Cervicovagopathy: ligamentous cervical instability and dysstructure as a potential etiology for vagus nerve dysfunction in the cause of human symptoms and diseases

Figures

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  Figure 1. The vagus nerve.

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  Figure 2. A list of diseases/conditions/symptoms that potentially involve the vagus nerves.

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  Figure 3. Interconnectedness of vagus nerves. (A) Anterior craniocervical junction (a. Jugular ganglion CN X, b. Nodose ganglion CN X, c. Superior ganglion CN IX, d. Inferior ganglion CN IX). (B) At level of brainstem and spinal cord (a. Dorsal motor nucleus of the vagus, b. Nucleus solitarius, c. Trigeminal nuclei, d. Nucleus ambiguus).

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  Figure 4. The cervical vagus nerves. (A) Anterior view. (B) Lateral view. The vagus nerves run dangerously close to the anterior cervical vertebrae, which is especially true at the atlanto-axial joint, where it is very vulnerable to traction stretch.

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  Figure 5. Forward head posture from hours of computer work and texting, resulting in cervical ligament laxity, ultimately compressing the internal jugular veins and vagus nerve. “Creep,” which is a term signifying the slow stretching of ligaments, most commonly occurs by a forward head posture from computer work or looking at a smartphone. As cervical vertebrae sublux anteriorly, a stretch compression can occur on the internal jugular veins and autonomic nerves in the anterior part of the neck, including the vagus nerves and cervical sympathetic ganglion.

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  Figure 6. Various types of structural dynamic internal jugular vein and vagus nerve compression and stretch.

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  Figure 7. Ligamentous upper cervical instability potential etiology of vagus nerve dysfunction. Vagus nerve dysfunction can result from degeneration or conduction blocks from stretch and compression on the nerve at the level of the atlas (C1).

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  Figure 8. Ultrasound of the carotid sheath showing the vagus nerve. (A) Normal. (B) Normal image magnified and measured. (C) Degenerated vagus nerve. (D) Degenerated image magnified and measured.

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  Figure 9. Ultrasound of vagus nerve in mid-cervical region with various neck positions. (A) Neck in neutral position. (B) Neck flexed. (C) Neck extended. (D) Neck rotated left. (E) Neck rotated right. As can be seen, the vagus nerve within the carotid sheath undergoes various structural tensions depending on neck positions.

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  Figure 10. Connection between ligamentous cervical instability, the vagus nerve, and heart rate variability parameters.

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  Figure 11. The potential symptoms from ligamentous cervical instability and the pathophysiology it causes, including vagus nerve degeneration and dysfunction.

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  Figure 12. Cervical treatment recommendations based on dynamic upright radiographic studies. Patients often have a combination of ligamentous cervical instability, cervical dysstructure (breakdown of cervical curve), and misalignments, the 3 pillars of cervical structural health. * Some extreme cases of instability require surgery or other methods. ** Optimizing cervical curve is multifaceted and can include ergonomics, exercise, physical therapy, low-force adjustments, and many other physical medicine techniques.