RU2742568C1 - Method of treating patients with posterior cervical sympathetic syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology and medical rehabilitation, and can be used for treating patients with posterior cervical sympathetic syndrome by drug therapy and correction of biomechanical disorders of cervical and thoracic spine. Correction of biomechanical disorders of cervical and thoracic spine is ensured by kinesiology taping. Tape application is performed paravertebrally on both sides in a projection of extensor muscles of the cervical and thoracic spine from the scalp to the Th12 level. That is followed by transverse administration of tape on a humeral arch in a projection of a horizontal dorsal portion of trapezoidal muscles, starting from protruding part of junction of cervical and thoracic spine in direction of acromial points to upper parts of shoulders with tension of up to 50% for 5 days, which is one course of treatment. Courses are performed 1-3 times, with a two-day pause between them.

EFFECT: method provides continuous exposure on a musculo-ligamentous apparatus and reduced head protrusion during the day, correction of upper cross syndrome, stabilization of tonus of all muscles of the cervical spine, reduced risk of expansion of intervertebral joint capsules due to kinesiology taping with tension up to 50%.

1 cl, 5 dwg, 9 tbl, 3 ex

Description

The invention relates to medicine, namely neurology and medical rehabilitation and can be used for the treatment and medical rehabilitation of patients with posterior cervical sympathetic syndrome, characterized by impaired blood flow in the vertebral arteries.

Currently, two main strategies are used to treat patients with posterior cervical sympathetic syndrome (PSCS) characterized by impaired blood flow in the vertebral arteries (PA): drug therapy and methods of conservative treatment.

According to modern literature data, neuroprotection is a complex of drug therapy aimed at compensating for the developing energy deficit of neurons, protecting them from the influence of damaging factors, activating neuroregeneration processes, and correcting blood flow to the brain [1]. In case of ZSSS, neuroprotection appears to be one of the most productive methods for the prevention of chronic cerebral ischemia, which is expressed in the form of insufficiency in the vertebrobasilar basin (VBB).

The list of medications for the treatment of ZSCH: Drugs acting on the venous outflow: semi-synthetic diosmin (Detralex, phlebodia), troxerutin, ginkgo-biloba. Non-steroidal anti-inflammatory drugs: nimesulide, lornoxicam, celecoxib, celebrex.

Drugs that normalize blood flow in PA: pentoxifylline, vincamine, vinpocetine, cinnarizine, nimodipine, nicergoline, sermion, instenon.

Cholinergic drugs: citicoline, ceraxon, recognan, gliatilin.

Complex neuroprotective drugs: Cytoflavin, Actovegin, Cerebrolysin, Piracetam, Mexidol.

Drugs for neurometabolic therapy: cytoflavin, mildronate, thiotriazoline, trimetazidine.

Drugs for symptomatic therapy - muscle relaxants: tolperisone, antispasmodics: drotaverine, histamine-like: betahistine, antimigraine: sumatriptan [2].

Despite the wide variety of groups of drugs used to correct vascular disorders, the effectiveness of none of the drugs used is sufficient, therefore drugs are most often used in combination. In addition, a long course of taking these drugs is required to develop a visible effect, and the presence of side effects in some cases limits their use. The latter is most relevant for a group of drugs with cholinergic action [3].

Conservative treatment includes: drug treatment, manual therapy, massage, acupuncture, physiotherapy, spa treatment [4, 5].

These methods have a number of contraindications, for example, massage is contraindicated in the acute period of the disease, manual therapy, acupuncture, physiotherapy have a number of limitations, which reduces the patient population.

In the treatment of patients with ZSS, along with traditional conservative therapy, puncture methods of exposure are used:

blockade of PA, stellate ganglion, inferior oblique muscle of the head, dereception of the intervertebral disc and facet joints [1]. One of the main disadvantages of this approach is the complexity of the implementation, due to the fact that puncture methods of exposure can only be performed by an anesthesiologist and neurosurgeon, and should also be performed in the presence of an intensive care unit, since when performing puncture methods, side effects associated with exposure to local anesthetics are possible.

Complex conservative treatment includes orthopedic effects on the source of pathology (traction of the cervical spine (CS), immobilization of the CS, manual therapy, etc.); novocaine blockade of spasmodically contracted and painful muscles of the SHOP; physiotherapeutic and balneological methods [5].

