The position of the displaced vertebra needs to be corrected in order to decrease the irritation of the nerves and to reduce unnecessary stress on the soft tissues of the spinal column.
There is a substantial conventional neurological literature showing that of the neck is associated with a substantial increased risk of vertebral artery territory stroke (Rothwell et al, 2001; Smith et al, 2003; Vibert et al, 1993). A recent paper that enrolled a nearly 1000 subjects noted that "cervical manipulation" preceded 7% of strokes caused by (Engelter et al, 2013), but only 0.6% of strokes not caused by cervical artery dissection. A 10:1 difference in risk. Other forceful activities such as heavy lifting, extreme head movements, and sports all were highly associated with greater risk of strokes from cervical artery dissection. It seems then that stretching the vertebral artery sometimes causes it to rupture.
Otoneurology (i.e. a neurologist that specializes in dizziness and hearing disorders) is the specialty that seems most reasonable for cervical vertigo - -but there are very few otoneurologists in the world. Practically, the safest thing to do to us seems to be to locate a sympathetic and thoughtful physician to be the "captain of the ship", see appropriate specialists to exclude alternatives involving the ear (e.g. BPPV) , and brain (e.g. migraine), and take reasonable measures to decrease neck pain and stiffness (e.g. physical therapy, and pain clinic if this fails).
Furthermore, as noted above, the world literature about cervical vertigo is full of strange and peculiar ideas and suggestions, and we would be hard pressed to recommend someone outside of the US either.
We are often asked about who can be seen locally to diagnose and treat cervical vertigo in the United States. The short answer is there does not seem to be any clinician in the United States who has written anything substantial on cervical vertigo. We are trying ourselves (e.g. Yacovino and Hain, 2013; Hain, 2015).
There are many potential causes of cervical vertigo. The situation today (2015), is that we have many potential mechanisms, but don't so far have a good way of separating them out from one another and, more importantly, finding effective treatment. (Hain, 2015)
In Bow-hunter's syndrome, the vertebral arteries in the neck (see above) can be compressed by the vertebrae (which they traverse -- see above), or other structures (Kamouchi, Kishikawa et al. 2003; Sakaguchi, Kitagawa et al. 2003). Arthritis, neck surgery, and chiropractic manipulation are all potential precipitants of neurological symptoms including stroke. According to Bogduk, compression can be due to anomalies of the origin of the vertberal artery, an anomalous course between the fasciles of either longus coli or scalenus anterior, and bands of deep cervical fascia (Bogduk, 1986). All of these mechanisms would presumably be associated with blockage of flow on turning the neck to one side or the other. It is usually of significance only in persons who have a substantial asymmetry in their vertebral circulation -- one being much smaller, or one being absent or terminating in PICA.
It is presently considered a problem when there is mechanical compression during head rotation due to muscular and tendinous insertions, osteophytes, and arthritis around the C1-C2 level. As the vertebral arteries enter the vertebrae around C4, it can also occur at lower levels. As about 50% of cspine rotation occurs around C1, this is likely the reason for the predominance at this level. Dynamic cerebral angiography is the preferred method of documenting this diagnosis, but this is almost never done as it requires a substantial amount of contrast and radiation, and it rarely results in a positive finding. One would think that MRA done in 3 positions -- head right, head center, head left, would also be diagnostic, but we have not seen any papers of this. In addition, while MRA does not have the radiation issue that CT does, it might require more contrast than reasonable.
This is not a common syndrome, but there is a substantial literature. About 20 papers in Pubmed have "Bow hunter's stroke" in their title, almost all being case reports from neurosurgeons. According to Choi et al (2005), who reported 4 cases, vertigo, tinnitus and nystagmus are due to labyrinthine ischemia. Logically, one would wonder why an artery that supplies the lower brainstem, would produce findings solely from ischemia of the labyrinth. In their cases, there was a mixed downbeat/torsional/horizontal nystagmus beating towards the compressed vertebral artery (i.e. away from the direction of head turning). In three patients the nystagmus spontaneously reversed direction. The nystagmus appears after a latency of about 5 seconds (the author has seen a patient in which it took 20 seconds). On repeat of head rotation, the nystagmus may be lessened. There seem to be many variants of "bow hunter's stroke", and certainly one cannot rely on all cases to show the same pattern.
is the term used to define a degenerative and an acute spine condition in which a single vertebra gets displaced and moves backwards onto the vertebra lying immediately below it. Vertebrae are the bones that make up the spinal column and are separated from each other by cushioning intervertebral discs.
The subclavian artery feeds the vertebral arteries in the neck, and thus disorders of the subclavian can interact with vertebral blood flow. The would be unlikely to affect vertebral blood flow as narrowing of the subclavian in TOS occurs after the vertebral arteries take off from the subclavian.