ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 24 of 61
Up
JMBS 2018, 3(5): 120–126
https://doi.org/10.26693/jmbs03.05.120
Clinical Medicine

Structural-Morphological Changes of the Сervical Column in Young Patients with Spondologenic Dyscirculation in the Vertebro-Basilary System

Nekrasova N. 1, Kostyukovska A. 2
Abstract

The study of the spondylogenic circulatory disorders in the vertebro-basilar system in terms of structural and morphological changes of the cervical spine and their association with hemodynamic determined metabolic disorders has a significant scientific interest. Material and methods. The study deals with researching the patterns of structural and morphological changes of cervical column of 141 patients with manifestations of vertebral-basilar insufficiency (VBI) of spondylogic origin. In order to detect the spondylogenic origin of the VBI, we performed an ultrasound doppler examination of the vertebral arteries using functional rotation head loads, followed by the calculation of functional hemodynamic indices. After examination 3 groups were formed: Group 1 (angiodystonic stage of VBI) consisted of 36 patients with changes of hemodynamic indices in vertebral artery on the background of VAT compared to rest state from 15÷30 %; Group 2 (angiodystonic-ischemic stage of VBI) consisted of 41 patients with changes of hemodynamic compared to rest state from 30≥50 %; Group 3 (ischemic stage of VBI) consisted of 64 patients with changes of hemodynamic compared to rest state ≥ 50 %. Changes of hemodynamic characteristics more than 15% along rotational probe compared to rest were considered to be spondylogenic. In order to exclude atherosclerotic lesions of VA and identification of the peculiarities of their course the duplex scanning of VA was done. Results and discussion. During the MRI of the cervical spine, we used a traditional scanning protocol (or a set of mp-sequences): T1FSE and T2FSE sequences in the sagittal plane, the T2FSE sequence in the axial plane. This set allowed us to detect most informative degenerative-dystrophic changes in the structures of the vertebral column. The Short TI Inversion Recovery (STIR) sequence in the coronary (frontal) plane, inclined along the X2 segment, allowed assessing the state of crochet-like processes and intervertebral joints, to form arthrosis changes, to detect extra-prominent protrusions and prolapses of intervertebral discs, which can cause lumbago or compression of the vertebral arteries. The coronal orientation of the sections also allows visualizing the changes of the VA passage. The leading MRI symptoms of degenerative-dystrophic lesions detected in all subjects were: changes in the physiological lordosis of Schwh, scoliostic deformations, decrease in the intensity of the signal from intervertebral discs in T2-weighted image, decrease in height between vertebral discs, marginal bone growth, thickening of the capsule’s apparatus for intervertebral joints, protrusion and prolapse of intervertebral discs, thickening of longitudinal ligaments. The presence of the spinal canal stenosis was noted in 25% of patients, significantly more often on the background of the progression of disease (p <0.05). Herniated intervertebral discs were reliably more often visualized at C5-C6 vertebral column, which corresponds to the entry of the vertebral artery into the osteoarticular canal. Conclusions. The study of the structural and morphological patterns of disorders in the cervical column allows us to expand our understanding of the pathogenetic mechanisms of the formation and development of spondylogenic blood dyscirculation in this category of patients and can be used as a prognostic diagnostic criterion in order to prescribe the subsequent therapeutic tactics for such patients.

Keywords: structural-morphological changes of the сervical column, spondylogenic vertebro-basilar insufficiency