In a review article by V.I. Shevtsova et al. Indicated that complex conservative treatment of patients with vertebrogenic syndrome of the vertebral artery includes orthopedic effects on the source of pathology against the background of ongoing drug treatment (vasodilator, desensitizing, antihistamines, analgesics, vitamins, biostimulants, etc.) [4] ...

As a prototype according to the closest technical essence, we have chosen a method of treating patients with ZSSD, which consists in the fact that against the background of drug therapy they use Shants' orthopedic cervical splint, which is worn during the day, the mode of wearing and the course is determined individually by an orthopedic traumatologist [6] ...

In this source, there is no specific listing of drugs or groups of drugs that make up the drug effect, it can only be assumed that the authors used the standard scheme recommended for the treatment of patients with posterior cervical sympathetic syndrome:

Rules for the drug treatment of PA syndrome:

1. Drugs acting on venous outflow: semi-synthetic diosmin (Detralex, phlebodia), troxerutin, ginkgo-biloba.

2. Non-steroidal anti-inflammatory drugs: nimesulide, lornoxicam, celecoxib, celebrex.

3. Drugs that normalize blood flow in PA: pentoxifylline, vincamine, vinpocetine, cinnarizine, nimodipine, nicergoline, sermion, instenon.

4. Cholinergic drugs: citicoline, ceraxon, recognan, gliatilin.

5. Complex neuroprotective drugs: Cytoflavin, Actovegin, Cerebrolysin, Piracetam, Mexidol.

6. Metabolic therapy: cytoflavin, mildronate, thiotriazoline, trimetazidine

7. Symptomatic therapy - muscle relaxants: tolperisone, antispasmodics: drotaverine, histamine-like: betahistine, antimigraine: sumatriptan [2].

The disadvantages of the method we have chosen as a prototype, according to our own data, include:

• insufficient effectiveness of treatment, since a decrease in complaints (dizziness, headache, pain in the cervical spine) occurs only for the period of wearing, and when the Shants orthopedic cervical splint is removed, the patient's complaints return, and the wearing mode is limited;

• the risk of stretching the capsules of the intervertebral joints and the possibility of loosening of the already loose vertebral segments, which enhances pain impulses [6];

• Difficulty in selecting the required size of the Shants orthopedic cervical splint, since there are only 4 sizes of product height;

• the risk of impaired venous outflow of the head, which is accompanied by an increase and / or increase in headache, which is often the reason for patients 'refusal to use Shants' orthopedic cervical splint;

• the presence of upper cross syndrome in patients of this group (protraction of the head), which requires correction of the posture of the thoracic region and the shoulder girdle, but when wearing the Shants orthopedic cervical splint it is impossible to influence the above-described links;

• a decrease in the tone of all muscles of the cervical spine, which has a negative effect on the hypermobility of the cervical spine, which, in turn, is a risk of injury to the ligamentous apparatus of the joints of the cervical spine;

• aesthetic side, which limits the use in the working environment.

The objective of the invention is:

• increase in the effectiveness of treatment, manifested in an increase in the linear velocity of blood flow along the PA in the extracranial and intracranial segments, a decrease in clinical manifestations in the form of dizziness, headache, pain in the cervical spine, upper cross syndrome;

• expansion of the contingent of patients at the expense of patients who refused to use the Shants orthopedic cervical splint due to impaired venous outflow of the head, which was accompanied by an increase and / or increase in headache, as well as those patients for whom it is not always possible to choose the required size of the Shants orthopedic neck splint as there are only 4 sizes, and also at the expense of those patients who refused to use the Schanz splint for aesthetic reasons, including limiting its use in working conditions.

The technical result of the invention is:

• the possibility of constant impact on the musculo-ligamentous apparatus and reduction of head protraction during the day, which will not only increase the effectiveness of the treatment method, but also will not limit its use during working hours;

• the possibility of correction of the upper cross syndrome (protraction of the head), including correction of the position of the head, shoulder girdle, as well as correction of the thoracic posture, characterized by the shoulder index according to O.A. Aksenova;

• the ability to stabilize the tone of all muscles of the cervical spine, which will reduce its hypermobility, which, in turn, will reduce the risk of injury to the ligamentous apparatus of the joints of the cervical spine;

• reducing the risk of stretching the capsules of the intervertebral joints.

