Dizziness is a common sensation, often described as lightheadedness, unsteadiness, or a feeling of spinning. This symptom can arise from various sources, making its underlying cause sometimes challenging to identify. Cervical myelopathy, a condition affecting the spinal cord in the neck, is one potential, though often overlooked, factor that can contribute to feelings of dizziness. This article explores the nature of cervical myelopathy and its possible connections to dizziness, among other neurological symptoms.
What is Cervical Myelopathy?
Cervical myelopathy is a condition characterized by the compression of the spinal cord within the cervical spine. This compression can lead to a range of neurological issues as the spinal cord’s ability to transmit signals between the brain and body is impaired. The most frequent cause of cervical myelopathy involves age-related degenerative changes in the spine.
These degenerative changes can include the development of bone spurs and the thickening of ligaments, such as the posterior longitudinal ligament. Herniated discs, where the soft inner material of a spinal disc pushes out, can also exert pressure on the spinal cord. All these factors can narrow the spinal canal, a condition called spinal stenosis, thereby compressing the spinal cord.
How Cervical Myelopathy Can Cause Dizziness
Cervical myelopathy can contribute to dizziness through several interconnected mechanisms. One primary way is through proprioceptive dysfunction. Proprioceptors are specialized sensory receptors in muscles, tendons, and joints that provide the brain with information about body position and movement.
Compression of the spinal cord in the neck can disrupt these proprioceptive signals, particularly those from the cervical spine. This abnormal or reduced input from the neck can create a sensory mismatch with information received from the visual and vestibular (inner ear) systems, leading to feelings of imbalance, disorientation, and dizziness.
Another mechanism involves vertebrobasilar insufficiency. Mechanical compression might affect the vertebral arteries, which supply blood to brain regions important for balance and coordination. Reduced blood flow to these areas could manifest as dizziness or vertigo. Additionally, chronic neck pain and stiffness, often associated with cervical myelopathy, can directly contribute to dizziness, sometimes termed cervicogenic dizziness. This type of dizziness results from abnormal sensory input originating from the neck’s musculoskeletal structures. Spinal cord compression may also affect autonomic nervous system functions, which could indirectly contribute to symptoms like lightheadedness or dizziness.
Other Common Signs of Cervical Myelopathy
Dizziness is often not the only symptom experienced by individuals with cervical myelopathy. Many people also report neurological symptoms in their arms, hands, legs, or feet, such as numbness, tingling, or weakness.
Difficulty with fine motor skills is a frequent complaint, making everyday tasks like buttoning a shirt, writing, or handling small objects challenging. Balance and gait disturbances are also common, manifesting as unsteadiness, stumbling, or a feeling of being off-balance, which can increase the risk of falls. Neck pain and stiffness can also be present. In advanced stages, individuals may experience bladder or bowel dysfunction.
Diagnosis of Cervical Myelopathy
Diagnosing cervical myelopathy begins with a thorough medical history and a comprehensive physical examination. During the examination, a healthcare professional assesses muscle strength, reflexes, and coordination to identify any neurological deficits. They may also observe gait and test fine motor skills.
Imaging studies are important for confirming the diagnosis. Magnetic Resonance Imaging (MRI) of the cervical spine is the primary diagnostic tool, as it visualizes the spinal cord and any areas of compression. X-rays and Computed Tomography (CT) scans may also be used to evaluate bone structure, spinal alignment, and to identify bone spurs or other degenerative changes. Electrophysiological tests, such as electromyography (EMG) and nerve conduction studies (NCS), may be performed to differentiate myelopathy from other nerve conditions. Consulting a healthcare professional is important for an accurate diagnosis and appropriate management plan.
Management and Treatment Approaches
Once cervical myelopathy is diagnosed, treatment approaches vary based on the severity of the condition and the progression of symptoms. Conservative management options are often considered for mild cases or as an initial approach. These may include physical therapy to improve strength, flexibility, and posture, as well as medication to manage pain and inflammation.
Activity modification, which involves adjusting daily routines to reduce stress on the neck, and short-term use of neck bracing may also be recommended. For individuals with progressive neurological symptoms or significant spinal cord compression, surgical intervention is frequently considered. Surgical procedures aim to decompress, or relieve pressure on, the spinal cord. Common surgical techniques include laminectomy, laminoplasty, and discectomy with fusion, which can be performed from either the front or back of the neck.