Vertebral Artery Syndrome In Cervical Osteochondrosis: Symptoms And Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Vertebral artery syndrome with cervical osteochondrosis

The content of the article:

1. The mechanism of development of the vertebral artery syndrome
2. Symptoms

3. Treatment

   1. Drug treatment
   2. Other types of conservative therapy
   3. Surgery
4. Video

Vertebral artery syndrome in cervical osteochondrosis occurs due to the compression of the neurovascular bundles by the elements of the disc (refers to the hemodynamic type of disorders). It does not appear immediately, the first stages of osteochondrosis are localized within the articular surface without directly entering the surrounding tissues.

Vertebral artery syndrome is caused by the peculiarities of the anatomical structure of the cervical spine

The mechanism of development of the vertebral artery syndrome

The mechanism of occurrence of pathology is influenced by the anatomical features of the cervical spine. Some points of the anatomical structure of this zone explain the occurrence of certain symptoms of the disease.

Anatomical structure	Characteristic
Vessels	The small size of the vertebrae combined with high pressure on this area. The absence of bodies at the first cervical vertebrae. At the C1-C2 level, osteochondrosis does not occur. The vertebral arteries run directly in the transverse processes of the vertebrae starting from C6. Sometimes the arteries are located at a higher level (C5). The medial wall of the canal, through which the vessel passes from each side, is formed by the lateral surface of the vertebral bodies (separated from them by a layer of fatty tissue). This explains the occurrence of compression even with minor movements (too close). The vertebral artery is a paired structure: the right one originates from the brachiocephalic trunk, and the left one from the aortic arch. This explains some difference in the clinic when one of the branches of the artery is compressed (more pronounced symptoms in case of damage to the left vessel). A nerve bundle always passes near the artery, which also explains the occurrence of neurological symptoms. Both arteries at the C1 level deviate forward upward and medially, pierce the atlanto-occipital membrane and the dura mater (in the brain they are combined into one large vessel). The arteries are involved in the formation of the main main vascular system in the brain - the Vilisian circle, which explains the appearance of ischemic symptoms from the brain in osteochondrosis of the cervical spine.
Nerves	Pressure is exerted on the entire nerve root, depending on the type of nerve fiber, various manifestations occur: 1. Somatic branches are involved in the innervation of muscle and cartilage structures. Their irritation explains local soreness and muscle spasm. 2. The visceral branches are involved in the innervation of organs in this zone. Their irritation leads to dysfunction of nearby structures (loss of facial sensitivity, for example). 3. Fibers of the sino-vertebral nerve Lyushka innervate discs, periosteum, ligaments of the spinal canal. Their irritation explains the occurrence of radicular symptoms.

As a result, due to even slight compression on the part of the disc elements, chronic irritation of the vertebral nerve and periarterial sympathetic plexus of the vertebral artery occurs.

Symptoms

There are three main types of disorders: cerebral, vascular and vegetative. Classification of the clinical picture depending on the degree of hemodynamic disorders:

1. Dystonic (functional). This form is characterized by a specific type of headache, which is burning in nature and spreads from the back of the head towards the forehead (a symptom of removing the helmet). There are also visual disturbances in the form of darkening in the eyes, photophobia.
2. Ischemic (organic). An extremely difficult variant, which is represented by transient ischemic attacks and ischemic strokes. Occurs with prolonged cerebral ischemia.

Clinical variants of vertebral artery syndrome:

Clinical syndrome	Description
Barre-Lieu syndrome (posterior cervical sympathetic syndrome)	It is associated with congenital disorders of normal innervation in the area of the cervical vertebrae. It often occurs at the level of C2-C3 and does not manifest itself for a long time. Over time, there are classic headaches, as well as autonomic and visual disturbances.
Cervicogenic migraine attack	It starts with visual impairment, which is accompanied by dizziness, tinnitus, ataxia. At the height of the attack, a headache occurs with loss of consciousness.
Vestibulo-atactic syndrome	Associated with a feeling of body instability, loss of balance, tachycardia. The person is lost in space.
Cochleo-vestibular syndrome	Associated with the appearance of noise, hearing loss, hearing loss. Often, along with this, there is a feeling of swaying and dizziness.
Ophthalmic syndrome	It is associated with a rapid decrease in vision, loss of visual fields, increased fatigue.
Autonomic Disorder Syndrome	There is an unreasonable feeling of fever / chills, impaired sensitivity of the extremities, impaired swallowing, chewing (lesion of the laryngeal-pharyngeal segment).
Transient ischemic attacks	Seizures are associated with motor and sensory impairments. Loss of consciousness is possible at the height of the attack.
Unterharnscheidt Syndrome (Syncope Vertebral Syndrome)	It occurs when there is a violation of blood circulation in the reticular formation of the brain stem. Manifested by loss of consciousness with sudden head movements.

There are two main types of vertebral artery syndrome development:

1. Compression-irritative form - arises due to direct compression of the arteries (most typical for osteochondrosis at the stage of intervertebral hernia).
2. Reflex-angiospastic form - appears in connection with reflex irritation of the nervous structure (most typical for osteochondrosis in the initial stages, when pathological impulses go from the affected disc).

The two presented forms have some similarity in clinical manifestation, an important difference lies solely in the cause of occurrence.

The clinical picture for two variants of the development of this pathology is presented in the table.