The technical result of the invention is achieved by the fact that the method for treating patients with posterior cervical sympathetic syndrome consists in carrying out drug therapy and correction of biomechanical disorders of the cervical and thoracic spine. Kinesio taping is used as a correction for biomechanical disorders of the cervical and thoracic spine. The tape is applied paravertebrally on both sides in the projection of the extensors of the cervical and thoracic spine from the scalp to the Th12 level. Then transverse application of the tape is carried out along the shoulder arch in the projection of the horizontal dorsal portion of the trapezius muscles, starting from the protruding part of the transition of the cervical and thoracic spine in the direction of the acromial points to the upper parts of the shoulders with a tension of up to 50% for 5 days, which is one course of treatment. The courses are performed 1-3 times, with a two-day break between them.

The method is carried out as follows: Patients with verified vertebral artery syndrome (posterior cervical sympathetic syndrome), against the background of basic drug therapy, including venotonics, NSAIDs, drugs that normalize blood flow in the vertebral arteries, neurometabolic drugs, muscle relaxants, antispasmodics, histamine-like, anti-migraine drugs, correction of biomechanical disorders of the cervical and thoracic spine by performing kinesio taping. The patient should be in a sitting position, the paravertebral zones of the skin of the cervical and thoracic regions are treated for defatting and disinfection, and the hair in these zones (if any) is removed, which improves the adhesive properties of the kinesio tapes. The length of the tape is measured from the occipital region of the cervical spine to Tn12 and along an arc at the back between the acromial points. The patient is in the most level position. The tape is applied paravertebrally on both sides in the projection of the extensors of the cervical and thoracic spine from the scalp to the Th12 level. Then transverse application of the tape is carried out along the shoulder arch in the projection of the horizontal dorsal portion of the trapezius muscles, starting from the protruding part of the junction of the cervical and thoracic spine in the direction of the acromial points to the upper parts of the shoulders with a tension of up to 50%. In this case, the tape is divided into two parts, attached to the middle area in the indicated anatomical landmark and further in the direction of the acromial points to the upper parts of the shoulders, first one half of the tape, then the other. The 2 cm ends of the tapes are attached unstretched. One course of treatment is 5 days. The courses are performed 1-3 times, with a two-day break between them.

The invention is based on the limitation of pathological mobility of the cervical vertebrae, stabilization of muscle tone, reduction of traumatization of the ligamentous apparatus of the uncovertebral and facet joints, reduction of muscle pain, which leads to a decrease in the influence of the main etiopathophysiological processes of ZHSS.

ZSSS occurs due to compression or spasm of the vertebral arteries.

A number of changes can be distinguished that lead to mechanical compression of the vertebral arteries and / or to irritation of the sympathetic plexus of the arteries, which densely innervates the anterior longitudinal ligament, the area of the annulus fibrosus, the ligamentous apparatus of the facet joints, which leads to reflex vasospasm [7, 8].

Thus, compression of the vertebral artery can occur in the first segment before it enters the canal of the transverse processes. Here, compression of the trunk of the vertebral artery by the scalene muscles occurs. Hypertonicity of the middle and longus muscles of the neck, as well as their defiance, can form a tunneling mechanism of artery compression [9].

The above changes in the muscle tone of the muscles of the cervical spine are formed in the upper cross syndrome, in which hypertonicity of the sternocleidomastoid muscles is also observed [9], which forms a persistent protraction of the head, which stimulates hypertonicity of the scalene, middle and length of the neck muscles. These pathological changes are the result of the activity of muscle groups with simultaneous reciprocal inhibition of their antagonists [10]. The use of kinesio taping to extend the cervical spine, according to the muscle theory, activates the antagonist muscles due to a mechanical effect on the tonic reflex [11, 12, 13, 14], which leads to a decrease in the hypertonicity of the sternocleidomastoid, scalene, middle and long neck muscles, the function of which is to flex the cervical spine, which reduces the risk of compression of the vertebral arteries at this level.

In the second segment in the canal of the transverse processes, a mechanical effect of the bone structures of the vertebrae occurs. The most frequent variant of reflex spasm of the vertebral arteries is associated with irritation of the sympathetic plexus around the vertebral artery, the anterior longitudinal ligament, the area of the annulus fibrosus, the ligamentous apparatus of the facet joints and consists in the development and influence of uncovertebral arthrosis, exostoses in the area of arthrosis, which cause mechanical irritation of the artery and sympathetic fibers plexus of the above structures. Such a mechanism is possible with overloads of individual joint pairs, as well as due to long-term subluxation [9], which is formed in the upper cross syndrome, which is often accompanied by functional blocks of the cervical spinal motion segments (SMS) or cervico-thoracic junction. In such cases, a vicious ring is formed, including blocked SMS, trigger points of overworked muscles, and an altered motor stereotype. A key role in discoordinated activity is played by the weakening of the lower fixators of the shoulder girdle (ie, the scapula), the ascending part of the trapezius muscles, the serratus anterior muscles, an increase in the tone of the pectoralis major and minor, and the descending part of the trapezius muscles lifting the scapula [10].

