RU2534859C2 - Diagnostic technique for spinal arterycompression in spinal artery canal - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: technique involves spiral computed tomography of the cervical spine. The spinal artery canal is examined to state a stenosis, if any. A cross-section area S_c of the spinal artery canal at the stenosis level is calculated. That is followed by colour duplex ultrasonographic imaging, and a cross-section area S_a of the stenosis-free involved spinal artery is calculated. The spinal artery compression index CI is calculated by formula CI=1/3S_c:S_a. If the derived index is equal to 1.0 or more, compression is stated to be absent; the value falling within the range of 0.9 to 0.7 enables diagnosing moderate compression of the spinal artery, with the values varying from 0.6 to 0.4 showing considerable compression, and below 0.4 - pronounced.

EFFECT: higher diagnostic accuracy ensured by taking into account the involved spinal artery size within the stenosis and outside of it.

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Description

The invention relates to medicine, ultrasound and radiation diagnostics, neurosurgery, neurology and can be used to determine compression of the vertebral artery in the channel of the vertebral artery in case of degenerative diseases and trauma of the cervical spine.

Closest to the claimed method is a method for the diagnosis of compression of the vertebral artery in the canal of the vertebral artery (RF patent No. 2437619, published December 27, 2011), adopted as a prototype. Spiral computed and magnetic resonance imaging of the cervical spine is performed, the canal of the vertebral artery is examined, its narrowing and / or deformation are revealed. Measure the cross-sectional area of the canal of the vertebral artery on both sides at the level of the identified pathology. The bone index is calculated according to spiral computed tomography and / or soft tissue, according to magnetic resonance imaging, compression by dividing the channel cross-sectional area from the pathology side to the area from the normal side. If the index value is from 1.0 to 0.7, moderate compression of the vertebral artery is diagnosed, when the index value is from 0.6 to 0.3, pronounced compression is diagnosed, when the index value is below 0.3, significant.

However, the prototype is not accurate enough, since only the vertebral artery channel is measured, not taking into account the size of the vertebral artery, the channels of the vertebral arteries are compared with the healthy and affected sides, the sizes of which can vary significantly, as well as the sizes of the vertebral arteries passing through them, which is not enough to choose an adequate treatment .

The invention is aimed at creating a method for diagnosing compression of the vertebral artery in the canal of the vertebral artery, providing improved accuracy.

, при значении индекса 1,0 и более компрессия отсутствует, при показателе от 0,9 до 0,7 диагностируют умеренную компрессию позвоночной артерии, от 0,6 до 0,4 - значительную, ниже 0,4 - выраженную.The specified technical result in the implementation of the invention is achieved by the fact that in the method for diagnosing compression of the vertebral artery in the canal of the vertebral artery, which includes conducting spiral computed tomography of the cervical spine, examining the canal of the vertebral artery, revealing the presence of its stenosis, the feature is that the cross-sectional area is calculated channel S _{to the} vertebral artery at the stenosis perform color duplex scanning and calculating the cross-sectional area OAPC night artery S _and on the side of stenosis is a pathology zone index calculated compression of the vertebral artery of the formula IC $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}$$

, with an index value of 1.0 or more, there is no compression, with a score of 0.9 to 0.7, moderate compression of the vertebral artery is diagnosed, from 0.6 to 0.4 - significant, below 0.4 - pronounced.

. При значении индекса 1,0 и более компрессия отсутствует, при показателе от 0,9 до 0,7 диагностируют умеренную компрессию позвоночной артерии, от 0,6 до 0,4 - значительную, ниже 0,4 - выраженную.The method is as follows. Patients with degenerative-dystrophic diseases and injuries of the cervical spine undergo spiral computed tomography of the cervical spine. The canal of the vertebral artery is examined, the presence of its stenosis is revealed. Measure the cross-sectional area of the canal of the vertebral artery S _k at the level of stenosis. Perform color duplex scanning and calculate the cross-sectional area of the vertebral artery S _a on the pathology side outside the stenosis zone. The vertebral artery compression index IR is calculated using the formula $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}$$

. With an index value of 1.0 or more, there is no compression, with a score of 0.9 to 0.7, moderate compression of the vertebral artery is diagnosed, from 0.6 to 0.4 - significant, below 0.4 - pronounced.

