Search Results (31)

Background/Objectives: The number of patients with cervical spine pain has been increasing in recent years, and some have been diagnosed with chronic cervicocephalic syndrome (CCS). Collagen mesotherapy of the spine is increasingly being used to treat chronic pain syndromes. This retrospective observational study was conducted to evaluate the efficacy and safety of collagen mesotherapy in the course of CCS. Methods: The study included 31 patients (19 women and 12 men; mean age, 45.0 ± 10.1) with chronic CCS (>12 weeks) who underwent cervical spine mesotherapy using injectable collagen. Mesotherapy was performed at weekly intervals, in 5 (in 18 patients) and 6 (in 13 patients) sessions. Patients were assessed using the Visual Analogue Scale (VAS) for cervical spine pain, pain radiating to the occipital region, dizziness, and tinnitus before the start of mesotherapy, one week after its completion, and 3 months later during a follow-up visit. Changes over time were analyzed using the Friedman test for repeated measures and Cochran’s Q test for binary outcomes. Results: Following collagen mesotherapy, cervical pain on the VAS decreased from 7 (IQR 6–8) at baseline to 2 (IQR 1–3) after treatment and remained at 2 (IQR 1–2) after the 3-month follow-up (p < 0.001). The proportion of patients with occipital pain decreased from 100% to 38.7%, dizziness from 83.9% to 38.7%, and tinnitus from 19.4% to 6.5%. No adverse effects related to the therapy were observed. Conclusions: Collagen mesotherapy was associated with improvements in pain and accompanying symptoms in patients with chronic cervicocephalic syndrome, with no treatment-related adverse events observed. Nevertheless, further research in this area is necessary. Full article

Atlantoaxial dislocation (AAD) or subluxation (AAS) is a potentially life-threatening disorder caused by instability between the atlas and axis. Typical symptoms include neck pain, torticollis, and neurological deficits, but dizziness has rarely been reported in association with AAD/AAS. We describe an adolescent girl who presented with non-spinning dizziness, neck pain, and torticollis after prolonged head flexion and extension. Neurological examination showed rightward torticollis without nystagmus. Cervical spine imaging revealed atlantoaxial rotatory dislocation and fixation, while CT angiography confirmed patency of both vertebral arteries. Conservative management with cervical traction was ineffective, and surgical reduction with C1–C2 fixation and fusion was performed. The patient experienced complete resolution of dizziness and torticollis postoperatively without complications. This image-based report describes a rare case of AAD in which dizziness was the main presenting symptom. This case highlights that cervical instability should be considered in the differential diagnosis of dizziness. Full article

Background and Clinical Significance: Vestibular disorders include a wide range of conditions with overlapping symptoms such as dizziness, vertigo and imbalance, often offering diagnostic challenges when distinguishing between peripheral and central etiology. Accurate differentiation is essential for establishing effective treatment plans. In rare or atypical cases with subtle findings, comprehensive diagnostic tools—such as extended vestibular tests and structured questionnaires like the Dizziness Handicap Inventory (DHI)—are critical for diagnosis and monitoring patient recovery. Case Presentation: A 35-year-old female presented with chronic imbalance and motion-induced dizziness persisting for four years. The patient had a surgical history of right-sided functional neck dissection for a parotid tumor. A comprehensive audiovestibular evaluation was performed, including pure tone audiometry (PTA), tympanometry, videonystagmography (VNG), cervical vestibular evoked myogenic potentials (cVEMP), ocular vestibular evoked myogenic potentials (oVEMP), video head impulse testing (vHIT), computerized dynamic posturography (CDP), and magnetic resonance imaging (MRI). The Dizziness Handicap Index (DHI) was administered at baseline and post-treatment to monitor subjective symptom changes. Objective testing revealed marked right–left amplitude asymmetry on cVEMP, which were recorded from the trapezius muscle due to prior neck dissection surgery, indicating isolated right-sided saccular hypofunction. Following targeted vestibular rehabilitation and pharmacologic treatment, the 3-month reassessment demonstrated resolution of symptoms and a reduction in DHI scores from 24 to 6. Conclusions: Comprehensive vestibular testing, performed in a single diagnostic session, enabled the accurate identification of isolated right-sided saccular hypofunction in this complex post-surgical case. Combining cVEMP, CDP, and DHI assessment provided a complete functional profile, guided targeted rehabilitation, and allowed objective monitoring of recovery. Full article