The use of kinesio taping in order to reduce the influence of the upper cross syndrome due to extension in the cervical and thoracic spine and reduce anteriorization and superiorization of the shoulders, as well as reducing the number of trigger points characterized by pain, according to muscle theory, is achieved through the activation of antagonist muscles and mechanical influence on the tonic reflex , in addition to this, a change in muscle tone is formed, due to the impact on proprio and interoreceptors and modeling of the movement pattern, due to the vector imposition of the tape [11, 12, 13, 14], which improves the motor stereotype and the feeling of the body scheme in space, which leads to increasing constant control of the patient's posture, equalizing the muscle tone of antagonists, reducing muscle overload, and traumatizing the musculo-ligamentous apparatus of the cervical and thoracic spine.

Reduction of pain syndrome at trigger points is realized through two mechanisms: activation of afferent flow from thick myelin A-β (A-beta) fibers and activation of microcirculation in connective tissue.

In accordance with the theory of "gate control" (afferent input), the pain impulse is suppressed in the gelatinous substance located in the second plate of the posterior horn (the second Rexed zone), by an impulse coming along A-β by thick myelin fibers, that is, an impulse from tactile and baroreceptors.

Kinesio tape applied to the surface of the skin irritates, first of all, tactile receptors and baroreceptors, from which the afferent signal enters the posterior horns of the spinal cord through thick myelin A-β fibers, reducing pain syndrome.

The second mechanism for reducing pain is realized when microcirculation is activated in tissues. Tissue damage is accompanied by the entry of inflammatory mediators into the intercellular substance: substance P, histamine, prostaglandins, etc. These substances cause sensitization of C-fiber nociceptors, which lowers the threshold of their excitability and increases the afferent pain flow. Kinesio tape applied to the skin, increasing the space in the connective tissue, activates microcirculation and promotes the elimination of inflammatory mediators. [11, 12, 13, 14]

In the third segment, at the exit point from the canal of the transverse processes, the vertebral artery is rewarded with anomalies of the upper cervical vertebrae - above the upper edge of the atlas arch, where the groove for the artery may be too deep or even turned into a bony canal. In addition, the vertebral artery can be compressed by tonic tension of the posterior inferior oblique muscle in inferior oblique muscle syndrome. In such cases, mechanical pressure is exerted on the posterior wall of the artery in the region of the groove of the atlas vertebral artery, where it is not covered behind by the articular processes. Pathological tension of this musculature is possible with hypermobility of the upper cervical PDS due to osteochondrosis [9] and with upper cross syndrome, as a result of which the occipital bone and C1-C2 are in hyperextension.

The use of kinesio taping in order to reduce the influence of the upper cross syndrome, head protraction due to the mechanisms described above, reduces the hyperextension of the occipital bone and C1-C2, which, in turn, reduces mechanical pressure on the vertebral arteries.

This information is confirmed in works with a whiplash injury of the neck. Kinesio tapes significantly affect pain and range of motion in the spine in case of whiplash injury of the neck, in which pathological mobility of the vertebrae is formed and trauma to the ligamentous apparatus of the intervertebral joints [15, 16].

Kinesio taping has a high level of effectiveness in reducing pain [17].

Under the influence of kinesio taping, the characteristics of muscle contraction change, which stabilizes muscle tone [18].

• Kinesio taping is performed with a tension of up to 50% according to the existing method of postural correction, which is aimed at changing the posture and body position [19].

• A two-day break between courses, selected from our own observations in a pilot study, is necessary to avoid irritation of the skin.

The set of essential distinctive features is new and ensures the achievement of the technical result and the achievement of the objective of the invention.

To confirm the effectiveness of the proposed method, we give examples from clinical practice:

Example 1. Patient M., 32 years old, office worker.

Diagnosis: Vertebral artery syndrome.

