tissue disorders and seven healthy subjects. All participants made horizontal head-free saccades to acquire a laser dot target that stepped pseudorandomly 30-65° to either side of orbital mid-position, first using typical head and eye movements and again after being instructed to increase head amplitudes as much as possible. results: Compared to healthy subjects, patients made smaller head movements that contributed only 6% to total gaze saccade amplitudes. Head movements were also slowed, prolonged, and delayed. VOR suppression was increased and prolonged. Gaze saccades were inaccurate and delayed with long durations and decreased peak velocities. conclusion: In patients with chronic neck pain, the internal commands issued for combined eye-head movements have large enough amplitudes to create accurate gaze saccades; however, because of increased neck stiffness and viscosity, the head movements produced are smaller, slower, longer, and more delayed than they should be. VOR suppression is disproportionate to the size of the actual gaze saccades because sensory feedback signals from neck proprioceptors are non-veridical, likely due to prolonged coactivation of cervical muscles. The outcome of these changes in eye-head kinematics is head-on-trunk stability at the expense of gaze accuracy. In the absence of vestibular loss, the practical consequences may be dizziness (cervical vertigo) in the short term and imbalance and falls in the long term. [ABSTRACT FROM AUTHOR]

Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3Dtrunk-excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of three vertigo-stopping needles on the contents of neuropeptide Y (NPY), endothelin (ET) and calcitonin gene-related peptide (CGRP) in plasma of patients with cervical vertigo, and to explore its mechanism of treatment. Methods One hundred and eighty patients with cervical vertigo were divided into group A [acupuncture at Rényíng ( ST 9) and Fēngchí ( GB 20), and frontal line], group B [acupuncture at Jing jiāji ( ), GB 20 and Baihuì ( GV 20)] and group C [intravenous infusion with ligustrazine and oral administration with flunarizine] according to simple randomization, with 60 cases in each group. For the patients in group A and group B, the treatment was conducted once a day, and ten times were considered as one course of treatment. Two days were free of treatment between two courses, and two courses were needed. For the patients in group C, the treatment was conducted for fifteen days. The contents of NPY, ET and CGRP in plasma before and after treatment were detected in patients with cervical vertigo. Results The contents of NPY in plasma of patients in the three groups after treatment were markedly lower than that before treatment (all P <0.01), and the differences were not statistically significant when compared the descending degrees among three groups ( P >0.05). The contents of ET in plasma of patients in the three groups after treatment were markedly lower than that before treatment ( P <0.05, P <0.01), the descending degree in group A was greater than that in group B and group C, and the difference was statistically significant ( P <0.01, P <0.05); while the difference was not statistically significant when compared the descending degrees between group B and group C ( P >0.05). The contents of CGRP in plasma of patients in the three groups after treatment were markedly higher than that before treatment ( P <0.05, P <0.01), the increasing degree in group A was greater than that in group B and group C, and the difference was statistically significant (both P <0.05); while the difference was not statistically significant when compared the increasing degrees between group B and group C ( P >0.05). Conclusion Three vertigo-stopping needles, acupuncture and medication can regulate the contents of NPY, ET and CGRP in plasma of patients with cervical vertigo, while three vertigo-stopping needles is significantly superior to acupuncture and medication in reducing ET and increasing CGRP. [ABSTRACT FROM AUTHOR]

Cervical vertigo is a syndrome of vertigo caused by cervical factors, happens more frequently in 40 years old, its clinical manifestations include vertigo, headache, tinnitus, deafness, nystagmus, nausea, vomiting, shoulder pain, palpitations, sweating. The symptoms are complex and not typical, so patients with cervical vertigo often suffer from the diseases of ENT Department and neurological Department. Some researches show that cervical vertigo accounts for 50% in the patients suffering from vertigo who were about 50 years old, the complexity of symptoms and high prevalence rate greatly affect patients' health and life. At present, the pathogenesis, diagnostic criteria and treatment methods are still not completely clear, which often leads to the misdiagnosis and mistreatment, and no treatment can completely cure the disease. Surgery is rarely applied on this disease and conservative treatment is the mainly used for it, including massage therapy, traction therapy, acupuncture and physiotherapy and Chinese and Western medicine therapy, nerve block treatment, etc. This article mainly review the research advancement of coservative treatment of cervical vertigo. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of moxibustion at Baihui (CV20) combined with acupuncture in treatment of cervical vertigo., Methods: From the databases, such as CNKI, VIP, WanFang, CBM, PubMed, Cochrane Library and Embase, the studies of randomized controlled trials (RCTs) on moxibustion at CV20 combined with acupuncture for cervical vertigo were searched from inception to September 15 th , 2021. The Cochrane risk of bias assessment tool was utilized to evaluate the quality of the included literature. Using RevMan5.3, Stata12.0 and TSA0.9.5.0 10 Beta software, the Meta-analysis and trial sequential analysis (TSA) were performed., Results: Seventeen RCTs with 1 232 patients were included. Meta-analysis showed that in the trial group (moxibustion at CV20 combined with acupuncture), the total effective rate ( RR =1.17, 95% CI ［1.12, 1.22］, P <0.000 1), the curative and remarkably-effective rate ( RR ＝1.28，95% CI ［1.20，1.36］， P <0.000 1) and the score of cervical vertigo ( WMD =2.88, 95% CI ［1.87, 3.89］, P <0.000 1) were all better when compared with the control group (simple acupuncture or electroacupuncture group). The results of trial sequential analysis indicated that for the cumulative Z-score of each RCT, the Z-curve crossed the conventional test boundary and TSA boundary, which further confirmed the clinical efficacy of moxibustion at CV20 combined with acupuncture on cervical vertigo., Conclusion: The clinical efficacy of moxibustion at CV20 combined with acupuncture is determined in treatment of cervical vertigo.

