Effects of Restrained Cervical Mobility on Involuntary Eye Movements

Abstract

The presumed connection between cervicogenic dizziness, cervical evoked involuntary eye movements and intervertebral joint blocks of the high cervical spine serves as a starting point for the manual therapist in treating patients suffering from neck pain, headache and dizziness. Cervical evoked involuntary eye movements are of diagnostic importance and proprioceptive cervical positional nystagmus is seen as pathognomic for high cervical intervertebral joint blocks. In a period of two years, 157 patients with neck pain, headache and dizziness were referred to and examined in our department. Thirty eight patients were diagnosed as having functional vertebrobasilar insufficiency and 17 patients presented with benign paroxysmal positional vertigo. These 55 patients were excluded from the study. The remaining 102 patients were included in the study. Passive functional tests of cervical motion segments OCC-C1, C1 through C4 according to Van der EI and Dvorák and Dvorák and the test for cervical evoked involuntary eye movements according to Oosterveld were carried out on the last group. In 84 of the 102 patients (82%) the passive functional tests of OCC-C1, C1 through C4 were evaluated as positive for one or more cervical motion segments in one rotational direction; in 18 of the 102 patients (18%) as positive in two rotational directions. In 13 of 102 patients (13%) the cervical evoked involuntary eye movements were evaluated as present for proprioceptive cervical positional nystagmus (mean latency: 4 sec.; frequency: decreasing); in 89 patients (90%) as absent. In 12 of the 13 patients (92.3%) intervertebral joint blocks were present at four levels of the high cervical spine OCC-C1, C1 through C4. There was a significant correlation between the number and level of the blocked cervical motion segments and the presence of the proprioceptive cervical positional nystagmus (Kendall's tau-b = 0.59; p < 0.05). The results of this study are not comparable with those reported in other studies because of differences in the methods and judgement of the cervical evoked involuntary eye movements (ENG versus visual observation using Frenzel's spectacles) and the function of the high cervical spine (no specific information versus manual diagnostic information per cervical motion segment). The findings suggest the need for further research.

Keywords:

• Mobility
• Cervical motion segment
• Cervical nystagmus
• Cervical dizziness
• Manual therapy