Before treatment:

She complained of dizziness (3b according to the international classification of functioning-ICF), headache (7.5 according to the visual analogue scale of pain - VAS), pain in the cervical spine (7 according to VAS), tinnitus (3b according to ICF), blurred vision (2b according to ICF), nausea (2b according to ICF), palpitations (2b according to ICF), decreased concentration and attention (2b according to ICF), shoulder index 86%.

When examining:

MRI of the brain without neoplasms and foci of gliosis;

on radiographs of the cervical spine, instability of C5-C6, straightening of physiological lordosis, violation of the static function of the spine, degenerative-dystrophic changes;

duplex scanning of the brachycephalic arteries revealed: non-straightness of the course of the vertebral arteries, vertebrogenic influence on the vertebral arteries during functional tests, increased tone of the arteries and decreased elastic properties. Against the background of drug therapy, including betahistine, nimesulide, citicoline, tolperisone, paravertebral kinesio taping was performed on both sides in the projection of the extensors of the cervical and thoracic spine from the scalp to the Th12a level, also on the brachial arch in the projection of the horizontal dorsal portion from the protruding part of the transition of the cervical and thoracic spine in the direction of the acromial points to the upper parts of the shoulders with a tension of up to 50% for 5 days with a single course. On the 7th day of treatment:

Dizziness (0b by ICF), headache (3 by VAS), pain in the cervical spine (0 by VAS), tinnitus (1b by ICF), blurred vision (1b by ICF), nausea (0b by ICF), palpitations (1b for ICF), decreased concentration and attention (0b for ICF), shoulder index 91%.

According to the data of duplex scanning of the PA, an increase in the indicators of linear blood flow velocities.

According to the Vertigo Scale (DHI), Vestibular Questionnaire (VRBQ), Short Life Quality Assessment Questionnaire (SF36), Sheehan Anxiety Scale and Beck Scale (Depression Test), there is an improvement in all indicators, including the quality of life and psycho-emotional state.

Example 2. Patient C., 33 years old, office worker.

Diagnosis: Vertebral artery syndrome.

Before treatment:

She complained of dizziness (3b according to ICF), headache (8.5 according to VAS), pain in the cervical spine (6 according to VAS), tinnitus (2b according to ICF), blurred vision (3b according to ICF), nausea (2b) according to ICF), heartbeat (0b according to ICF), decreased concentration and attention (3b according to ICF), shoulder index 87%. When examining:

On MRI of the brain, replacement hydrocephalus, without neoplasms and foci of gliosis, on radiographs of the cervical spine, staircase instability C2-C6, straightening of physiological lordosis, degenerative-dystrophic changes in the form of initial spondylosis, spondyloarthrosis, the presence of Kimmerle's anomaly, duplex scanning of blood vessels revealed brachyceph by 30%, hypoplasia of the vertebral artery on the right, non-straightness of the course of the vertebral arteries, vertebrogenic effect on the vertebral arteries during functional tests, increased tone of the arteries.

Against the background of drug therapy, including diosmin, betahistine, nimesulide, citicoline, tolperisone, paravertebral kinesio taping was performed on both sides in the projection of the extensors of the cervical and thoracic spine from the scalp to the TM2 level, as well as in the area of the dorsal brachial arch in the horizontal projection trapezius muscles, starting from the protruding part of the transition of the cervical and thoracic spine in the direction of the acromial points to the upper parts of the shoulders with a tension of up to 50% for postural correction for 5 days with a two-day break between two courses.

Dizziness (1b according to ICF), headache (0 according to VAS), pain in the cervical spine (0 according to VAS), tinnitus (1b according to ICF), blurred vision (0b according to ICF), nausea (0b according to ICF), palpitations (0b by ICF), decreased concentration and attention (0b by ICF), shoulder index 92%.

According to the data of duplex scanning of the PA, an increase in the parameters of the linear blood flow velocity.

Similar results according to the Vertigo Scale (DHI), Vestibular Questionnaire (VRBQ), Short Life Quality Assessment Questionnaire (SF36), Sheehan Anxiety Scale and Beck Scale (depression test) showed improvement in all indicators, including quality of life and psycho-emotional states.

Example 3. Patient O., 28 years old, teacher.

Diagnosis: Vertebral artery syndrome.

