Cervical Spondylosis & Hypertension

This week from Dr. Cerami and Utah Sports and Wellness

From: Medicine, March 2015

Quick Summary:

This current study, “clearly indicates that hypertension can be associated with cervical spondylosis, as a secondary condition.” These authors report 2 patients with cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. The clinical benefits remained stable a year later. “Cervical spondylosis is a common cause of chronic neck pain, radiculopathy and/or myelopathy resulting in significant disability.” “Patients with cervical spondylosis are often accompanied with vertigo.” Vertigo may be present in 50%-65% of patients with cervical spondylosis.

Abstract:

Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.

These authors also note:

• Patients with cervical spondylosis tend to have concomitant cervical vertigo symptoms such as tinnitus, headache, blurred vision, and palpitations.
• “Insufficient blood supply to posterior circulation is called vertebrobasilar insufficiency. The most common complaint in patients with vertebrobasilar
  insufficiency is vertigo.”
• The vascular supply to the vestibulocochlear organ is an end artery, making this organ “more susceptible to vertebrobasilar insufficiency.”
• Neurons, axons, and hair cells in the vestibulocochlear system “respond to ischemia by depolarizing, causing transient hyperexcitability with ectopic
  discharges, manifesting as tinnitus, vertigo, and dizziness.”
• Vertebral artery insufficiency secondary to cervical spondylosis could result in vertigo.
• Stimulation of the sympathetic nerve fibers (without vertebral artery compression) induces vertigo, tinnitus, nausea, and vomiting.
• “The mechanisms of hypertension induced by cervical spondylosis could be the same as that of cervical vertigo. It is well known that cervical discs, dura mater, and the posterior longitudinal ligament are rich in sympathetic fibers.”
• “Sympathetic nerve fibers distributed around the vertebral artery have been implicated in the autoregulation of vertebrobasilar artery blood flow and cerebral blood flow.”
• “Degenerative painful discs are always inflammatory discs.”
• Painful discs have elevated inflammatory molecules (cytokines, prostaglandins, etc.), which increase discogenic pain. And in a feedback loop, inflammatory molecules accelerate disc degeneration.
• Cervical spondylosis can cause chronic neck pain, and chronic neck pain itself can cause hypertension.
• “Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension.”
• “Chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms.”
• “Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.”