Background/Objectives: Dizziness is a frequent medical complaint with neurological, otolaryngological, and psychological origins. Imaging studies such as CT (Computer Tomography), cervical X-rays, and ultrasound aid diagnosis, while MRI (Magnetic Resonance Imaging) is crucial for detecting brain abnormalities. Our purpose is to identify structural brain changes associated with vertigo, assess pre-MRI diagnostic approaches, and evaluate treatment strategies. Methods: A case-control study of 232 vertigo patients and 232 controls analyzed MRI findings, pre-MRI examinations, symptoms, and treatments. Statistical comparisons were performed using chi-square and t-tests (p < 0.05). Results: White matter lesions, lacunar infarcts, Circle of Willis variations, and sinusitis were significantly more frequent in vertigo patients (p < 0.05). Pre-MRI diagnostics frequently identified atherosclerosis (ultrasound) and spondylosis (X-ray). Common symptoms included headache, imbalance, and visual disturbances. The most frequent post-MRI diagnosis was Benign Paroxysmal Positional Vertigo (BPPV). Treatments included lifestyle modifications, physical therapy (e.g., Epley maneuver), and pharmacological therapies such as betahistine. Conclusions: MRI revealed structural brain changes linked to vertigo. Pre-MRI assessments are essential for ruling out vascular and musculoskeletal causes. A multidisciplinary treatment approach is recommended. Trial Registration: This study was registered in ClinicalTrials.gov with the trial registration number NCT06848712 on 22 February 2025. Full article

Background and Objectives: Questionnaires are patient-reported outcome measures that require a validation process to assess their reliability and replicability. Over time, questionnaires have not only focused on a single health condition, such as neck pain, but also expanded their assessment spectrum to other areas in order to gather additional and relevant information from the patient. The main objective of this study was to conduct a systematic review of the different structural and psychometric characteristics of neck pain questionnaires. Materials and Methods: A systematic review was conducted following the PRISMA recommendations. The search strategy was implemented across various databases (PubMed, Cochrane, EMBASE, CINHAL, Trip Medical Database, Scopus) using terms such as neck pain, cervicalgia, cervical pain, questionnaire, survey, index, validity, validation, and reliability. COSMIN criteria were used to identify valid questionnaires for this systematic review based on their psychometric properties. Results: A total of 15 articles were identified in this systematic review, of which 8 assessed the level of disability, while the rest evaluated dizziness in neck pain, anxiety and/or depression, beliefs about fear and avoidance, and perception of scarring and symptoms after neck surgery. The main findings show that neck pain questionnaires exhibit very good values for reliability and internal consistency, along with a high variability for construct validity. Conclusions: This study highlights the good values exhibited by neck pain questionnaires despite their heterogeneity in structural characteristics, demonstrating good values in psychometric properties. Nevertheless, the latter should be further investigated to gather more information. Full article

Objectives: Muscular dysfunction of the cervical spine is the most likely cause of somatosensory tinnitus and dizziness. Some patients can modulate their tinnitus through movement or palpation. This study aimed to investigate the effect of manual therapy on muscle pressure pain, range of motion in the cervical spine, and tinnitus and dizziness. Methods: A pilot randomized controlled trial with a waiting-group design was conducted in a university hospital setting. Participants in the intervention group received manual therapy to the head and neck region combined with stretching exercises and muscle relaxation techniques such as releasing tense muscles and myofascial trigger point therapy involving muscle and connective tissue techniques. The primary and secondary outcome measures were pressure pain, tinnitus modulation by head and neck muscles, and range of motion of the cervical spine. Tinnitus and dizziness were assessed before and after the intervention using the Tinnitus Handicap Inventory and the Dizziness Handicap Inventory. Results: After the intervention, significant differences were observed in pressure pain, tinnitus modulation, and range of motion as well as the Tinnitus Handicap Inventory (U = 644; p < 0.001) and the Dizziness Handicap Inventory (U = 133.5; p = 0.010), favoring the intervention group. Conclusions: The results demonstrate that manual therapy significantly altered pressure pain in the head and neck muscles as well as symptoms such as tinnitus and dizziness in the intervention group. Manual therapy may be beneficial in treating cervicogenic somatosensory tinnitus, provided that other potential causes such as otorhinolaryngological pathology have been ruled out. Full article

