Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study

World Neurosurg. 2018 Nov;119:e686-e693. doi: 10.1016/j.wneu.2018.07.243. Epub 2018 Aug 6.

Abstract

Objectives: Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis.

Methods: Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically.

Results: After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P = 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs.

Conclusions: Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.

Keywords: Cervical intervertebral disc degeneration; Cervicogenic dizziness; Neck pain; Proprioception; Ruffini corpuscles.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cervical Vertebrae / surgery*
  • Disability Evaluation
  • Diskectomy / methods*
  • Dizziness / etiology*
  • Dizziness / pathology
  • Dizziness / surgery
  • Female
  • Humans
  • Immunohistochemistry
  • Intervertebral Disc Degeneration / complications*
  • Intervertebral Disc Degeneration / pathology
  • Intervertebral Disc Degeneration / surgery
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neck Pain / etiology*
  • Neck Pain / pathology
  • Neck Pain / surgery
  • Prospective Studies
  • Range of Motion, Articular / physiology
  • Spinal Fusion / methods*
  • Treatment Outcome
  • Young Adult