Oscillopsia caused by cervical spine instability and neck pain

Ross Hauser, MD, Caring Medical Florida

If you have been diagnosed or suspected of having Oscillopsia, you know what Oscillopsia is and you know it took you a long time to get to a diagnosis and understanding of this disorder. For many, Oscillopsia can be one of many diagnoses or comorbidities that you suffer from and a contributing factor for the myriad of symptoms that are causing your health challenges. This article will focus on the problem of a “world in motion,” and other vision problems and how one explanation as to why treatments and therapies have not helped you is because you have unidentified cervical neck / spine instability.

This article is part of a series of articles that include:

Your journey to a diagnosis of Oscillopsia

You have a vision problem where you see things that bounce, jump, or appear to be in some type of motion when in fact these objects are not moving at all. In your talking to your doctors, you went through a screening process to see what is causing these problems for you.

You may have been asked about head injuries or trauma, inner ear problems such as Meniere’s disease, a history of seizures, and meningitis. Older patients may be asked about a history of stroke. For other patients, a discussion of nystagmus may be discussed. These are vision problems caused by involuntary or abnormal eye movement. Let’s hear a real person’s story who came into our office.

A patient describes her symptoms

In this video, one of our patients describes her Oscillopsia journey. A summary transcript is below.

I have a symptom where everything bounces when I move my head up and down. Everything is jumping. I have been told this is called Oscillopsia.

When it started

These symptoms started after the birth of my first child when I was 24. I have had about 30 years of treatments and I have just been dealing with this problem. I have not been able to get help. When my symptoms got really bad I would start going into dizzy spells that would last 24 hours. Then I would be fine with the dizziness but then I noticed my field of vision was really bad.

A clue – pain at the C1. Symptoms can be made worse by pressing on the C1 area.

At 1:07 of the video, the patient demonstrates that pressing on the back of her head can make the symptoms appear

  • If I press here on my C1 area I can get that same sensation (everything in her vision range is bouncing or vibrating)  as if I’m moving my head, it’s a very weird thing. Everything bounces. If I could immobilize my head everything would be okay, but when I start walking, every step I take, everything bounces.

In this screenshot from the video, the patient says: I press here on my C1 area I can get that same sensation as if I'm moving my head, it's very weird thing. Everything bounces. If I could immobilize my head everything would be okay, but when I start walking, every step I take, everything bounces.

In this screenshot from the video, the patient says: I press here on my C1 area I can get that same sensation as if I’m moving my head, it’s very weird thing. Everything bounces. If I could immobilize my head everything would be okay, but when I start walking, every step I take, everything bounces.

Oscillopsia caused by cervical spine instability and neck pain

We will discuss this patient’s treatments below and the improvements she has seen to date. In this patient we were able to identify that cervical spine instability was the root cause of her vision problems and oscillopsia. While not very case of oscillopsia may be traced to cervical spine instability, unresponsive cases to conventional treatments may find their answers in the cervical spine.

Vestibular Migraine and Oscillopsia. A clue that cervical spine instability is at the root of the problem?

In my article: Vestibular migraine and spontaneous vertigo – Migraine Associated Vertigo, I note: “Poorly understood” is a recurrent theme when it comes to patients with Vestibular migraine and spontaneous vertigo. A study published in October 2019, lead by researchers at Massachusetts Eye and Ear Infirmary, Harvard Medical School, and Ohio State University  examined Vestibular migraine as one of the most common causes of spontaneous vertigo and why this problem remains poorly understood. The study was published in Scientific Reports (1).

The study’s learning points suggest:

  • Vestibular migraine patients were abnormally sensitive to roll tilt (a misalignment of the eyes disrupting sense of gravity and space), which co-modulates semicircular canal and otolith organ activity (this is an ability to sense gravity and sense motion), but not to motions that activate the canals or otolith organs in isolation (where fluid in the ears stabilizers balance), implying sensitization of canal-otolith integration. (Something is off but it is not a Meniere’s Disease type problem.)
  • The researchers suggest a pathogenic model where vestibular symptoms emanate from the vestibular nuclei, (the the cranial center point for the vestibular nerve) which are sensitized by migraine-related brainstem regions and simultaneously suppressed by inhibitory feedback from the cerebellar nodulus and uvula, the site of canal-otolith integration.

