Cervical Spine Issues and Oscillopsia

Introduction to Cervical Spine Disease

• The American Association of Neurological Surgeons and other guideline societies describe the neurological manifestations of cervical spine disease, which include cervical radiculopathy and cervical spondylotic myelopathy, but do not mention oscillopsia as a symptom or complication of cervical pathology 1, 2, 3, 4, 5.

Clinical Presentation of Cervical Spine Disease

• Cervical radiculopathy presents with arm pain in a dermatomal distribution, sensory dysfunction, motor weakness in corresponding myotomes, and neck pain that may radiate to the shoulder 3.
• Cervical spondylotic myelopathy presents with gait disturbance and balance difficulties due to spinal cord compression, not vestibular dysfunction, as well as hand clumsiness and fine motor deterioration 5.

Differential Diagnosis of Oscillopsia

• Primary vestibular causes of oscillopsia include bilateral vestibular hypofunction, superior canal dehiscence, and Ménière's disease 4, 5.
• Central causes of oscillopsia include brainstem or cerebellar pathology, multiple sclerosis, posterior circulation stroke, and medication effects 5, 6.
• Oculomotor causes of oscillopsia include nystagmus and ocular motor nerve palsies 5.

Management of Cervical Myelopathy

• The Congress of Neurological Surgeons and other guideline societies recommend urgent surgical evaluation for patients with cervical myelopathy and progressive neurological deficits, regardless of visual symptoms 5.
• Delaying surgery in the presence of myelopathy risks permanent neurological deficit, and gait disturbance represents established myelopathy requiring decompression 5.