Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer?

Benign paroxysmal positional vertigo is one of the commonest peripheral vestibular causes of vertigo. The particle repositioning manoeuvre (Epley's manoeuvre) has become the 'gold standard' treatment for this disorder. Benign paroxysmal positional vertigo can affect any age group but is commoner in older patients. Cervical spine problems (e.g. spondylosis and disc prolapse) are commoner in this age group. Epley's manoeuvre necessitates passive neck movements. Such movements may not be wise in patients at risk of cervical spine fracture. This study included 40 patients complaining of vertigo and diagnosed as having benign paroxysmal positional vertigo. A new particle repositioning manoeuvre was designed for these patients, as an alternative to Epley's manoeuvre. At one week review, 36 patients (90 per cent) reported total relief from vertigo. Three patients reported a major improvement in their vertigo, and their residual vertigo was relieved by performing the new manoeuvre again after two weeks. Further clinical reviews at one month, three months, six months and one year found that seven patients had suffered minor attacks of typical benign paroxysmal positional vertigo after three months. All seven were relieved of their symptoms after undergoing the new particle repositioning manoeuvre again. The proposed new manoeuvre is simple, effective and safe for treating patients with benign paroxysmal positional vertigo and cervical spine problems.