CONCUSSION

You can't disagree that assessment of the cervical spine in post-concussion management and treatment is important. However, the prevalence of cervical spine pathology in concussed patients is unknown. Many authors express interest and promote the manual assessment of the cervical structures, including Leddy et al 2015,Gergen 2015, Scorza et al 2012,Ellis et al 2015,Craton et al 2017,Cheever K et al 2016, Matsuszak et al 2016,Morin et al 2016,Marshall et al 2015, Elkin et al 2016,Putukian 2017,Lundblad 2017 Growbaski et al 2017, and Kosoy/Feinstein 2018.

Also, you can also go back to 1956 to read an article by Seletz in Calif Med Journal entitled, "Craniocerebral Injuries" (a free paper). So, yes, this concept is not new.

There will be tons more coming out in the concussion literature over the next few years to aid in prevalence rates themselves, but here are studies we present to our classes:

Kennedy et al 2017, in a retrospective chart review study, found that 32 of 45 (69.5%) of patients with persistent post-concussion symptoms, were found to have cervicogenic component. The authors highlight the value of physiotherapy assessment and treatment of the cervical spine following a concussive injury.

Reneker et al 2015, in a cross-sectional study of athletes after a concussion, found 82.9% had cervical involvement and 26.8% presented with Cervicogenic Dizziness.

A classic, Scheider et al 2014, in a randomized controlled trial to treat concussion in adolescents, found 100% of patients in both treatment AND control group had cervical spine findings. Moreover, 93.33% in treatment group had neck pain while 87.5% in control group had neck pain. Additionally, 86.33% had dizziness in treatment group and 82.75% had dizziness in control group.

Marshall et al 2015, albeit a review paper BUT also a case series, discusses the role of many theories causing post-concussive syndrome. Pertinent to this post, the authors give credence to "a very treatable" cause of it---the cervical spine.

Jensen et al 1990 found that 18 out of 19 (94.7%) patients with persistent post-concussive syndrome had upper cervical spine restrictions when compared to an uninjured control group. Their work concludes that it supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.

Treleaven et al 1994 demonstrated in 12 patients with post-concussive had upper cervical spine dysfunction compared to a normal control group.

Going back even further, Mager et al 1989, noted a block of the upper cervical spine and of the cervicothoracic area was proved in 83.53% of patients who were hospitalized upon a head injury.

Whiplash

The literature on this is somewhat older but still very pertinent, stands true to today, and actually we have more data from multiple sources. I always say about half of patients who have had whiplash-associated disorder experience dizziness and/or imbalance. To name a few, I recommend reading the works of Diane Wrisley 2000, Oostesteveld et al 1991, Skovron 1998, Humphreys & Peterson 2013. 

NON-TRAUMATIC CERVICOGENIC DIZZINESS

For those who are not treating the elderly and not dealing with trauma, the numbers are not nearly as hefty. I always mention to my students that the prevalence in this realm is ~10%. Even though the patient age and criteria within these studies vary, I lump this under non-traumatic Cervicogenic Dizziness. This is where I get my data:

Ardic et al 2006, in a retrospective chart review, noted dizziness of cervical origin at 7.5%.

Luscher et al 2014, in a prospective, observational, multi-center study, noted dizziness of cervical origin at 6.4%.

Reid et al 2015, in a randomized-controlled trial, had 8.5% of participants fulfill the inclusion and exclusion criteria as having Cervicogenic Dizziness.

Vindigni et al 2019 respondents reported that over 44% of their older adult patients with neck pain were at risk of falls, and over one-quarter of them suffered from cervicogenic dizziness.

From the outside looking in, the literature is all over the place with our prevalence numbers! This is what makes the condition challenging and exciting to treat and help others. You can consider Cervicogenic Dizziness as a single entity, double entity and even traumatic vs non-traumatic origin. Therefore, the prevalence of Cervicogenic Dizziness can be challenging to truly calculate. I hope this information helps you make a better decision in the office.