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

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.