Ross Hauser, MD
In our experience, of the many patients we see who suffer from cervical spine instability, will also suffer from drop attacks. A drop attack is commonly seen as a sudden fall without the loss of consciousness. Typically drop attacks are linked to Ménière’s disease and inner ear disorders and neurological or cardiovascular problems. In our articles and clinical data we also see a link in some patients between cervical spine instability, Ménière’s disease. Please see my articles:
- Meniere’s Disease and hearing problems caused by cervical neck instability,
- Neurologic-like symptoms and conditions of Cervical Spine Instability.
Also see my article on cardiovascular problems and cervical spine instability titled:
In our research we have proposed a cervical spine instability link with those conditions as well as poor blood and fluid flow in the brain as causes of many problems including drop attacks. This would include compression of the carotid sheath and internal jugular veins.
These subjects are covered at length in my articles:
- Dynamic carotid sheath compression | Symptoms and treatments
- Symptoms and conditions of internal jugular vein compression and stenosis
In our office we utilize Prolotherapy, a simple dextrose solution or Prolotherapy use bone marrow stem cells or blood platelets (PRP) treatments to help repair and strengthen the ligaments of the cervical spine to bring a natural cervical curve and stability to the neck, helping preventing compression of the nerves and blood vessels.
The cervical spine instability answer to drop attacks is not the right answer for every patient. However, when no answers can be found, an examination of the neck may be warranted.
Cervical spine instability and ligament damage – The definition of ligamentous
The word ligamentous refers to “ligaments.” Ligaments are the strong connective tissue that hold bones in place.
- “Ligamentous upper cervical instability” refers to damaged, weakened, loose, or “lax” ligaments in the C1-C2 region that are no longer strong enough to prevent the upper cervical vertebrae from wandering out of position.
- “Ligamentous cervical instability” refers to damaged, weakened, loose, or “lax” ligaments in the C3-C7 region that are no longer strong enough to prevent the cervical vertebrae from wandering out of position.
When the ligaments are no longer strong enough to prevent the bones from sliding on top of each other, the ligaments can then be seen as the main culprit of nerve impingement, herniation of discs, arterial and vein compression, and other challenges that lead to the symptoms and conditions of the neurologic and neurologic-type symptoms that many people we see with a long history of neck problems suffer from.
Damaged ligaments may also play a role in Functional neurological disorders, being an “unseen” culprit causing neurological symptoms such as seizures, or tremors, without any “clear” underlying structural damage to the brain or nervous system.
What makes ligament weakness “unseen?” Ligaments are typically not the primary, secondary or even third, fourth or fifth problem explored by doctors. MRI and x-ray can reveal herniated discs and various spinal deformities in the neck, but not reveal the instability caused by cervical ligament weakness.
Cervical ligament drop attacks are a condition where excessive neck instability or wandering neck bones, especially in the upper cervical spine (C1/C2), compresses the vertebral arteries that supply blood to the brainstem and cerebellum. This temporary loss of blood flow can lead to dizziness, loss of balance, and a sudden fall. Other symptoms may include ringing in the ears, visual changes, and numbness. Diagnosis involves a thorough history and physical exam, and may include tests like Transcranial Doppler (TCD) ultrasound to assess blood flow. Treatment focuses on identifying and managing the underlying cause, such as cervical instability.
Cervical Spine Instability, Vein blockage, fluid build-up, and intracranial hypertension.
Blurry vision, eye pain, eye pressure, light sensitivity and other vision problems, along with symptoms including drop attacks are among the more troubling and disabling symptoms that are often due to cervical spine instability. A summary and explanatory notes of this video can be found here at: Blurry vision, light sensitivity, brain fog, increased ocular pressure and cervical Instability.
Atlantoaxial instability and Atlas displacement
Atlantoaxial instability and Atlas displacement are a primary focus of the Hauser Neck Center at Caring Medical Florida. In my article, Compression of the brainstem – Atlantoaxial instability and Atlas displacement I discuss the possible bizarre and disabling neurological symptoms that have gone undiagnosed or unresolved and the impact of Atlantoaxial instability and Atlas displacement, and upper cervical instability on the brainstem, nerve, and blood vessel compression including the carotid artery, and the jugular veins.
Atlantoaxial instability is the abnormal, excessive movement of the joint between the atlas (C1) and axis (C2). The bundle of ligaments that support this joint is strong bands that provide strength and stability while allowing the flexibility of head movement and allow unimpeded access (prevention of herniation or “pinch”) of blood vessels, nerves that travel through them to the brain and the spinal cord itself.
Outside of our published research there is limited studies suggesting a connectiopn between cervical spine instability and drop attacks
In 1996, Dutch surgeons made a connection between drop attacks and cervical spine instability. Briefly describing two case histories in The Journal of bone and joint surgery. British volume (1) the doctors described two elderly men who had drop attacks and cervical spine instability. In both cases the attacks stopped following a limited fusion of the cervical spine. While the doctors wrote, “We cannot prove that compression of the vertebral artery was the cause,” they did note “but this seems likely because of the good results of fusion. Any fracture or dislocation of the cervical spine above the sixth cervical intervertebral foramen may compromise the vertebral arteries, and relative vascular insufficiency may occur in the basilar artery and its branches as well as in the anterior cervical artery.”
The first case was an 85-year-old man who experienced unexplained drop attacks for 10 years. The episodes occurred suddenly without loss of consciousness and were followed by brief confusion, slurred speech (dysarthria), and temporary weakness of all four limbs (transient tetraparesis), resolving within minutes. After one fall in which he injured his neck, cervical flexion during examination triggered another drop attack. Imaging revealed severe instability at the C5-C6 level, particularly during neck flexion. He underwent anterior cervical fusion, and surgical findings confirmed longstanding instability. Following surgery, he remained free of drop attacks for at least 3.5 years.
The second case was a 79-year-old man experienced 10 drop attacks over three years. Each episode lasted about one minute and was associated with temporary weakness in all four limbs (transient tetraparesis), slurred speech (dysarthria), and dizziness, but no loss of consciousness. He also reported intermittent arm tingling (paraesthesiae) and developed neck pain after his most recent fall. Neurological examination showed weakness of the left deltoid muscle and reduced biceps reflexes bilaterally. This case further supports that cervical spine pathology should be considered in patients with unexplained drop attacks, especially when episodes are accompanied by transient neurological symptoms such as tetraparesis, dysarthria, dizziness, arm paraesthesiae, or neck pain. The absence of a cardiovascular cause and the presence of focal neurological findings suggest a cervical spinal origin rather than a cardiac or vascular disorder.
A 2024 paper in the journal Healthcare (2) also suggested that instability at the upper cervical levels can cause vertebrobasilar insufficiency, and includes drop attacks among common vascular symptoms. It also notes that these symptoms can be provoked by head position, especially combinations of flexion/rotation or extension/rotation.
Similar articles
Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability
Our published research
References
1, Van Norel GJ, Verhagen WI. Drop attacks and instability of the degenerate cervical spine. The Journal of Bone & Joint Surgery British Volume. 1996 May 1;78(3):495-6. [Google Scholar]
2 Godek P, Ruciński W. Differentiating the structural and functional instability of the craniocervical junction. InHealthcare 2024 Oct 7 (Vol. 12, No. 19, p. 2003). MDPI. [Google Scholar]