Before treatment:

She complained of dizziness (2b according to ICF), headache (6 according to VAS), pain in the cervical spine (7.5 according to VAS), tinnitus (2b according to ICF), blurred vision (2b according to ICF), nausea (1b according to ICF), heartbeat (2b according to ICF), decreased concentration and attention (2b according to ICF), shoulder index 85%.

When examining:

On MRI of the brain, expansion of cerebrospinal fluid spaces, without neoplasms and foci of gliosis, on radiographs of the cervical spine, staircase instability C4-C6, straightening of physiological lordosis, degenerative-dystrophic changes in the form of initial spondyloarthrosis, the presence of incomplete Kimmerle anomaly, with duplex scanning of blood, brachycephalic arteries were revealed by 20%, non-straightness of the course of the vertebral arteries, vertebrogenic effect on the vertebral arteries during functional tests with a 30% decrease, increased tone of the arteries. Against the background of drug therapy, including diosmin, betahistine, nimesulide, citicoline, tolperisone, paravertebral kinesio taping was performed on both sides in the projection of the extensors of the cervical and thoracic spine from the scalp to the TM2 level, as well as in the area of the dorsal brachial arch in the horizontal projection trapezius muscles, starting from the protruding part of the junction of the cervical and thoracic spine in the direction of the acromial points to the upper parts of the shoulders with a tension of up to 50% for postural correction for 5 days with a two-day break between three courses.

On day 21 of treatment:

Dizziness (0b according to ICF), headache (0b according to VAS), pain in the cervical spine (1b according to VAS), tinnitus (0b according to ICF), blurred vision (0b according to ICF), nausea (0b according to ICF), palpitations (0b by ICF), decreased concentration and attention (0b by ICF), shoulder index 91%.

According to the data of duplex scanning of the PA, an increase in the parameters of the linear blood flow velocity.

Similar results according to the Vertigo Scale (DHI), Vestibular Questionnaire (VRBQ), Short Life Quality Assessment Questionnaire (SF36), Sheehan Anxiety Scale and Beck Scale (depression test) showed improvement in all indicators, including quality of life and psycho-emotional states.

We examined 60 people. All observed patients were diagnosed with posterior cervical sympathetic syndrome. All underwent general neurological and otoneurological examinations. The patients were randomized into 2 groups. The first group received drug treatment and wearing an orthopedic cervical splint Shants for 40 minutes in the morning and evening (group Control), the second group - drug treatment and kinesio taping (group CT).

Both groups received basic drug treatment, including venotonics, NSAIDs, drugs that normalize blood flow in the vertebral arteries, neurometabolic drugs, muscle relaxants, antispasmodics, histamine-like, anti-migraine drugs.

Posture was assessed by determining the shoulder index (stoop index) according to O.A. Aksenova. Index score: up to 89.9% - slouching, from 90 to 100% - normal posture.

The effectiveness of therapy was determined based on the analysis of patients' complaints (assessment of the frequency and severity of attacks of dizziness, headache and pain in the cervical spine).

The severity of dizziness attacks was assessed using the [Dizziness Handicap inventory (DHI)] on day 1, day 7 of treatment.

DHI was developed by G. Jacobson and C.W. Newman [20] in 1990 and is widely used to objectify the severity of vertigo in various clinical studies. The scale includes 25 questions with three possible answers to each ("yes", "no", "sometimes"). The answer to the question "yes" was estimated at 4 points, "sometimes" - at 2 points, "no" - at 0 points. Therefore, the DHI score can range from 0 (no dizziness) to 100 (very dizziness). The sum of points from 1 to 30 - slight dizziness, from 31 to 60 - moderate, over 60 - severe dizziness. DHI has three subscales: functional (to what extent dizziness disrupts the patient's daily activity), emotional (to what extent dizziness disrupts the patient's emotional state) and physical (to what extent head and body movements affect dizziness) [20]. In general, this scale allows one to quantify the influence of vestibular diseases on the physical and emotional state of the patient, which is especially important for dynamic control over the course of treatment.

Headache and cervical pain were assessed using a visual analogue scale (VAS) on the 1st and 7th day of treatment.

A general neurological examination was also carried out according to the standard technique and an otoneurological examination of positional tests (Dix-Hallpike and McClure-Pagnini, Halmaga's test, a test with vigorous shaking of the head (headshaking), gait (flank, tandem), Fukuda's test, Weber's and Rinne's test, Valsalva, orthostatic test). To assess the dynamics of blood flow, duplex scanning of the brachycephalic arteries was used with the assessment of parameters (Vm; Vps; Vd; RI; PI).

