Cervical Myelopathy – Cervical Degenerative Disc Disease – Cervicovagopathy

Understanding the broken neck structure problem can help you understand why you have problems such as cervical spinal stenosis, cervical spine arthritis, cervical degenerative disc disease,  and bulging and herniated discs. Understanding the broken neck structure problem may also explain why you have the many symptoms described here.

What are we seeing in this image?

This slide is at 1:10 of the video. At this point in the video, Dr. Hauser is demonstrating functional problems in the cervical spine caused by cervical instability of broken neck structure. This slide has a diagnosis on the right and a possible treatment recommendation on the left. These treatments will be described briefly here and then expanded on further in this video summary and notes.

• Capsular facet ligament injury
  • In our research published in The Open Orthopaedics Journal, (1) we describe the capsular ligaments as the main stabilizing structures of the facet joints in the cervical spine, and injury, laxity, or weakness in these ligaments have been implicated as a major source of chronic neck pain. Many diagnoses including disc herniation, cervical spondylosis, whiplash injury, and whiplash-associated disorder, post-concussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome can be linked to capsular facet ligament injury.
  • Prolotherapy. To the right is a treatment to restore ligament strength. This is Prolotherapy. Prolotherapy is the use of simple dextrose injections to reawaken the healing immune response. This is explained further below.
• Vertebral rotation (subluxation) is as it sounds the cervical vertebrae are now twisting out of place or are in a condition of subluxation.
  • After an examination, we may suggest Dynamic ortho neurological correction which is a specific kind of chiropractic adjustment that we do at the Hauser Neck Center. In Dynamic ortho neurological correction, we watch the movement of the bones under the Digital Motion X-Ray imaging and then adjust to try to correct the bone’s position and get them back into a better alignment.
  • Chiropractic may be a good place to start, especially if you have dull pain.
• The adjacent vertebra moves forward (anterior). Commonly cervical spondylolisthesis. Cervical Spondylosis is an umbrella term used to describe degenerative changes in the cervical spine when there is no clear answer as to why you suffer from any one of a long list of symptoms already mentioned above.
• Cervical curve collapse
  • Cervical curve correction. Caring Cervical Realignment Therapy (CCRT) or what we often call “Curve Correction” for short is a treatment I (Ross Hauser, MD) developed after decades of treating patients with neck disorders. CCRT combines individualized protocols to objectively document spinal instability, strengthen weakened ligament tissue that connects the vertebrae, and re-establish normal biomechanics and encourage restoration of lordosis. Please see our article Caring Cervical Realignment Therapy – Curve Correction.

What are we seeing in this image? A visual description of how compression in the cervical spine can lead to problems of cervical spine neurology

This image is at 1:40 of the video.

Here we see that the carotid sheath and all its vital structures lay on top of the C1 Atlas. When the Atlas or C1 starts “wandering” out of place it takes the carotid sheath with it, stretching the arteries, veins, and the glossopharyngeal nerve and vagus nerve or compressing the arteries, veins, and glossopharyngeal nerve, and vagus nerve. When there is compression there can be symptomology. The person is now suffering from “neurologic-like” symptoms.

Changes in the cervical curve

At 2:00 of the video presentation, Dr. Hauser describes changes in the cervical curve that can cause many of the symptoms that we see in our patients.

In this image, there is a left-to-right comparison being illustrated in two patients’ neck curves. On the left is a normal cervical curve. The focus is on the correct position of the vagus nerve. The vagus nerve will be discussed below. In the abnormal curve demonstrated on the right, the vagus nerve is being stretched and compressed. It is this stretching and compression that can lead to the neurological-like, cardiovascular-like, psychological-like symptoms that many of our patients suffer from.

When you have cervical dysstructure, you can have symptoms of neck pain, headaches, dizziness, tinnitus, ringing in the ears, vertigo, swallowing difficulty, speech difficulty, digestive problems, tachycardia, POTS, mast cell activation, and others. Our treatment philosophy is not to treat all these maladies as separate challenges but rather look for the underlying cause of all of them in the cervical spine that has a broken neck structure.

Progressive disorder

Cervical dysstructure is a broken neck structure it starts with the breakdown of the cervical capsular ligaments that hold the facet joints in place. Once the ligaments become weakened it allows the bones of the neck to start rotating and wandering out of place. The person develops vertebral rotations or vertebral subluxation and these problems can cause the person the challenges they face.

In this scenario, sometimes the person can find symptomatic relief with chiropractic. Even a minor adjustment to the spine can sometimes have a dramatic effect. In some people, chiropractic may be a good place to start in the determination of their situation, especially in people with dull pain and minus the neurologic-like symptoms.

