Dybkaliuk S. Degenerative-dystrophic lesions of the spine with compression syndrome of the spinal artery. Diagnosis and treatment.

Object: patients with degenerative-dystrophic lesions of the cervical spine and compression syndrome of the spinal artery which is caused by dynamic myogenic compression of the vertebral artery in the scalenus-vertebral triangle. Aim: improving the results of treatment of patients with degenerative-dystrophic lesions of the spine in conditions of compression of the vertebral artery by developing medical technologies based on the study of links in the pathogenesis of positional compression of the vertebral artery, creating and introducing effective diagnostic and differentiated etiopathogenetic surgical methods of treatment. Methods: clinical; paraclinical; instrumental non-invasive; spiral computed tomography with angiography; ultrasound dopplerography; mathematical. First determined "the scalenus-vertebral canal", the diameter of which changes depending on the head position. For the first time, on the created finite-element model of the vertebral artery, it was proved that due to the action of external forces, the compressed section returns in a helical trajectory to an angle φ ≤ 200˚. For the first time it is proved that with a decrease in the area of intersection of the vertebral artery by 8 times the pressure drop on the deformed section reaches 5237 Pa (39 mm). Pathohistological studies of skeletal muscle biopsy material carried out; it was proved that dense connective tissue was observed in the areas of maximal compression in biopsy materials (66.7 % ˗ levels of transition of segment V1 to segment V2; 47.1 % ˗ of the transverse process of CVII; 37.3 % ˗ in the area of the head and ribs; 27.5 % ˗ in the area of the mouth of the vertebral artery and attachment of the step muscles to the 1st rib). Significant dependence is proved between clinic of vertebrobasilar fail syndrome and expressiveness of a cervicobrachial syndrome (І group ˗ р =-0.82; ІІ group ˗ р = -0.78; р < 0.05). The significant correlation is proved between clinical course and positional changes to a blood-groove owing to compressions V1 (р = 0.84 is established; mp = 0.008, р < 0.01). Significant easing correlation between clinical course of degenerative-dystrophic lesions of the cervical spine and positionally dynamic changes to a blood-groove in segments V2 was found. Efficiency of multifocal decompression of neurovascular complex is proved during surgical treatment with quantity of excellent and good results (89.3 ± 57) % (р < 0.05) in one year after intervention. After 3-5 years showed significant differences in the assessment of quality of life of patients who underwent surgical treatment: EUROQOL (1993), t = 4.9, (p < 0.001). It was developed mathematical and grafoanalitic models which reflect little-known item in pathogenesis of positional compression of the vertebral artery, process of transformation of intense-deformed conditions of the vertebral artery in hydrodynamical fluctuations of liquids. The topographic and anatomic formation "scalenus vertebral channel" was described. It was established, that vertebral myogenic tunnel compression of the vertebral artery in segment V1 has item character, gistological and morphologic basis of which is fibrous changes in muscles. Ultrasonic research of segments of the vertebral artery with use of item orthopedic tests at authentic correlations of hemodynamic changes was found informative for diagnostics of compression syndrome. Indications and methods of surgical treatment based on clinical Doppler and neuroimaging patterns were developed. The expediency of surgical treatment was proved, that promotes recourse of clinical symptoms. It was found that the treatment of chronic orthopedic diseases caused by the occurrence of pathological motor, is the prevention of the development and progression of ischemic disorders. The concept of surgical pathology of the vertebral artery was established, the success of which depends on the differentiated use of pathogenetically based decompression surgical interventions. An algorithm for making a decision on the expediency of surgical treatment of degenerative-dystrophic lesions of the spine with the syndrome of compression of the vertebral artery has been developed. The research results are introduced into the educational process of the Department of Orthopedics and Traumatology No. 1 of Shupik National Medical Academe of Postgraduate Education, research and practical work of the University clinic of the Shevchenko Kyiv National University, into clinical practice of the Chernihiv City Clinical Hospital No. 2, the Department of Orthopedics of the Kyiv City Clinical Hospital No. 8, the Alexandrovsky Clinical Hospital (Kyiv), National Military Medical Clinical Center "Main Military Clinical Hospital"; the central hospital of the Military Medical Directorate of the SSU; the central polyclinic of the Military Medical Directorate of the SSU; Obolonsk subdivision of the medical center "Ukrainian portal of medical equipment". Traumatology and Orthopaedics.