Cervical spine degenerative conditions will potentially mimic cerebral pathologies. Some of the examples are illustrated below:
Vertebral Artery Syndrome
Vertebral Artery Syndrome is characterized by recurrent transient episodes of cerebral symptoms, dizziness, nystagmus, and sudden postural collapse
The acute attack is precipitated by rotation and hyperextension of the neck which results in temporary occlusion of the vertebral artery (transient cerebral ischemia)
Combinations of
- Cerebrovascular arteriosclerosis
- Cerebral spondylosis
In brief anatomy, the vertebral artery is the tributaries of the basilar artery
So, the vertebral artery when blocked momentarily during rotation and hyperextension, the symptoms appear like dizziness, and when compression is released symptoms subside.
In the case of advanced cervical degeneration, the vertebral artery is displaced which is compressed by osteophytes at the level of transverse foramina. So, during small movement of cervical spine there is Complete vertebral block
Diagnosis
- MRI/ CT angiography
Treatments
Different treatment options are available from conservative to operative.
- Preventing extreme hyperextension and rotation by applying a cervical collar brace
- Cervical isometric exercises help
- Severe focal compression at one at transverse foramina + symptoms: Surgical Decompression
- Diffuse block + symptoms: Carotid end atherectomy, Improve collaterals.
Syndrome of Greater occipital nerve
Syndrome of the greater occipital nerve is characterized by sub occipital unilateral pain due to sub occipital compression by degenerative pathology.
Rotator movement of the neck combined with hyperextension is the predisposing cause of pain
The degenerative joint disease of the atlantoaxial joint is seen
The painful episode occurs mostly at night
Numbness and tingling of parietal and occipital area of scalp
On examination, there is tenderness seen at the region of the 2nd cervical root as well as the course of the greater occipital nerve
Pain may be produced by rotating the occiput towards the painful site or by hyperextending the neck
Investigation
Open mouth/ lateral radiographs are usually Normal
Treatment:
Option varies from conservative to operative
- Conservative with cervical traction + oral NSAIDs
- Steroid injection over tender area in sub occipital region
- Rarely, operative management is required where 2nd cervical nerve root is explored at the C1- C2 joint and decompressed