The suggestion is simply, something is happening to the vestibular nerve which is overly sensitized to pain by the reaction of something happening to the brainstem and the process is further sent into panic by a dysregulation of the function of the balance mechanism in the ear.

Why certain patients were not benefiting from certain treatments for their Vestibular Migraines and Oscillopsia. No one was looking at their neck.

Now let’s look at a May 2020 paper (2) from the Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina wanted to see why certain patients were not benefiting from certain treatments for their vestibular migraines. Here are the summary learning points.

  • 47 patients evaluated for treatment of definite vestibular migraine.
  • Treatments included antidepressants, antiepileptics, beta blockers, and vestibular rehabilitation (physical therapy). Patients failing initial therapy received botulinum toxin per the PREEMPT (a treatment guideline to prevent recurrence of migraine) protocol and vestibular rehabilitation for motion desensitization in case of known vestibular dysfunction.

This was an effective treatment for many. But not all. Let’s see who these treatments did not help. Success of the treatment was based on reduction of dizziness.

  • Results: 47 patients underwent therapy for vestibular migraine.
  • This population had a significant dizziness reduction with therapy.
  • BUT, if you had neck pain and oscillopsia, these treatments did not help your migraine as much as those patients without neck pain and oscillopsia.

Unilateral,  Bilateral Vestibular Loss and Oscillopsia. A clue that cervical spine instability is at the root of the problem?

Loss of hearing and oscillopsia symptoms. 

We see many patients who have a problem with hearing and oscillopsia symptoms. Unilateral and bilateral vestibular loss, hearing loss in one or both ears can be caused by many things. Finding out which one of these many things is the cause have proved to be very challenging to doctors.

A paper in the journal Therapeutic advances in neurological disorders (3) describes some of the symptoms:

  • Patients with bilateral vestibular loss may present with or without vertigo and hearing loss.
  • They usually complain about oscillopsia during head movements and about unsteadiness, especially while walking in the dark.
  • Common causes of bilateral vestibular loss are side-effects of vestibulotoxic antibiotics (or ototoxic antibiotics) (especially gentamicin), even after short periods of administration. Symptoms of ototoxicity are hearing loss, vertigo, and tinnitus
  • Autoimmune ear diseases such as Cogan’s syndrome, Menière’s disease and meningitis
  • Bilateral vestibular loss, may also be associated with hereditary diseases

Even with all of these possibilities, doctors continue to find isolating on the cause of the patients problems of hearing loss and oscillopsia.

  • It should be noted that in this study, patients with instability of the cervical spine and abnormal brainstem or cerebellum on MRI were not included.
  • When a patient has hearing loss and oscillopsia and cervical spine instability is noted, the testing and provocation needed to confirm study results may be considered dangerous for patients or because of the instability, the study results may be skewed. Either way, as we have seen in our clinical work, it is these people, who we can trace to having cervical spine instability, that we can help with their oscillopsia.

After Prolotherapy injections – improvements seen.

Our patient above described her symptoms over the course of 30 years of unsuccessful treatment. She presented a very complicated case.

Prolotherapy treatments these are simple injections that are explained and demonstrated below. These improvements were seen after 8 treatments.

  • Improvements with the optic nerve.
    • I went to go see my doctor last summer and he told me both of my eyes (vision) got better at the same time which is very unusual supposedly because of my age (mid-50s).
  • Discontinued Adderall 
    • I got off my Adderall that was another huge thing for me. Because the treatments here have helped me get more blood flow to the brain, my vision has improved enough. (Not seeing too many things at once).
  • TMJ pain imporvement
    • I’ve had TMJ pain since I was in my twenties. I could never figure out where my bite was and now I know where my bite

The impact on symptoms including vision problems when treating cervical neck instability

We are going to start with an introductory video by Ross Hauser, MD. Below the video is a summary of the video with explanatory notes to help further and explain some of the concepts that Dr. Hauser is putting forth in explaining vision problems as they relate to neck pain.

