Dizziness and vertigo account for over eight million primary care visits in the US each year. Disequilibrium may arise from one or multiple anatomical structures. “Central” origins include the brain stem, cerebellum, or other supratentorial structures (or the vasculature supplying those tissues). “Peripheral” origins include the vestibular, visual, and spinal proprioceptive systems.
The most common cause of vertigo is from a peripheral source: the cervical spine. Proprioceptive input from the cervical spine plays a critical role in the maintenance of balance. Most researchers ascribe to an altered “mechanoreceptive” theory as the origin to cervicogenic vertigo. The upper cervical (C0-3) facet joints are highly innervated, supplying up to 50% of all cervical proprioceptive input. Abnormal stimulation of the articular capsule and muscle spindle mechanoreceptors from joint dysfunction or muscle hyperactivity provides conflicting input with visual and vestibular afferents. This sensory mismatch between visual, vestibular, and cervical mechanoreceptive input “confuses” the brain into a temporary state of dizziness.
New research from Peng (2018) implicates cervical spine degeneration as a trigger for vertigo.
“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 hypertonic 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.” (1)
True cervicogenic vertigo typically responds to chiropractic manipulation, myofascial release, and rehab exercises. These patients are often home runs that would otherwise fail medical management. Medicine may be a good treatment option for many chemical problems, but cervicogenic vertigo is a mechanical problem.
Cliff Atwell, B.S., D.C.