If the instability progresses and joint instability is a progressive disorder, once you have one ligament injury in the neck the destructive forces go to the next joint in the neck, straining those cervical ligaments, this is why symptoms programs because cervical instability is a progressive disorder. Eventually, the adjacent vertebrae move forward.

This image is at 4:25 of the video:

What are we seeing in this image? The vertebrae will eventually fall like dominos because of cervical instability is a progressive disorder moving up and down the cervical spine collapsing the cervical spine like a bunch of dominos.

What are we seeing in this image? Cervical curve collapse of cervical dysstructure under x-ray

A description of the 5 major detrimental effects of Cervical Kyphosis (Dysstructure).

• Weight of head in front of cervical curve
• Stretching of the posterior ligament complex
• Increased for of atlantoaxial (C1-C2) joint.
• Lengthening (stretching) of neck neuro vasculature including the vagus nerve.
• Increased tension on the brainstem.

The red line and the black line

The neck x-ray above displays this patient’s problem. The Black dash line is the path a normal curve should take in the neck normal curve. Now compare this with the red line. The red line is tracing the path of the curve or lack of a curve that this patient’s neck is taking. That red line is an illustration of cervical dysfunction.

Look at where the C1 is so far forward from the normal curve. This is cervical curve collapse. Eventually, the C1 is going to hit all the structures in the front of the neck including the vagus nerve, the glossopharyngeal nerve, and the spinal accessory nerve.

A brief explanation of the cervical spine alignment goals

Restoring a normal cervical curve is paramount to the treatment of a patient diagnosed and suspected of having cervical instability. Below are images of the types of cervical spinal curvatures we routinely encounter in our patients. How did these necks get this way? They could be the result of impact injury whether in sports, whiplash, or work-related problems. What these necks routinely have in common is cervical spine ligament weakness and damage, commonly referred to as cervical ligament laxity as a possible leading factor in curvature problems of the neck.

To further demonstrate these problems the image “cervical degenerative dysstructure” also shows the progressive nature of cervical instability leading to a breakdown of the cervical curve. this can result in destructive forces being placed on vital neurovascular structures including the spinal cord.

Cervical spine patients do a lot of research. Their health problems are so vast and sometimes so complex that research provides many patients a degree of comfort through understanding. In some of our very well-read patients, we can hear the arguments they have been given to proceed with surgery as the “only answer.” Again, for some patients, surgery is the only answer. But it is not always the case.

Here is something typical of what we hear in our consultations:

Symptoms related to vagus nerve compression

The symptoms of vagus nerve compression are vast: Here are some of my articles where vagus nerve compression is implicated:

• Hiccups, Neck Pain, and Vagus and Phrenic Nerve Injury
• Pyloric stenosis in the adult patient: A problem of Vagus nerve impingement?
• SIBO: Small intestinal bacterial overgrowth and the Vagus nerve. The problem of nerve compression.
• Cluster headache treatment – cervical ligament instability and the trigeminal and vagus nerves
• Cervical spine problems, Vagus nerve compression, as cause urinary incontinence
• Ear pain, ear fullness, sound sensitivity, Tinnitus, Meniere’s Disease and hearing problems caused by neck instability
• When persistent post-concussion syndrome turns into a neurologic mystery
• Cervical Angina
• Inappropriate sinus tachycardia – Elevated heart rate

Symptoms related to glossopharyngeal nerve compression

In the book Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. (x) Dr. H. Kenneth Walker describes symptoms related to glossopharyngeal nerve compression:

• “Glossopharyngeal nerve lesions produce difficulty swallowing; impairment of taste over the posterior (back) one-third of the tongue and palate; impaired sensation over the posterior one-third of the tongue, palate, and pharynx; an absent gag reflex; and dysfunction of the parotid gland (problems of salivation.)

These symptoms and conditions are discussed in our articles:

•  Is Burning Mouth Syndrome a problem of cerebral blood flow?
•  Empty nose syndrome
•  Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear, and throat pain?
•  Cervical disc disease and difficulty swallowing – cervicogenic dysphagia
•  Neck-Tongue Syndrome treatments

When you have cervical dysstructure, the C1 rotates and becomes subluxed (or dislocated or mis-locates) out of its normal position. So your C1 is not where it is supposed to be. Now, in this moving out of place, the C1 will drag, stretch and put tension on the spinal cord, the vagus nerve, the carotid artery, and the internal jugular vein.