In addition to general clinical and neurological examinations, all patients underwent: computed or magnetic resonance imaging of the brain, radiography of the cervical spine with functional tests.

To analyze the initial data obtained during the execution of the work, the STATISTICA for Windows system (version 10 Persons. BXXR310F964808FA-V) was used. [21].

The initial data set consisted of the results of the visual analogue scale (VAS), data of the vertigo rating scale (DHI), data of duplex scanning of linear blood flow velocities in the vertebral arteries, data of the brachial index for 60 patients of two groups: gr. CT, gr. The control.

In accordance with the goals and objectives of the study, as well as taking into account the characteristics of the analyzed variables, we carried out:

- construction and visual analysis of graphs and data scatter diagrams;

- definition of types of data distributions;

- plotting data scatter histograms;

- calculation of changes in the analyzed parameters by the 7th day of treatment.

- calculation of elementary statistics (mean values, errors of means, standard deviations, range of data spread, median and quartiles) [21].

Assessment of the comparability of groups by gender was carried out using nonparametric methods χ2, Pearson's test, Fisher's test. [22, 23].

Comparison of the studied quantitative parameters, incl. changes in indicators over time. Age, characteristics of kinesio taping, shoulder index, linear blood flow velocities, data of questionnaires and scales in the study groups were carried out using the Mann-Whitney, Kolmogorov-Smirnov criteria, median chi-square and ANOVA module. [22, 23].

To assess the change in indicators by day 7, compared with the first, the nonparametric Wilcoxon and Signs criteria were used.

To visualize the structure of the initial data and the obtained results of their analysis, we used the graphical capabilities of the Statstica for Windows system and the diagramming module of the Microsoft Office system. For completeness of description and ease of perception and comparison, we presented quantitative indicators in various studied subgroups in the form of "Bokh & Whisker Plot" - Tukey's diagrams, when the median, quartiles, minimum and maximum for a specific parameter are reflected on one field with different groupings based on qualitative criteria ... We considered the P <0.05 generally accepted in medicine as the criterion for the statistical significance of the findings. [22, 23]. The randomization was carried out by the attending physician's random selection of one of the groups according to which the treatment would take place. The results of assessing the severity of dizziness according to the DHI dizziness assessment scale (SHOG) on the 1st day of treatment and on the 7th day are presented in table. 4.

As you can see from the table. 4, the mean DHI scores in the kinesio taping group decreased significantly on day 7 (i.e., the difference between scores ≥10); moreover, these changes are statistically significant (p <0.05).

The dynamics in the group with kinesio taping was also noted when analyzing the average score for the functional, emotional and physical DHI subscales: the indices of the 1st and 7th days differ significantly and are statistically significant (p <0.05).

The statistic data of the visual analogue headache score average is shown in FIG. one.

The statistic data of the mean with standard deviation of the visual analogue cervical pain rating scale is shown in FIG. 2.

From the data of FIG. 1. and FIG. 2 statistical indicators of the mean with standard deviation shows a significant decrease in pain in the kinesio taping group in comparison with the values of the control group on the 7th day of treatment, and these changes are statistically significant (p <0.05).

The value of the statistical indicator of the mean with the standard deviation of the shoulder index according to O.A. Aksenova in the kinesio taping group on the 7th day of treatment, in comparison with the control group, posture normalization is noted, which can be seen from Table 5.

This makes it possible to judge the effectiveness of kinesio taping for the correction of the upper cross syndrome, the changes are statistically significant on the 7th day of treatment (p <0.05).

The values of the median and the range of minimum and maximum values of linear blood flow velocities (pulse velocity) during ultrasound examination of the right and left vertebral arteries at the extracranial level are presented in Table 6.

Table 6 shows that the improvement of linear blood flow velocities in the right and left vertebral arteries (pulse velocity) at the extracranial level in the group using kinesio taping is statistically significant on the left (p <0.05).

The values of the range of minimum and maximum values and the median of linear blood flow velocities (minute velocity) in ultrasound examination of the right and left vertebral arteries at the extracranial level are presented in Table 7.

According to table 7, it can be seen that the increase in linear blood flow velocities (minute velocity) through the vertebral arteries at the extracranial level in the group using kinesio taping is statistically significant on the left (p <0.05).

