Assessment of hemodynamics in the vertebral arteries with instability of the cervical vertebrae and uncovertebral arthrosis with functional tests

Abstract

Instability of the cervical vertebrae and uncovertebral arthrosis are often the cause of hemodynamic disorders in the vertebral arteries. The aim of the investigation was to perform Doppler analysis of the parameters of blood flow in the vertebral arteries in patients with instability of the cervical spine (CS) and uncovertebral arthrosis with functional tests. Materials and methods. We examined 43 patients aged 18 to 44 years with CS instability, in 34 cases in combination with uncovertebral arthrosis (UVA). Determined Vs, Vd, RI, PI, MFV at the level in the second segment of the VA in the neutral position of the head and functional tests. Instability and uncovertebral arthrosis were diagnosed by radiography of the neck in frontal and lateral projections. Doppler sonography was performed on a Philips HD 11XE device using linear and microconvection sensors in the frequency range of 5-10 MHz Results. In patients with antilisthesis, the Vs value in the extension position was 32.1 ± 3.4 cm / s, RI - 0.71 ± 0.03, CCV - 84 ± 7 ml / min, significantly (P <0.05) lower than in the case of retrolisthesis and in comparison group (CG). With head flexion, the lowest Vs value was found in the group with retrolisthesis and was 31.5 ± 3.1 cm / s, RI – 0.72 ± 0.03, CCV – 87 ± 8 ml / min, significantly (P<0.05) lower than with antelisthesis and in CG. In the case of left localization of UVA, the lowest Vs value was recorded in the left VA during ipsilateral head rotation and amounted to 31.2 ± 2.9 cm / s, RI index - 0.72 ± 0.03, PI - 1.03 ± 0.06, and MFV - 85 ± 9 ml / min, reliably (P<0,05) are lower than the indices of the right VA with right-sided localization of UVA. In right-sided uncovertebral arthrosis, Vs in the right VA had the smallest value and amounted to 30.4 ± 3.2 cm / s, RI index - 0.73 ± 0.03, PI - 1.04 ± 0.06, MFV - 81 ± 8 ml / min, respectively. These indices significantly (P <0.05) differed from the indices of the left VA in the case of left-sided localization of UVA. Conclusions. With antelisthesis, the deterioration of blood flow parameters in the form of a decrease in systolic peak velocity and minute blood volume, as well as an increase in resistance and pulsation indices, occurs during extension, and in retrolisthesis, on the contrary, with bending of the head. With uncovertebral arthrosis, the deterioration of hemodynamic parameters is better manifested with rotational head movements. A decrease in the systolic velocity and minute volume of blood flow, an increase in the indices of resistance and pulsation occur during impsilateral rotation of the head on the side of arthrosis. Key words: instability of the cervical vertebrae, uncovertebral arthrosis, duplex scanning, vertebral arteries, functional tests.