• Once you start stretching the carotid artery, the artery that supplies blood to the brain, you narrow the arterial opening. Simply that means you get less blood flow into the brain.
• Once you start stretching the jugular vein, you diminish the vein’s ability to drain the blood from the brain. You get fluid to back up in the brain. This will cause issues of brain fog, dizziness, head pressure, and eye pressure, pain, and blurry vision.

When you stretch the vagus nerve at C1 you may develop the cardiac-like symptoms of tachycardia. As the vagus nerve helps calm the body down, if your vagus nerve is getting stretched and the nerve impulses sent and received by the vagus nerve are distorted, you get develop anxiety, your emotional state can be in a constant state of being on edge. The vagus nerve is part of the mechanism that controls inflammation. If the vagus nerve is compromised you may develop chronic inflammation throughout your body. This may lead to a diagnosis of fibromyalgia or multiple chemical sensitivity or mast cell activation or POTS. The underlying cause of many of these conditions can be low vagal tone or dysautonomia.

Compression on the brain stem

Compression on the brain stem not only occurs when the bones of the neck press on them. Compression on the brain stem also occurs when the bones of the neck start wandering and stretching and pulling on the brain stem. The brain stem becomes elongated. This causes the relay centers of the brain stem, such as the nausea center which is right next to the medulla (see below) right above the spinal cord. So a person may have nausea. A person may have unexplained shortness of breath. Your respiratory center is right above the spinal cord. I’ve had patients who feel that they have to think about breathing. It is possible cervical dysstructure has affected their breathing center.

Research notes:

A paper in the medical journal The Neurologist (2) suggested that the “control of ventilation (breathing) depends on a brainstem neuronal network that controls the activity of the motor neurons innervating the respiratory muscles. This network includes the pontine respiratory group and the dorsal and ventral respiratory groups in the medulla. Neurologic disorders affecting these areas or the respiratory motor unit may lead to abnormal breathing.

Manifestations associated with disorders of this network include sleep apnea and dysrhythmic breathing frequently associated with disturbances of cardiovagal and sympathetic vasomotor control. Common disorders associated with impaired cardiorespiratory control include brainstem stroke or compression, syringobulbia (syrinx), Chiari malformation, high cervical spinal cord injuries, and multiple system atrophy.”

“Patients with degenerative cervical myelopathy (DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort.”

A January 2022 study in the journal World neurosurgery (3) found

“Patients with degenerative cervical myelopathy (DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort.” The researchers of this study then aimed to investigate the relationship between atypical symptoms of degenerative cervical myelopathy and the segments of spinal cord compression.

How did they do it”

• 166 degenerative cervical myelopathy patients with atypical symptoms were divided into vertigo, headache, blurred vision, tinnitus and palpitations groups according to their atypical symptoms; while the typical group was 214 degenerative cervical myelopathy patients with typical symptoms only.

Result:

• The incidence of vertigo 37%,
• The incidence of headache 18%,
• The incidence of blurred vision 15%,
• The incidence of tinnitus 11%.

Compared to the typical group, patients in the blurred vision and tinnitus group were older and the incidence of spinal cord compression at C3-5 in the vertigo group, C4-5 in the headache group and C6-7 in the palpitation group was higher.

The scores of vertigo, headache and palpitations decreased after surgical decompression, whereas only vertigo and headache scores decreased after non-surgical treatment.

Atypical symptoms were common in patients with degenerative cervical myelopathy and the segments of spinal cord compression might be associated with specific atypical symptoms. Surgical treatment is effective in relieving some of the atypical symptoms.

What are we seeing in this image?

The brain stem and spinal cord in relation to the C1 and C2. The medulla oblongata, as just outlined, plays a vital role in communicating signals between the spinal cord and the brain that controls heartbeat, respiration, and the nausea center among other functions.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this video informative and it helped answer many of the questions you may have surrounding  Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain. . . Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Reach out to the Hauser Neck Center Patient team

Subscribe to our newsletter 

References for this article:

1 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
2 Nogués MA, Benarroch E. Abnormalities of respiratory control and the respiratory motor unit. The neurologist. 2008 Sep 1;14(5):273-88. [Google Scholar]
3 Yuan H, Ye F, Zhou Q, Feng X, Zheng L, You T, Cao R, Feng D. The Relationship between Atypical Symptoms of Degenerative Cervical Myelopathy and the Segments of Spinal Cord Compression: A Retrospective Observational Study. World Neurosurg. 2022 Jan 26:S1878-8750(22)00089-4. doi: 10.1016/j.wneu.2022.01.075. Epub ahead of print. PMID: 35092814.