Background and Aim: Neuropathic pain leads to a significant deterioration in health-related quality of life (HRQOL). Treating neuromusculoskeletal pain is especially important to prevent and improve physical frailty and the locomotive syndrome. Varied pharmacotherapies could be applicable for neuropathic pain patients, but evidence has been limited for a wide range of neuropathic pain conditions with different etiologies. The aim of this review was to highlight mirogabalin, a novel calcium channel α2δ ligand which was first approved in Japan, and which is effective for various types of neuropathic pain diseases. Methods: We conducted a narrative review of the recent evidence that mirogabalin has significant analgesic potency for varied types of neuropathic pain conditions. Futher, this review highlighted specific advantages over other calcium channel ligands. Results: Analgesic potency of mirogabalin could cover peripheral neuropathic pain conditions including post-herpetic neuralgia, diabetic peripheral neuropathy, cauda equina syndrome caused by lumbar spinal stenosis, radiculopathy caused by cervical spondylosis, and also central neuropathic pain conditions like spinal cord injury. Mirogabalin consistently demonstrated daytime sleepiness and dizziness as adverse effects, but most of these were mild. Conclusions: Mirogabalin is recommended as the first-line drug against most molecular mechanisms that cause neuropathic pain regardless of whether they have a peripheral or central origin. Mirogabalin demonstrates relatively less daytime sleepiness, making it age-friendly in the current global situation where population aging is accelerated. Considering the epidemic of ‘opiophobia’ in Japan and other countries, pharmacotherapy using mirogabalin could treat neuropathic pain associated with cancer and its treatment (e.g., chemotherapy-induced peripheral neuropathy), as well as non-cancer etiologies worldwide. Full article

Whiplash-Associated Disorders (WADs) often result from traffic accidents, leading to persistent symptoms, including neck pain, disability, dizziness, and central sensitization (CS). A key concern is cervical range of motion (cROM) impairment and sensorimotor dysfunction, which contribute to prolonged disability. This study assessed functional performance in individuals with subacute (>1, <3 months) WADs (n = 122) compared to healthy controls (n = 45). Clinical measures included cROM, movement control (Butterfly test), and position sense (Head–Neck Relocation Test, HNRT). Patient-reported outcomes included neck disability, pain intensity, central sensitization, and dizziness. Mixed and linear models evaluated group differences and the influence of demographic and symptom-related factors. WAD patients had significantly reduced cROM and impaired movement control (p < 0.001). Neck disability (p < 0.001) and pain intensity (p = 0.015) affected cROM within the WAD group. Interaction effects revealed greater amplitude accuracy (AA) impairments at greater difficulty levels (p = 0.043), while time on target (TOT) differences decreased (p < 0.001). Dizziness was associated with increased undershoot (p < 0.001), while pain negatively impacted both AA (p = 0.003) and TOT (p = 0.037). Position sense did not differentiate WAD patients from controls. Findings suggest task-dependent sensorimotor deficits, highlighting the need for multimodal assessment. Early CS screening may optimize rehabilitation and prevent chronic disability. Full article

Background/Objectives: Dizziness and vertigo are common symptoms. Vertigo, caused by vestibular deficit, is usually diagnosed with videonystagmography (VNG) and cervical vestibular evoked myogenic potential (cVEMP). Normative values of these examinations have been established for adults; however, the impact of age is still uncertain. This study aimed to compare the results of VNG and cVEMP between adults and children. Methods: We analyzed and compared the results of VNG and cVEMP in 119 patients (35 adults and 84 children.) Results: Statistically significant differences were observed between adults and children in the amplitude of the cVEMP examination. In the subgroup analysis by age, we also noticed differences in VNG examination in nystagmus induced by rotation in patients with peripheral vertigo and in IFO (index fixation test) and VOR (vestibulo-ocular reflex) in patients with non-peripheral vertigo. Conclusions: This study confirms that there are differences in vestibular examination results between children and adults. However, the exact impact of age on each part of the vestibular examination requires further investigation. Full article

Background: Bilateral vestibulopathy (BVP) is a disabling condition characterized by a deficit in vestibular function on both sides. Current diagnostic criteria consider instrumental data only from horizontal canals, excluding vertical canals and otolithic function, with the possibility of not including some variants of BVP. This study aims to evaluate vestibular functions in people with chronic vestibular syndrome through a comprehensive battery of tests. Methods: This diagnostic accuracy study included patients who met criteria for probable BVP. The index test included a thorough evaluation of the vestibular system, using the video Head Impulse Test (vHIT) to measure the gain of the angular vestibulo-ocular reflex (aVOR) in all six semicircular canals and the cervical and ocular vestibular-evoked myogenic potentials (VEMPs) to assess otolith function. The diagnostic criteria established by the Barany Society were considered the standard reference, including only the horizontal vHIT as an instrumental assessment. Results: 78 patients (41 male, age 61.40 ± 12.99) were enrolled. The Barany criteria showed a low ability to rule out BPV (sensitivity = 46%). The median Dizziness Handicap Inventory (DHI) varied from 66 to 69 among the models studied, and a significant difference in DHI scores between positive and negative tests was observed for the Barany criteria and the six-canals vHIT model. Conclusions: Our findings highlight the potential to transform BPV diagnostic criteria. The identification of new bilateral vestibular dysfunction variants through improved diagnostic tools calls for revising current criteria, with promising implications for patient care and understanding of etiological and prognostic aspects. Full article