Summary learning points

  • Dr. Hauser emphasizes that to understand the impact on symptoms of cervical neck instability causes, including ultimately vision problems, you have to understand that the nerves that travel the spine are so intertwined with each other and through the cervical vertebrae that any compression to the nerves will cause far-reaching problems.

Focus on C1-C2

  • At 1:30 of the video: Dr. Hauser talks about C1-C2 instability and its impact on the Vagus Nerve (Cranial Nerve X)
    • When the Vagus nerve is injured by compression caused by instability at C1-C2, this can cause vasospasms (narrowing of the arteries and reduction of blood flow). If these vasospasms impact the ophthalmic artery, the artery that supplies blood to the eye and eye area including the orbit – this can lead to some of the symptoms are patients describe to us such as darkening, black spots, or grayness in the vision of one eye.

At 2:00 Minutes of the video, Dr. Hauser refers to this slide:

In this image, vision problems caused by cervical spine instability is connected to Diminished ocular blood flow, Exaggerated pupillary hippus dilating, Hampered accommodation or human ocular accommodation mechanism or accommodation reflex, Increased intra-ocular pressure or elevated intraocular pressure, Limited pupillary constriction, Optic nerve damage

In this image, vision problems caused by cervical spine instability is connected to Diminished ocular blood flow, Exaggerated pupillary hippus dilating, Hampered accommodation or human ocular accommodation mechanism or accommodation reflex, Increased intraocular pressure or elevated intraocular pressure, Limited pupillary constriction, Optic nerve damage. Here are brief explanatory notes:

  • Diminished ocular blood flow can cause symptoms, usually in one eye, of blurred vision or partial or complete loss of vision
  • Exaggerated pupillary hippus dilating and constricting which can cause problems with light sensitivity and the pupil fails to respond correctly to light sources.
  • Hampered accommodation or human ocular accommodation mechanism or accommodation reflex. This is the function of the eye that maintains a clear focus on objects whether close by or far away.
  • Increased intraocular pressure or elevated intraocular pressure. This is high pressure inside the eye is caused by an imbalance of production and drainage of the inner eye fluids. The symptoms here include various vision disturbances. Researchers speculate a connection to the development of glaucoma.
  • Limited pupillary constriction. This is also a problem with the dilation of the pupil. Your eye may not respond properly or at all to light stimulus.
  • Optic nerve damage caused by blood flow restriction.

Demonstration of Prolotherapy treatment

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders.

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative/reparative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD, is giving the injections.

In 2015, our research team published our findings in our paper “The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study.” This peer-review research was published in the European Journal of Preventive Medicine.(4)

Here we wrote:In an effort to facilitate the diagnosis and treatment of clinical cervical spine instability and chronic neck pain, we investigated the role of proliferative injection Prolotherapy in the reduction of pain and recovery of constitutional and neurological symptoms associated with increased intervertebral motion, structural deformity and irritation of nerve roots. . . 95 percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality.”

If this article has helped you understand the problems of oscillopsiaand you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists

 

1 King S, Priesol AJ, Davidi SE, Merfeld DM, Ehtemam F, Lewis RF. Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications. Scientific reports. 2019 Oct 4;9(1):1-2. [Google Scholar]
2 Dornhoffer JR, Liu YF, Donaldson L, Rizk HG. Factors implicated in response to treatment/prognosis of vestibular migraine [published online ahead of print, 2020 May 24]. Eur Arch Otorhinolaryngol. 2020;10.1007/s00405-020-06061-0. doi:10.1007/s00405-020-06061-0 [Google Scholar]
3 Petersen JA, Straumann D, Weber KP. Clinical diagnosis of bilateral vestibular loss: three simple bedside tests. Therapeutic advances in neurological disorders. 2013 Jan;6(1):41-5. [Google Scholar]
4 Hauser RA, Steilen D, Gordin K. The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study. European Journal of Preventive Medicine. 2015 Jun 16;3(4):85. [Google Scholar]

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