Evaluation of hemodynamics in vertebral arteries in case of herniated cervical intervertebral discs using functional tests

Abstract

Background. Degenerative changes of the vertebral-motor segment occupy an important place among the causes of cervicogenic headache, neck pain with radiation to the shoulder and arm, noise in the head, dizziness. The same symptoms are often found in vertebral artery syndrome, which is a set of disorders of vertebral-basilar dynamics. Dopplerography makes it possible to obtain quantitative parameters of blood flow in the vertebral arteries, thereby assessing the level of pathological changes in blood flow.
 Purpose. Dopplerographic assessment of blood flow parameters in vertebral arteries in patients with herniated cervical intervertebral discs using functional tests.
 Materials and methods. An analysis of the results of dopplerography of the vertebral arteries in 42 young patients with herniated cervical intervertebral discs was carried out. Peak systolic velocity (Vs), end-diastolic velocity (Vd), indices of peripheral resistance (RI) and pulsatility (PI), minute volume of blood flow (HOK – Vvol) in the second segment of the VA at the C2-C3 level were determined at functional prob.
 Results and discussion. With a left-sided hernia, the value of Vs in the left VA during contralateral head rotation was 34.1 ± 2.9 cm/s, RI – 0.71 ± 0.03, PI – 1.04 ± 0.06, HOC – 85 ± 9 ml/min, and in the comparison group – 45.3 ± 3.8 cm/s, 0.59 ± 0.02, 0.85 ± 0.04, 118±13 ml/min, respectively. In patients with a right-sided hernia, Vs in the right VA during contralateral head rotation was 32.6 ± 3.2 cm/s, RI – 0.72 ± 0.03, PI – 1.03 ± 0.06, COC – 83 ± 8 ml/min, and in the comparison group – 44.8 ± 4.1 cm/s, 0.60 ± 0.02, 0.87 ± 0.04, 117 ± 12 ml/min, respectively. The difference between Doppler blood flow parameters obtained during contralateral head rotation in patients with disc herniation and the comparison group (persons without disc herniation) was significant (P < 0.05).
 Conclusion.Hemodynamically significant disruption of blood flow in the vertebral artery occurs when the paramedian and posterolateral hernia is localized on the side of the same name during head rotation to the opposite side. These violations consist in a significant decrease in systolic speed and minute volume of blood flow, in an increase in indices of resistance and pulsatility compared to persons without disc herniation.