Our research was conducted to evaluate correlation between cervical myogenic trigger points and disequilibrium. Two groups participated in the research: relevantly healthy and individuals with revealed cervical trigger points. Both groups were evaluated once and on equal terms. It is shown that force plate indexes correlate with cervical trigger points. For instance, it is shown that trigger points affect considerably balance function in the terms of Romberg test. Upper portion of trapezoids muscle have comparatively slight impact on individual's stability. Other cervical factor effects on balance are supposed. [ABSTRACT FROM AUTHOR]

Abstract: Background context: A functional association between cervix and vertigo has been observed in patients with cervical vertigo, implicating correlation between cervical spinal and sympathetic ganglia. However, it is unclear where there is an anatomic connection between those two groups of ganglia. Purpose: This study aimed to investigate the existence of the neural connections between cervical spinal and sympathetic ganglia. Study design/setting: FluoroGold staining patterns in cervical spinal and sympathetic ganglia were evaluated using FluoroGold retrograde tracing in New Zealand rabbits. Methods: New Zealand rabbits were randomly divided into superior cervical spinal ganglion injection groups, inferior cervical spinal ganglion injection groups, superior cervical sympathetic ganglion injection group, and inferior cervical sympathetic ganglion injection group. Four percent FluoroGold solution was injected into these ganglia. Distribution of FluoroGold in cervical spinal and sympathetic ganglia was observed under a microscope. Results: When FluoroGold solution was injected into C2 and C3 superior cervical spinal ganglia or C5–C6 inferior cervical spinal ganglia, fluorescence was only observed in the ipsilateral superior or inferior cervical sympathetic ganglia, respectively. When FluoroGold solution was injected into superior or inferior cervical sympathetic ganglia, fluorescence was found mainly in the ipsilateral C3–C4 superior or C5–C8 inferior spinal ganglia. No fluorescence was observed in contralateral ganglia of experimental animals and all ganglia of matched control animals injected with physiological saline. Conclusions: Bidirectional nerve fiber connections between cervical spinal and sympathetic ganglia were observed, and these connections are arranged in a segmental distribution. This observation may provide a possible neuroanatomic basis for the pathogenesis of cervical vertigo. [Copyright &y& Elsevier]

Abstract: Intermittent positional down beat nystagmus (p-DBN) is rare. We describe an unusual case of intermittent p-DBN which was induced by rotation, anteflexion, and lateral flexion of the neck. A 59-year-old man complained of loss of consciousness and lightheadedness. Positional testing revealed the p-DBN. The evoked p-DBN had latency and the patient had a feeling of passing out while the p-DBN was present. There were no abnormal findings in the vestibular functional examinations. Findings of the MRI were negative. MRA revealed no stenosis of the vertebral artery bilaterally, but there was an anatomical difference. The p-DBN characteristics were documented by electronystagmography during the positional test. The p-DBN lasted intermittently while maintaining the provoking position. It was found that p-DBN occurred with not only the rotation of the neck, but also in the anteflexion and lateral flexion of the neck. There was no stenosis of the vertebral artery (VA) on angiography, but we speculated that the cause of the p-DBN was the VA occlusion due to rotation, anteflexion, and lateral flexion of the neck. [Copyright &y& Elsevier]

Cervical vertigo (CV) is defined as vertigo or dizziness due to neck disorders. This paper presents the clinical picture and the results of examinations of three patients who have been referred to the Department of Audiology and Phoniatrics in Łódź for dizziness of unknown etiology. The clinical picture of the patients seemed to vary, from central dizziness to vestibular vertigo. The history, medical examination and videonystagmography tests helped to exclude the vestibular contribution, neurological examination and magnetic resonance were used to exclude the neurological reasons. Asymmetry of C1-C2 junction observed in open mouth X-ray was the common findings in the symptomatic patients. After a more accurate diagnosis and analysis of functional tests, in each of the persons we observed abnormal blood flow of varying intensity in the vertebral and basilar arteries and dysregulation of vestibulo-oculomotor and cervico-oculomotor reflexes. Atlanto-axial junction functional abnormalities might be one of the reasons of the increased proproceptive stimulation and hemodynamic abnormalities in cerebellar or pontine flow, which may underlie the symptoms in those patients. Study involving a larger group of subjects, and most of all studies using functional angiography could explain the significance of the vascular components in those individuals. Physiotherapy treatment intended to improve the vertebral function will possibly enable to assess the effect of those changes on the reported abnormalities and explain the mechanisms of cervical vertigo. [ABSTRACT FROM AUTHOR]