Nekrasova N. Clinico-pathogenetical peculiarities of spondylogenic disorders of blood circulation in vertebra-basilar system and its correction is young patients

The thesis solved the actual problem of modern neurology: to develope the system of diagnostics, prognosis and treatment of spondylogenic circulation disorders in the vertebra-basilar system based on the clinical, hemodynamic, structural-morphological, autonomic and metabolic manifestations, depending on the stage of spondylogenic vertebra-basilar insufficiency (SVBI) in young people. Based on the study of the frequency and diagnostic significance of neurological manifestations at the stages of SVBI, the usage of the algorithm for early diagnostics of SVBI in young patients is substantiated. Hemodynamic features at the stages of SVBI according to the ultrasound diagnostics data are characterized by a change in the blood flow velocity along the causal vertebral artery under the influence of a functional (rotational) load. In the presence of SVBI, individual phenotypic and somato-visceral markers are informative, taking them into account makes possible to assess the presence of connective tissue dysplasia. It was revealed that in patients with SVBI-III, the frequency of combined lesions of the craniovertebral junction and C4-C5, C5-C6 levels were significantly higher than in patients with SVBI-I. Identified pathogenetic interconnections between hemodynamic, endothelium-dependent and atherogenic processes of the vascular wall indicate, that the increasing of systolic-diastolic ratio (ISD>2.2) is correlated with an increasing the serum level of ET-1. An increasing the level of interdependence between ISD and the content of ET-1 was noted at the stages of the progression of SVBI (in SVBI-I - rXY=+ 0.100; in SVBI-II - rXY=+0.220; in SVBI-III - rXY=+0.420). On the base of obtained data the hemodynamically-induced increasing of shear stress of the endothelium, reflecting the endothelial dysfunction progression was revealed. The assessment of tissue hypoxia according to the data of 2.3-DFG erythrocytes, identified the significant increasing of 2.3-DFG level with a simultaneous increasing of the ISD index (p<0.05) in examined patients. A multi-level clinical-diagnostic informational system “SVBI-pro” has been developed. The system consists of: risk assessment - clinical diagnostics - differential diagnosis - predicting the course of SVBI. The complementing the technology of individualization of diagnostic and treatment-correction complexes by the expert estimation method was substantiated.