With moderate and significant compression of the vertebral artery, conservative treatment and minimally invasive puncture interventions are possible, with severe, open surgical removal of compressing substrates is necessary.

The claimed method for diagnosing compression of the vertebral artery in the spinal canal has passed clinical trials in the treatment of 64 patients with suspected compression of the vertebral artery.

We give clinical examples - extracts from medical records.

Example 1. Patient A., 51 years old, East. Disease No. 12413, was admitted to the Road Clinical Hospital of St. Petersburg in a planned manner with complaints of pain and restriction of movement in the cervical spine, pain in the right upper limb that arose after physical exertion and has been disturbing for the past 3 weeks. Outpatient treatment without significant effect. Previously, periodic neck pains have been bothered for the past 15-17 years. Upon admission, the condition is satisfactory, pulse 74 beats per minute, rhythmic, blood pressure 115 and 75 mm Hg, vesicular respiration in the lungs. In the neurological status: hypesthesia in the innervation zone of C ₃ -C ₇ roots on the right, limitation and pain during movements in the cervical spine, pain during palpation of paravertebral points and spinous processes of the cervical vertebrae.

. Диагностирована умеренная компрессия позвоночной артерии.A comprehensive examination was performed. With CT of the cervical spine, a narrowing of the channel of the vertebral artery on the right at the level of C ₃ -C ₄ vertebrae due to osteophytes was revealed. According to the claimed method, with SCT, stenosis of the channel of the right vertebral artery was established at the level of C ₃ -C ₄ vertebrae, the cross-sectional area of the channel of the right vertebral artery was measured at the level of stenosis: S _k = 26.9 mm ² . When color duplex scanning determined the diameter (3.6 mm) and calculated the cross-sectional area of the right vertebral artery outside the level of stenosis: S _a = πr ² = 3.14 × 1.8 ² = 10 mm ² . The compression index of the right vertebral artery was calculated $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}=26.9:3:10=0.9$$

. Diagnosed with moderate compression of the vertebral artery.

A complex conservative treatment was prescribed, including vascular preparations, a course of physiotherapeutic procedures, massage and physiotherapy exercises. A gradual regression of pain and neurological symptoms was noted. When viewed after 1 month on an outpatient basis, no complaints, no neurological loss.

Thus, according to the claimed method, the patient revealed the presence of degenerative-dystrophic disease of the cervical spine with signs of moderate compression of the vertebral artery, which allowed for a conservative treatment course with a positive result.

Example 2. Patient X., 47 years old, medical history No. 12567, was admitted to the Road Clinical Hospital of St. Petersburg in a planned manner with complaints of limited mobility and pain in the cervical spine radiating to the left upper limb. Sick for a long time, the current exacerbation is about a month. Upon receipt, the condition is satisfactory, pulse 82 beats per minute, rhythmic, blood pressure 130 and 70 mm RT. Art., in the lungs vesicular breathing. During a neurological examination: hypesthesia in the innervation zone of the C ₅ -C ₆ root on the left, decreased muscle strength when the forearm is bent to 4 points, limited range of motion and pain on palpation of the spinous processes in the cervical spine.

. Диагностирована значительная компрессия позвоночной артерии.A comprehensive examination was performed. With spiral computed tomography of the cervical spine, subchondral sclerosis, lateral osteophytes of C ₄ -C ₆ vertebrae, arthrosis of the uncovertebral and intervertebral joints, left-sided lateral hernia of the C ₅ -C ₆ intervertebral disc up to 4.5 mm are determined. According to the claimed method, with SKT, stenosis of the canal of the vertebral artery is established at the level of C ₅ -C ₆ on the left, the cross-sectional area of the canal of the left vertebral artery is measured at the level of stenosis: S _k = 19.1 mm ² . During color duplex scanning, the diameter (4.0 mm) was determined and the cross-sectional area of the left vertebral artery outside the stenosis level was calculated: S _a = πr ² = 3.14 × 2 ² = 12.6 mm ² . Left vertebral artery compression index $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}=19.1:3:12.6=0.5$$

. Significant compression of the vertebral artery was diagnosed.