View	Symptoms
Reflex-angiospastic syndrome	1. Hemodynamic type headaches with a wavy character (reminiscent of migraine attacks). Clear dependence on external conditions. 2. Changes in total blood pressure. Hypertension appears, because due to spasm of the vertebral arteries, centralization of blood circulation occurs (the body's attempts to compensate for the lack of blood flow to the brain). 3. Fainting, dizziness, noise in the head, hot flashes. All this is combined into a single syndromic complex - Unterharnscheidt's syncope. 4. Impaired coordination of movements, impaired spatial coordination (impaired blood supply to the vestibular apparatus). 5. Visual disturbances, which include blurred vision, photophobia, lacrimation, flashing flies before the eyes. 6. Laryngeal-pharyngeal symptoms, which are manifested by sensations of tingling, tickling and coughing, impaired taste perception, dysphagia. 7. Disorders in the mental sphere of the type of hysterical, asthenic or anxiety-hypochondriacal states.
Compression-irritative syndrome	1. Headaches of the hemicranic type with irradiation to nearby areas. The attack is aggravated by head movements. 2. Painful contracture of the muscles of the neck, sensations of stretching and crunching in the neck during movements. Tonic muscle tension. 3. Vestibular disorders (loss of spatial orientation, misunderstanding of body position relative to surrounding objects, unsteadiness of gait). Significant affected area (peripheral, stem, supranuclear vestibular formations). 4. Various variants of epileptic seizures (Wallenberg-Zakharchenko syndrome, “drop-attack” seizures, hypothalamic disorders).

It is sometimes difficult to clearly establish the patient's specific belonging to a certain group (symptoms are presented in a classical form, which is relatively rare, more often there are mixed forms).

Treatment

To treat vertebral artery syndrome with osteochondrosis is required taking into account all types of disorders:

• treatment of mechanical compression (restoration of normal disc structure);
• vascular treatment (restoration of normal blood circulation);
• auxiliary, mainly symptomatic treatment.

Drug treatment

Drug therapy does not have a strict scheme and includes various options for drugs (the selection is strictly individual in each case).

The scheme is variable, may include:

1. Non-steroidal anti-inflammatory drugs - provide the removal of edema and inflammation from the surrounding tissues, since this significantly potentiates the symptoms of the vertebral artery syndrome itself. Example: Nimesulide - 100-200 mg / day, Lornoxicam - 8-16 mg / day, Celecoxib - 200-400 mg / day.
2. Drugs aimed at enhancing venous outflow. They are prescribed for the prevention of edema, which are formed as a result of venous stasis. Example: Troxerutin - 600-900 mg / day, Ginkgo-biloba - 80-160 mg / day, Diosmin - 600-1200 mg / day.
3. Medicines aimed at normalizing blood circulation. Medicines can belong to different groups, but all have a positive effect on hemodynamics. Example: Pentoxifylline - 300-900 mg / day, Cinnarizine - 75-150 mg / day, Nicergoline - 30-60 mg / day, Instenon - 2.0 ml IV or 5-6 tablets / day.
4. Drugs from the group of neuroprotectors that prevent severe ischemic brain damage. Also presented by different groups (metabolic drugs, classical neuroprotectors): Citicoline - 500-1000 mg / day, Actovegin - 200-1000 mg / day, Piracetam - 1200-2400 mg / day, Mildronate - 500-750 mg / day …
5. Muscle relaxants - belong to the group of auxiliary drugs in the treatment of vertebral artery syndrome and are associated with the elimination of local muscle spasm of the skeletal muscles (back muscles). Example: Tolperisone - 150-450 mg / day.
6. Antimigraine drugs are rarely used, but due to some similarity in vascular disorders of the brain, they can have a positive effect in patients with vertebral artery syndrome. An example of drugs: Sumatriptan - 50-100 mg once, 100-300 mg / day.
7. Antispasmodics - drugs for symptomatic therapy, allow you to somewhat relax the smooth muscles (pharynx, larynx). Example: Drotaverine - 40-80 mg / day.

Other types of conservative therapy

1. Exercise therapy. The set of exercises is aimed at eliminating compression and restoring normal joint function. Not allowed in the acute phase (additional pain stimulation).
2. Neck massage - provides stimulation of local blood flow (inclusion of collateral circulation). Any massage techniques are permissible: classic, acupressure, segmental. This also includes various techniques for manual therapy (acupuncture).
3. Physiotherapy methods. They are aimed at reducing inflammation, eliminating muscle spasm and stimulating regenerative processes in tissues. It is permissible to combine with drugs for local use (electrophoresis with novocaine). Typical treatment options: phonophoresis, UHF, electrotherapy, magnetotherapy, cryotherapy.
4. Novocaine blockade of the sympathetic plexus. It is used more often in the case of lumbar osteochondrosis, since it has a high risk of adverse reactions and complications (hematomas, paresis, paralysis). It is rarely used in the neck area, since there is a high risk of trauma to the surrounding tissues.

Once a year, rehabilitation in a special type of sanatorium is desirable (for people with diseases of the musculoskeletal system).

Orthopedic devices can significantly relieve symptoms of compression of the vertebral artery

Surgery

Surgical treatment is carried out against the background of a lack of improvement after several courses of conservative therapy or a sharp deterioration in the course of the disease.

Method	Description
Periarterial sympathectomy	An operation, the essence of which is to cross the sympathetic nerve trunk.
Decompression of the vertebral arteries	It is used to relieve increased pressure from blood vessels by creating collaterals with smaller arteries. A path is created that bypasses the directly restrained area, thus normalizing normal blood circulation in the brain.
Removal of uncovertebral growths and osteophytes	The operation does not affect the vessels themselves, but ensures the removal of the deformed elements of the joint, which led to compression.
Fenestration of intervertebral discs	The technique involves the elimination of a part of the vertebra (arch) and the restoration of normal blood flow.
Plastic surgery of intervertebral discs	Plasty of the affected area is possible with the help of various implants (both from one's own tissues and using special titanium-nickel plates).

The essence of the complex of surgical measures is to create decompression and stabilization of the restrained neurovascular bundle.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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