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to “informational noise” which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as “general instability”. Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL. Full article

Background: Neck pain is a prevalent musculoskeletal disorder that can cause other additional misalignments and other misalignment-induced chronic musculoskeletal diseases. Although numerous risk factors for chronic neck pain have been researched, systemic symptoms have not received the same level of investigation. The aim of this study was to analyze the link between subjective systemic symptoms and neck pain based on initial holistic interviews, with the objective of identifying potential predictive factors for neck pain. Methods: This retrospective cross-sectional study included patients hospitalized due to acute neck pain between January 2018 and August 2021. Data collected included demographic information, treatment details, neck-pain characteristics, medical history, and co-occurring symptoms regardless of their known association with neck pain. Statistical analyses, including independent t-tests, Mann–Whitney U tests, chi-squared tests, Fisher’s exact tests, and correlation analyses, were performed. Results: With regard to the demographic characteristics, a significant positive correlation was observed between age and initial pain intensity (p < 0.01), while female sex was associated with changes in pain intensity (p < 0.05). Past medical conditions, including diabetes, hyperlipidemia, heart attacks, and psychological medical history, demonstrated a significant relationship with neck pain (p < 0.01, p < 0.05, p < 0.05, and p < 0.05, respectively). Hospitalization duration, cervical dizziness, limitations in the cervical range of motion (ROM), and widespread pain were significantly associated with neck pain (p < 0.05, p < 0.05, p < 0.01, and p < 0.001, respectively). Among the subjective systemic symptoms, only upper gastrointestinal (GI) disturbance displayed a significant association with neck pain (p < 0.01). Conclusions: This study identified several potential predictors of neck pain—notably, upper GI disturbances—providing a new avenue to investigate the prognostic factors of neck pain. However, further study is needed to substantiate these findings and elucidate the precise nature of these associations. Full article

This article details the existing wearable assistive devices that could mimic a human’s active range of motion and aid individuals in recovering from stroke. The survey has identified several risk factors associated with musculoskeletal pain, including physical factors such as engaging in high-intensity exercises, experiencing trauma, aging, dizziness, accidents, and damage from the regular wear and tear of daily activities. These physical risk factors impact vital body parts such as the cervical spine, spinal cord, ankle, elbow, and others, leading to dysfunction, a decrease in the range of motion, and diminished coordination ability, and also influencing the ability to perform the activities of daily living (ADL), such as speaking, breathing and other neurological responses. An individual with these musculoskeletal disorders requires therapies to regain and restore the natural movement. These therapies require an experienced physician to treat the patient, which makes the process expensive and unreliable because the physician might not repeat the same procedure accurately due to fatigue. These reasons motivated researchers to develop and control robotics-based wearable assistive devices for various musculoskeletal disorders, with economical and accessible solutions to aid, mimic, and reinstate the natural active range of motion. Recently, advancements in wearable sensor technologies have been explored in healthcare by integrating machine-learning (ML) and artificial intelligence (AI) techniques to analyze the data and predict the required setting for the user. This review provides a comprehensive discussion on the importance of personalized wearable devices in pre- and post-clinical settings and aids in the recovery process. Full article

Gardasil 4, a human papilloma virus vaccine, has been shown to protect against various cancers, including cervical cancer. Common side effects include injection site pain, fever, headaches, and muscle aches. In some individuals, the severe side effect of postural orthostatic tachycardia syndrome (POTS) has been reported. POTS is characterized by the abnormal response of lightheadedness, blurry vision, and dizziness while transitioning to an upright posture. POTS predominately affects women, with more than eighty-five (85) percent of POTS patients being female. POTS, on average, takes five years and eleven months to receive diagnosis. Additionally, a strong association between POTS and Ehlers–Danlos Syndrome Type III (EDS) exists. Eighty (80) percent of patients with EDS have POTS. This severe side effect indicates that providers need to be aware of this strong association of HPV vaccinations and POTS. In this report, we will present a case of a young women with a past medical history significant for EDS type III who was diagnosed with POTS after receiving Gardasil 4 vaccination. This case demonstrates the need for physicians to be aware of the association of POTS with EDS type III and HPV vaccination. Physician awareness of the associations, signs, and symptoms of POTS and earlier testing at the first presentation of signs and symptoms will limit the negative impact on patient’s quality of life. Full article

Objective: Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls. Methods: 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated. Results: in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears (p = 0.04) and compared to healthy controls (p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy. Conclusion: We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test. Full article