Association between cervical curvature and cervical sympathetic symptoms
From: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009 Jun;31(3):381-2
To investigate the association between cervical curvature and cervical sympathetic symptoms, the clinical data of 318 patients with cervical spondylosis who underwent surgical treatment in our department between July 2003 and December 2007 were retrospectively analyzed. All patients were divided into group without sympathetic symptoms (n = 284) and group with sympathetic symptoms (n = 34). The curvatures of both groups on cervical lateral radiographs were measured using Borden method and statistical analysis was performed.
The incidence of abnormal cervical curvature in group with cervical sympathetic symptoms were 67.6% (23/34), which was significantly higher than that in group without cervical sympathetic symptoms (50.7%, 144/284). Cervical curvature abnormality may be an independent factor that affects the cervical sympathetic symptoms.
In Zhonghua Wai Ke Za Zhi. 2008 Sep 15;46(18):1424-7, Treatment and mechanism of cervical spondylosis with sympathetic symptoms concluded: The sympathetic nerve fibers distributed in the cervical posterior longitudinal ligament maybe another one significant factor causing sympathetic symptom of cervical spondylosis.
Posterior Cervical Sympathetic Syndrome is a condition that is characterized by a host of cranial symptoms, such as headaches, abnormal functions of the eyes and the ears, and psychological and mental disorders. This syndrome usually appears after neck injuries, inflammation, or neoplasm.”
Sympathetic symptoms related to the neck may include; vertigo, disequilibrium, tinnitus, scotomata, decreased vision, dysphagia, dysphonia, cough, anxiety and asthenia.
History: In 1925, Jean Alexandre Barre, M.D., a French neurologist, and in 1928, Yong-Choen Lieou, a Chinese physician, each independently described a syndrome with a variety of symptoms thought to be due to a dysfunction in the posterior cervical sympathetic nervous system (a group of nerves located near the vertebrae in the neck). The posterior cervical sympathetic syndrome became known as Barre-Lieou Syndrome.
In a case documented in Vertebrogenic autonomic dysfunction-subjective symptoms published in The Journal of the CCA. 1981 Jun;25(2): 51-7,
Mrs. F. presented with neck pain and headaches. She had sustained a whiplash injury 2 years previously and her symptoms had cleared with chiropractic therapy. Her present symptoms had recurred 2 months prior to her consultation here. She complained of a constant, moderate to severe upper cervical ache which radiated into the occipital-frontal regions. The cephalalgia occurred daily and intensified in the midafternoon. She reported associated dizziness and difficulty in focusing her eyes. She could not clearly focus on close objects and stated that while driving, the windshield seemed to move back and forth in relation to her eyes. She was constantly squinting in an effort to see clearly. She had been seen by an optometrist 3 weeks previously with negative findings.
On examination, cervical extension, right side-bending and left rotation were painful and limited. There was palpable paravertebral muscle spasm and restriction of motion in the upper cervical articulations. Trigger points were found here which reproduced the cephalalgia.
Cervicogenic autonomic dysfunction was objectivated with the following manoeuvres:
1. Triggers: Firm pressure over the right lamina of C2 precipitated an immediate bout of blurred vision and diplopia.
2. Resisted Motion: Resisted cervical extension (with the head fixed so as to exclude vestibular motion) resulted in an episode of “swooning” and vertigo.
3. Cervical Torsion: The patient’s head was fixed by an assistant (so as to exclude vestibular motion) and the torso was rotated, flexed, extended, side-bent and circumducted under the immobilized cranium. These manoeuvres precipitated vertigo.
