The Status of Cervical Vestibular Evoked Myogenic Potentials in Patients
with Cervical Discopathy and Different Types of Vertigo
Objective: This research study aims to assess the status of cervical
vestibular evoked myogenic potentials (cVEMP) in patients diagnosed with
cervical discopathy and experiencing different types of vertigo.
Cervical discopathy is a common condition characterized by disc
degeneration and herniation in the cervical spine. Vertigo, a symptom of
vestibular dysfunction, can be caused by various factors including
cervical discopathy. However, the relationship between cervical
discopathy and different types of vertigo remains unclear.
Design:
The study will recruit a sample of patients diagnosed with cervical
discopathy, and presenting with different types of vertigo. The cVEMP
test will be conducted to evaluate the vestibular function specifically
related to the cervical disc status. The cVEMP test involves measuring
the muscular responses of the sternocleidomastoid muscle in response to
auditory stimuli.
Result: The primary outcomes of this study include the assessment of
cVEMP parameters such as peak-to-peak amplitudes and latencies in
patients with cervical discopathy and various types of vertigo. These
parameters will be compared with a control group of individuals without
cervical discopathy or vertigo. Additionally, the study will explore
potential correlations between cVEMP findings and clinical symptoms and
characteristics related to cervical discopathy.
Conclusion: The results of this research will provide valuable insights
into the vestibular function associated with cervical discopathy and
different types of vertigo. The findings may contribute to the
understanding of the pathophysiology of vertigo in patients with
cervical discopathy and help develop targeted management strategies.
Ultimately, this study aims to improve the diagnosis and treatment of
patients experiencing vertigo associated with cervical spine disorders.
Keywords: cervical vestibular evoked myogenic potentials, cVEMP,
cervical discopathy, vertigo, vestibular dysfunction
Key points
- Cervical discopathy refers to the degenerative changes that occur in
the cervical spine and are associated with symptoms such as neck
stiffness, radiculopathy, and vertigo.
- cVEMP is the extraction of the information from the inner ear
vestibular portion by the recording of induced sternocleidomastoid
muscle mechanoreceptors potentials.
- Among patients with cervical discopathy, benign peripheral vertigo is
more frequently observed compared to cervical vertigo, making it the
most common type of vertigo in this population
- The study findings indicated that the presence or absence of cervical
disc pathology did not show any statistically significant difference
in cVEMP results.
- The use of cVEMP for assessing peripheral vertigo seems to be
applicable regardless of the presence or absence of cervical disc
pathology.
Introduction
Cervical spondylosis and cervical disc herniation are highly prevalent
degenerative diseases affecting the cervical spine. In certain
instances, they can lead to myelopathy, thereby elevating the potential
for significant disability. Key manifestations of these conditions
encompass neck pain, stiffness, radiculopathy, and symptoms specific to
the affected segment of the spinal cord. 1
Cervical vestibular evoked myogenic potentials (cVEMP) provide an
objective approach to extracting information about the vestibular
portion of the inner ear through the stimulation of the
sternocleidomastoid muscle. cVEMPis elicited by delivering alternating
500 Hz tone bursts via air conduction and is directly recorded from the
sternocleidomastoid muscle mechanoreceptors.2 This
response originates from a reflex circuit that begins in the saccule and
proceeds to the ipsilateral vestibular nuclei, ultimately reaching the
ipsilateral spinal accessory nerve
nuclei.3Abundant manuscripts could
be found about cervical vertigo and cervical disc pathologies.4,5 On the other hand the effect of
cervical disc pathologies on cVEMP in patients that have noncervical
vertigo remains scarce.
The aim of this present study is to investigate the prevalence and the
types of peripheral vertigo in patients with cervical hernia and to
consider the difference in the cVEMP results of the vertigo patients
according to cervical disc status
Material and Methods
Subjects
Between January 2021 and July 2022 thirty-three patients with different
diagnoses of peripheral vertigo enrolled in this study. Written informed
consent was obtained from the patients. The study design and reporting
followed the guidelines set forth by the EQUATOR network for prospective
studies.
After taking medical records, all patients with vertiginous symptoms
underwent detailed ear nose and throat physical examination. The most
common peripheral vertigo diagnosis were; benign paroxysmal positional
vertigo (BPPV), vestibular migraine, semicircular canal dehishence
syndrome . Benign paroxysmal positional vertigo diagnosed with head
thrust, rotating chair and dix-hallpike tests. Vestibular migraine
diagnosis was by the criteria of at least five episodes with vestibular
symptoms of moderate or severe intensity, lasting five minutes to
seventy-five hours, current or previous history of migraine, and one or
more migraine features with at least 50% of the vestibular episodes.6 Semicircular canal dehiscence syndrome was diagnosed
with thin slice petrous temporal tomography in the patients with
complaints of hearing loss, vertigo and/ or pulsatile tinnitus.
All the patients were checked for the pain that radiates through the
ear, neck, arm and shoulder with a gait and imbalance and the numbness
of the shoulder and arm. Any of the mentioned complaints were recorded
when the patient underwent a cervical MRI.
The cervical VEMP (cVEMP) procedure was started with skin preparation by
using an alcohol swap. Three electrodes (active, reference and ground)
were placed. The active surface electrode was placed at the skin,
approximately to the sternocleidomastoid muscle middle part. The upper
sternum was the reference electrode location. The forehead was the
ground electrode location.
The unilateral air conducted alternating 500 Hz tone bursts was applied
by using ER3A-insert earphones. (Etymotic Research, Elk Grove Village,
IL, USA.) The initial stimulus intensity was 85 dBnHL and increased
incrementally to 95 dBnHL and 105 dBnHL. Electromyography signals were
identified, amplified (5000X), filtered (Blackman gating function
bandpass 10-1500 Hz) and recorded. The calculation of the interaural
difference (IAD) ratio was made by dividing the inter-ear difference of
p1-n1 interamplitude by the sum of the p1-n1 interamplitude of both
ears. (7,8)
Statistical Analysis
Statistical analysis made by STATA SE 17 software (Copyright 1985-2021
StataCorp LLC StataCorp 4905 Lakeway Drive College Station, Texas 77845
USA). Mean±standard deviation is the expression of continuous data.
Non-normal data were converted into logarithmic form and compared with
the Mann-Whitney U test. The comparison of variables was performed by
the independent student T-Test, p values under <0,05
considered statistically significant. This study has been approved by
Local Committee of Ethics at the University XXX.
Conflict of Interest : None
Results
33 patients 20 female, 13 male. Age 51.51 ±15.67 (min 21- max 85) Most
common peripheric vertigo etiology left benign paroxysmal positional
vertigo (bppv), right bbpv and migratuar vertigo. (Table 1)
Table 1: The distribution of different types of peripheral vertigo among
the study population