Hauser, Danielle Steilen, Ingrid Schaefer Sprague. Cervical Instability as a Cause of Barré-Liéou Syndrome and Definitive Treatment with Prolotherapy: A Case Series. Barré-Liéou syndrome, or posterior cervical sympathetic syndrome, has symptomatology related to underlying cervical instability. While classified as degenerative retrolisthesis l5 s1 rare disease, Barré-Liéou syndrome is likely underdiagnosed.
Barré-Liéou syndrome presents a unique challenge to the clinician since its diagnosis is under-recognized and definitive treatment of the condition requires elucidation. Although data indicate Barré-Liéou syndrome affects less than 200,000 patients in the U. Barré-Liéou syndrome is a syndrome of the cervical sympathetic nerves and ganglia that includes the common symptoms of headaches, dizziness, vertigo, and auditory and visual manifestations—which are frequently attributed to the diagnosis of migraine headache. It is curious to consider Barré-Liéou syndrome, or posterior cervical sympathetic syndrome, as the etiology of these common symptoms, as they are often considered idiopathic with no known cause. As there are no strict criteria for the diagnosis of Barré-Liéou syndrome and its related symptoms can be observed in the general population, this syndrome may actually be more common than previously thought despite its low rate of diagnosis. Barré-Liéou syndrome is thought to be caused by a disruption of sympathetic nerve function by structural deformation of the cervical spine. Other symptoms can include laryngeal disturbances known as “oscillating aphonia” as well as neck muscle cramps and psychoneurotic manifestations, typically insomnia, anxiety, and depression.
A differential diagnosis of Barré-Liéou syndrome involves the comparison of symptoms of Barré-Liéou syndrome, post-concussion syndrome, whiplash, atlanto-axial instability, and vertebrobasilar insufficiency. In the differential diagnosis these symptoms along with a complete history that includes neck trauma would indicate Barré-Liéou syndrome. This is referred to as “creep,” the time-dependent elongation of a ligament under constant, low level stress. Barré and Liéou surmised that cervical arthritis or injury provoked an irritation of both the vertebral nerve and the sympathetic nerves, producing related symptoms. Etiology withstanding, the resultant cervical arthritis that causes irritation of the vertebral nerve and surrounding structures in turn allows for the manifestation of symptoms associated with Barré-Liéou syndrome.
In automobile accidents, neck sprain or strain is the most common type of injury as the forced hyperflexion and extension can cause ligamentous damage in the cervical spine. Both of these types of injuries can involve forces great enough to cause vertebral fractures or tears to ligaments, muscles or tendons in the neck. Ligamentous changes are also observed in patients who administer self-manipulation, as these repetitive movements can cause increased strain on cervical ligaments and subsequent cervical ligament laxity. Changes in the sympathetic nervous system can be related to injury of the cervical nociceptors along with soft tissue injury. CT scan shows subluxation of the facet joint at C1-C2.
Injury to the facet joint and capsular ligament laxity results in Barré-Liéou syndrome. Capsular ligament laxity causes anterior cervical instability when the neck is flexed, resulting in impingement of the cervical sympathetic ganglion and producing symptoms of Barré-Liéou syndrome. Of these patients, the incidence of instability was much higher in women than men. The authors concluded, “Cervical spine instability is crucial in diagnosing sympathetic cervical spondylosis. These cervical spine injuries can result from side or back impacts in traumatic accidents causing extreme flexion and extension of the neck, which can lead to increased laxity in the capsular ligaments and then the potential for further complications. The transverse ligaments are important stabilizers to the joints.
Because of its added mobility, the upper cervical spine is particularly vulnerable to injury. These symptoms often include headache, neck pain, dizziness, and vertigo, which all overlap with Barré-Liéou syndrome. It may not be immediately clear whether someone has suffered a cervical spine injury since ligamentous injuries are often underdiagnosed as related to concussions. This instability of the cervical spine and its ligaments can compress vertebral blood vessels and the posterior cervical sympathetic chain. Due to the overlap in symptomatology between these conditions, a common etiology such as underlying cervical instability should be considered. Barré-Liéou syndrome may be more common in the general population and could be misdiagnosed as any of these other syndromes.
For these reasons, an underlying cause of neck instability should be considered. Barré-Liéou syndrome patients who present classic symptoms of the condition for treatment may often be provided temporaneous amelioration of their symptoms with medications designed for migraines, vertigo, or pain. However, these medications provide limited relief for specific episodes, and are not curative. Vertebral instability or malalignment, which occurs when neck ligaments become injured, affects the function of the nerve cell aggregations located anterior to the vertebrae.