The patient underwent percutaneous laser nucleoplasty of the C ₅ -C ₆ intervertebral disk, which passed without complications. In the postoperative period, there was an improvement in well-being and a regression of neurological symptoms.

. Компрессия позвоночной артерии умеренная.At the follow-up examination after 3 months does not show complaints, proceeded to the previous work. According to the claimed method, in the control SKT of the cervical spine, we measured the cross-sectional area of the canal of the vertebral artery on the left at the level of stenosis that took place: S _k = 26.4 mm ² . During color duplex scanning, the diameter (3.8 mm) was determined and the cross-sectional area of the left vertebral artery outside the level of stenosis was calculated: S _a = πr ² = 3.14 × 1.9 ² = 11.3 mm ² . Left vertebral artery compression index $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}=\mathrm{26,4}:3:11.3=0.8$$

. Vertebral artery compression is moderate.

Thus, the patient revealed the presence of degenerative-dystrophic disease of the cervical spine with hernia formation at the level of C ₅ -C ₆ and established, according to the claimed method, significant compression of the left vertebral artery, which made it possible to undertake a minimally invasive puncture method of treatment with a laser with a good result.

Example 3. Patient T., 32 years old, source of illness No. 13789, was admitted to the St. Petersburg Road Clinical Hospital by transfer from the Tosno Central District Hospital. 3 days before entering work, he slipped, fell on the rails, hit his neck. Upon receipt of a complaint of pain in the cervical spine, dizziness, weakness and numbness in the right upper limb. At a neurological examination: paresis of the muscles of the extensors of the shoulder up to 4 points, with extensors of the hand and fingers up to 3 points, hypoesthesia of the radicular type in the innervation zone of C ₅ -C ₇ roots.

. Диагностирована выраженная компрессия позвоночной артерии.Conducted a comprehensive survey. Spiral computed tomography of the cervical spine revealed a fracture dislocation of C ₄ -C ₅ vertebrae with stenosis of the canal of the right vertebral artery at this level. According to the claimed method, with CT, stenosis of the channel of the right vertebral artery at the level of C ₄ -C ₅ vertebrae was revealed, the cross-sectional area of the channel of the right vertebral artery was measured at the level of stenosis: S _k = 9 mm ² . In color duplex scanning, the diameter (4.8 mm) was determined and the cross-sectional area of the right vertebral artery outside the stenosis level was calculated: S _a = πr ² = 3.14 × 2.4 ² = 18 mm ² . Right vertebral artery compression index $$\mathrm{AND}\mathrm{TO}=\raisebox{1ex}{$\mathrm{one}$}\!\left/ \!\raisebox{-1ex}{$3$}\right.S_{\mathrm{to}}:S_{\mathrm{but}}=9:3:\mathrm{eighteen}=0.2$$

. A pronounced compression of the vertebral artery was diagnosed.

The operation was performed: open reduction of fracture-dislocation, bone decompression of the right vertebral artery, fixation with a loop bracket made of titanium nickelide. The postoperative period without complications, the wound healed by primary intention.

The patient was discharged in satisfactory condition for further outpatient treatment by a neurologist at the place of residence, rehabilitation courses are recommended. At the control examination on an outpatient basis, after 8 months, a complete regression of neurological symptoms was noted.

Thus, according to the claimed method, in a patient with an injury of the cervical spine, pronounced compression of the vertebral artery is established, which made it possible to establish indications for its surgical decompression and to obtain a good long-term result.

Claims (1)

A method for diagnosing compression of the vertebral artery in the canal of the vertebral artery, including conducting spiral computed tomography of the cervical spine, examining the canal of the vertebral artery, revealing the presence of its stenosis, characterized in that they calculate the cross-sectional area of the canal of the vertebral artery S _k at the level of stenosis, perform color duplex scanning and calculating the cross-sectional area S of the vertebral artery _and in the pathology of the stenosis is zone index calculated compression vertebral IR artery by the formula

, with an index value of 1.0 or more, there is no compression, with a score of 0.9 to 0.7, moderate compression of the vertebral artery is diagnosed, from 0.6 to 0.4 - significant, below 0.4 - pronounced.