Full text: PDF (Ukr) 218K

References
  1. Bakhtadze MA, Vladymyrova VP, Sydorskaya NV, Plotnykov VG. Kompressyya pozvonochnoy arteryy: dostatochnoe uslovye dlya razvytyya vertebralno-bazylyarnoy nedostatochnosty yly zadnego sheynogo sympatycheskogo syndroma? Manualna terapiya. 2006; 3 (23): 32-8. [Russian]
  2. Bugrovetskaya OG, Rudkovskyy AI, Tard MV, Arshynov BV. Vlyyanye proby s povtornymy povorotamy golovy na krovotok v pozvonochnykh arteryyakh u bolnykh s kranyotservykalgyey. Neyrodyagnostyka y vysokye byomekhanycheskye tekhnologyy. 2010; 4: 20-4. [Russian]
  3. Vereshchagyn NV. Patologyya vertebralno-bazylyarnoy systemy y narushenye mozgovogo krovoobrashchenyya. Moskva: Medytsyna, 1980. 312 s . [Russian]
  4. Goydenko BC, Zagorskaya HA. Byodynamycheskaya korrektsyya osteokhondroza pozvonochnogo stolba y myofastsyalnykh bolevykh syndromov. Uchebnoe posobye. Moskva, 1998. [Russian]
  5. Dzhalkkhy AM. Spondylogennye narushenyya krovoobirashchenyya v vertebralno-bazylyarnom basseyne (klynycheskye varyanty, kompleksnoe lechenye): Abstr. PhDr. (Med.). SPb: BI, 1995. 18 s. [Russian]
  6. Dravert NE. Osobennosty tserebralnoy gemodynamyky u bolnykh s syndromom pozvonochnoy arteryy. Zhurn Nevrol y Psykhyatr. 2010; 1: 20-4. [Russian]
  7. Zhulyev NM, Kandyba DV, Yakovlyev HA. Sheynyy osteokhondroz. Syndrom pozvonochnoy arteryy. Vertebralno-bazylyarnaya nedostatochnost. Sankt-Peterburg: «Lan», 2002. 576 s. [Russian]
  8. Zakhmatova TV. Kontent-analyz ynformatsyy o klynyko-luchevoy dyagnostyke povrezhdenyy y degeneratyvnykh zabolevanyy sheynogo otdela pozvonochnyka (obzor lyteratury). Radyologyya - praktyka. 2016; 4 (58): 30-41. [Russian]
  9. Kalashnykov VI. Syndrom pozvonochnoy arteryy. Therapia. 2007; 10: 31-3. [Russian]
  10. Kamchatnov PR, Chugunov AV, Mykhaylova NA. Vertebralno-bazylyarnaya nedostatochnost – problemy dyagnostyky y terapyy. Medytsynskyy sovet. 2013; 1: 69–73. [Russian]
  11. Kandyba DV. Spondylogennyy syndrom pozvonochnoy arteryy: posobye dlya vrachey. SPb: SPbMAPO, 2009. 64 s. [Russian]
  12. Rozhdestvenskyy AS, Smyalovskyy VE, Savchenko AYu, y dr. Vertebrogennyy y aterosklerotycheskyy mekhanyzmy vertebralno-bazylyarnoy nedostatochnosty: sravnytelnaya ultrazvukovaya kharakterystyka. Ynsult: prylozhenye k zhurn nevrol y psykhyatryy. 2005; 13: 42-50. [Russian]
  13. Kovalenko OE. Klynyko-dyagnostycheskaya kharakterystyka, profylaktyka y lechenye narushenyy krovoobrashchenyya v vertebralno-bazylyarnom basseyne pry patologyy sheynogo otdela pozvonochnyka: Abstr. Dr. Sci. (Med.). K, 2007. 36 s. [Russian]
  14. Kolyadenko OP, Radysh BB, Kutenom AV. Vertebralno-bazylyarnaya nedostatochnost pry posttravmatycheskykh spondylogennykh narushenyyakh. Vestnyk Russkogo unyversyteta druzhby narodov. 2000; 2: 91-3. [Russian]
  15. Kurtusunov BT, Asfandyyarova EV. Nedostatochnost krovoobrashchenyya v systeme pozvonochnykh arteryy v svete anatomycheskykh yssledovanyy. Astrakhanskyy medytsynskyy zhurnal. 2010; 5 (4): 49-51. [Russian]
  16. Lyubimov OV. Spondylogennaya vertebralno-bazylyarnaya nedostatochnost: dyagnostyka, lechenye y profylaktyka: Abstr. Dr. Sci. (Med.). M, 2010. 38 s. [Russian]
  17. Mazheyko LY, Doryna MM. Klynyko-rentgenologycheskye pryznaky kranyovertebralnoy patologyy u patsyentov s tservykogennymy golovnymy bolyamy. Russkyy zhurnal boly. 2017; 1 (52): 22-3. [Russian]
  18. Markelova MV. Anatomyya kanala y strukturno-morfometrycheskye osobennosty vnutrykanalnogo otdela pozvonochnykh arteryy u cheloveka: Abstr. PhDr. (Med.). Novosybyrsk, 2009. 21 s. [Russian]
  19. Nefedov AYu. Patogenez y dyagnostyka spondylogennoy nedostatochnosty krovoobrashchenyya v vertebralno-bazylyarnoy systeme. Novye podkhody k lechenyyu: Dis. Dr. Sci. (Med.). M., 2005. 198 s. [Russian]
  20. Novoseltsev CB. Spondylogenna-kranialna nedostatochnost mozgovogo krovoobrashchenyya v vertebralno-bazylyarnom basseyne y ee korrektsyya: Abstr. PhDr. (Med.). SPb: Spbgmu ym IP Pavlova, 2004. 20 s. [Russian]
  21. Payenok AV, Kozar-Gursha OM. Vertebrobazylyarna nedostatnist mozkovogo krovoobigu ïï zv'yazok iz patologichnymy zminamy u shyynomu viddili khrebta. Bukovynskyy medychnyy visnyk. 2012; 16 (63): 67–70. [Ukrainian]
  22. Patent 116879 A Ukraine, A 61 V 10/00. Sposib diagnosyky spondylogennoyi vertebrobazylyarnoyi nedostatnosti u osib molodogo viku / Nekrasova NO, M’yasoyedov VV, Tovazhnyanska OL, Grygorova IA. (UA); opubl. 12.06.2017, Byul. № 11. [Ukrainian]
  23. Rudkovskyy AY, Stulyn YD, Tard MV, Bugrovetskaya OG. Klynycheskoe znachenye proby s povtornymy povorotamy golovy pry dopplerografycheskom yssledovanyy krovotoka v pozvonochnykh arteryyakh y pozvonochnom venoznom spletenyy. Manualnaya terapyya. 2010; 3 (39): 3-9. [Russian]
  24. Sytel OB, Kuzmynov KO, Bakhtadze MA. Vlyyanye degeneratyvno-dystrofycheskykh protsessov v sheynom otdele pozvonochnyka na narushenye gemodynamyky v vertebralno-bazylyarnoy systeme. Manualnaya terapyya. 2010; 1 (37): 10-21. [Russian]