Is Your Year-Long Dizziness a Sign of Cervical Spine Issues?

Is dizziness for over a year related to cervical spondylosis?

Hello, doctor.
I have been experiencing dizziness for over a year.
After undergoing numerous tests, I was diagnosed with severe obstructive sleep apnea and mild fatty liver.
Since the onset of dizziness last year until January of this year, my symptoms have worsened, and I now feel a swaying sensation.
Recently, the dizziness seems to have intensified, especially in the cold weather here in Australia, becoming more pronounced after noon and worsening at night, particularly after taking a hot shower, which feels like the blood vessels in the back of my head are dilating.
I walk every morning, but I spend most of my time sitting.
The symptoms lessen or disappear when I sit or lie down.
I believe the issue is primarily related to my head, as I sometimes experience tremors, numbness in my hands and feet, and occasional gastric burning sensations.
I also find myself losing patience and wonder when I will recover.
At night, I cannot rest my head on the back of my neck without feeling a sense of pressure; if I avoid that position, I sleep better, but once I fall asleep, I can end up pressing on it again.

I have undergone a CT scan of the brain, X-rays, MRI, intracranial ultrasound, EEG, balance testing, eye movement testing, echocardiogram, ECG, 24-hour Holter monitor, exercise ECG, cervical CT, autoimmune tests, liver and kidney ultrasound, colonoscopy, blood tests, and urinalysis.
Aside from the severe obstructive sleep apnea (which I have had for seven years), there are no significant issues, although I do have mild fatty liver and cervical endplate osteophytic lipping posteriorly at C3/4, minimal annular bulging at C2/3 and C3/4, minimal posterocentral broad-based protrusion at C4/5 slightly indenting the thecal sac, and mild broad-based posterocentral protrusion at C5/6 also slightly indenting the thecal sac.
The neural foramina are spacious, and there is no evidence of exiting nerve root compression.
Last year, I experienced sensations similar to earthquakes, but the swaying symptoms began in mid-January of this year.
I noticed that heat application to my neck or taking a hot shower would make me feel more dizzy, and even after neck traction performed by a therapist, I would feel more dizzy.
Initially, I thought it might be cervical spondylosis, as I sometimes experience numbness in my hands and feet (especially on the left side).
Western medicine suggested it might be psychosomatic.
Additionally, spending too much time in an air-conditioned room can make me uncomfortable, and my dizziness seems to worsen during bad weather.
My massage therapist noted that my neck and shoulder muscles are not stiff, but I do feel tightness near the Fengchi point.
After each massage, gua sha, or physical therapy session, I often feel uncomfortable for a day or two.
The swaying sensation only started in mid-January of this year, and I also experienced a cooling sensation in my left foot at that time.
This ongoing dizziness has significantly impacted my daily life, and I am currently walking for exercise and taking traditional Chinese medicine for two months.
However, the dizziness does not seem to have improved, and I feel somewhat irritable.

Doctor, could you please tell me what might be wrong with me? Thank you.

Alvin, 40~49 year old female. Ask Date: 2017/06/20

Dr. Chen Yongxue reply Orthopedics

Hello, cervical spine issues typically do not cause dizziness in patients.
Generally, when dizziness occurs, it is important to investigate the source of the problem, which may require an examination by a neurologist or an otolaryngologist.
Thank you.

Reply Date: 2017/06/20

More Info

Your symptoms of persistent dizziness, especially when combined with the findings from your cervical spine imaging, suggest that there may indeed be a connection between your cervical spine issues and your dizziness. While your MRI results indicate some degenerative changes in the cervical spine, such as minimal annular bulging and mild broad-based protrusions at certain levels, it is important to understand how these findings can relate to your symptoms.

Understanding Cervical Spine Issues and Dizziness
Cervical spine problems can lead to a variety of neurological symptoms, including dizziness. This can occur due to several mechanisms:
1. Nerve Compression: Although your MRI report indicates that there is no evidence of exiting nerve root compression, the presence of protrusions and bulging discs can still affect the cervical spinal cord and surrounding structures. Even minimal compression can lead to symptoms like dizziness, especially if it affects the proprioceptive pathways that help maintain balance.

2. Vestibular Dysfunction: The cervical spine is closely linked to the vestibular system, which is responsible for balance. Dysfunction in the cervical spine can lead to altered proprioceptive input, which can confuse the brain and result in dizziness or a sensation of imbalance.

3. Muscle Tension and Spasms: You mentioned experiencing tightness around the occipital area and that certain therapies exacerbate your dizziness. Muscle tension in the neck can lead to irritation of the nerves and blood vessels that supply the head, potentially contributing to your symptoms.

4. Cervicogenic Dizziness: This is a specific type of dizziness that arises from cervical spine issues. It is characterized by a sensation of unsteadiness or lightheadedness that is often triggered by neck movements or positions.

Other Contributing Factors
Your history of severe obstructive sleep apnea and fatty liver disease may also play a role in your overall health and symptoms. Sleep apnea can lead to intermittent hypoxia (low oxygen levels), which can contribute to cognitive and neurological symptoms, including dizziness. Additionally, the discomfort you experience when lying on your back may be related to your sleep apnea, as this position can exacerbate airway obstruction.

Recommendations for Management
1. Consult a Specialist: Given the complexity of your symptoms, it may be beneficial to consult a neurologist or a specialist in vestibular disorders. They can perform a thorough evaluation and potentially recommend vestibular rehabilitation therapy.

2. Physical Therapy: Engaging in a targeted physical therapy program focusing on cervical spine stabilization and vestibular rehabilitation may help alleviate some of your symptoms. A physical therapist can guide you through exercises that improve neck strength and flexibility, as well as balance training.

3. Monitor Sleep Apnea: Since you have a history of severe sleep apnea, it is crucial to ensure that it is well-managed. Poorly controlled sleep apnea can exacerbate dizziness and other neurological symptoms.

4. Lifestyle Modifications: Consider making lifestyle changes that may help reduce your symptoms. This includes maintaining a healthy weight, engaging in regular physical activity, and avoiding prolonged periods in air-conditioned environments if they exacerbate your symptoms.

5. Medication Review: If you are taking medications, discuss with your healthcare provider whether any of them could be contributing to your dizziness. Sometimes, adjusting dosages or switching medications can lead to improvements.

6. Alternative Therapies: While you are currently using traditional Chinese medicine, it may be worth discussing with your healthcare provider whether any complementary therapies, such as acupuncture or chiropractic care, could be beneficial for your symptoms.

Conclusion
In summary, while your cervical spine issues may be contributing to your dizziness, it is essential to consider the broader context of your health, including sleep apnea and muscle tension. A multidisciplinary approach involving specialists in neurology, physical therapy, and sleep medicine may provide the best chance for improvement. It is crucial to communicate openly with your healthcare providers about your symptoms and any changes you experience as you pursue treatment options.

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