The value of the dynamics of indicators along the left vertebral artery is extracranial, i.e. the difference between the values of the linear blood flow velocities of the 1st and 7th day is presented in FIG. 3. Statistically significant results (p <0.05) improvement in blood flow velocity were obtained in the group of kinesio taping from the left vertebral artery, in comparison with the control group, and according to the data on the dynamics of the range of minimum and maximum values and the median, statistically significant (p < 0.05) increase in blood flow velocities in comparison with the control group. According to the literature, this may be due to the peculiarities of the anatomy of the canal and the structural and morphometric features of the intracanal part of the vertebral arteries in humans, which consists in the predominance of the diameter of the left vertebral artery, as well as the predominance of the diameter of the holes of the transverse processes on the left. Perhaps this is also due to the structural features of the vessels and the separation of the LA from the aortic arch [24].

The value of the dynamics of indicators along the right vertebral artery is extracranial, i.e. the difference between the values of the linear blood flow velocities of the 1st and 7th day is presented in FIG. 4. No statistically significant change in the linear blood flow velocities in the right vertebral artery in comparison with the control group was obtained, but according to the data of the dynamics of the range of minimum and maximum values and the median, there is a statistically significant (p <0.05) increase in blood flow velocities in comparison with the control group ...

The values of the median and the range of minimum and maximum values of linear blood flow velocities in ultrasound examination of the right and left vertebral arteries at the intracranial level are presented in Table 8.

The values of the median and the range of minimum and maximum values of linear blood flow velocities during ultrasound examination of the right and left vertebral arteries at the intracranial level are presented in Table 9.

From these indices of the median and the range of minimum and maximum values, an increase in the blood flow velocity intracranially through the vertebral arteries is seen in the group using kinesio taping on the 7th day of treatment in comparison with the control group, but no statistically significant improvement in linear blood flow velocities at the intracranial level was obtained, but according to the values of the dynamics of changes in the linear blood flow velocities in the kinesio taping group observed a statistically significant (p <0.05) increase in blood flow velocities in comparison with the control group. The posterior cervical sympathetic syndrome is characterized by biomechanical disorders in the form of an upper cross syndrome, manifested by a decrease in the shoulder index.

FIG. 5 shows the indicators of the average shoulder index according to O.A. Aksenova. on the 1st and 7th day, on which the dynamics of changes in the shoulder index in the group using kinesio taping is visible, where the change in the value towards normalization of posture is statistically significant (p <0.05) in comparison with the control group.

Thus, the claimed method of treating patients with posterior cervical sympathetic syndrome provides:

• constant impact on the musculo-ligamentous apparatus and reduction of head protraction during the day;

• correction of the upper cross syndrome (protraction of the head), including the correction of the position of the head, the shoulder girdle, as well as the correction of the posture of the thoracic region, characterized by the shoulder index according to O.A. Aksenova;

• stabilization of the tone of all muscles of the cervical spine, which reduces its hypermobility, which, in turn, reduces the risk of injury to the ligamentous apparatus of the joints of the cervical spine;

• reducing the risk of stretching the capsules of the intervertebral joints,

What allow:

• to increase the effectiveness of treatment, which is manifested in an increase in the linear velocity of blood flow along the PA in the extracranial and intracranial segments, a decrease in clinical manifestations in the form of dizziness, headache, pain in the cervical spine, upper cross syndrome;

• expand the contingent of patients at the expense of patients who refused to use the Shants orthopedic cervical splint due to impaired venous outflow of the head, which was accompanied by an increase and / or increase in headache, as well as those patients who are not always able to choose the required size of the Shants orthopedic cervical splint as there are only 4 sizes, and also at the expense of those patients who refused to use the Schanz splint for aesthetic reasons, including limiting its use in working conditions.

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Claims (1)

A method of treating patients with posterior cervical sympathetic syndrome by carrying out drug therapy and correction of biomechanical disorders of the cervical and thoracic spine, characterized in that kinesio taping is used as a correction of biomechanical disorders of the cervical and thoracic spine, while the tape is applied paravertebrally on both sides in the projection extensors of the cervical and thoracic spine from the scalp to the Th12 level, then transverse application of the tape is carried out along the shoulder arch in the projection of the horizontal dorsal portion of the trapezius muscles, starting from the protruding part of the junction of the cervical and thoracic spine in the direction of acromial points to the upper parts of the shoulders with tension up to 50% for 5 days, which is one course of treatment, courses are performed 1-3 times, with a two-day break between them.

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