Investigation of the Relationship Between Cervical Vertebral Column Degeneration and Posterior Circulation Perfusion Area Ischemia

Öz

Aim: The primary objective of this study was to establish whether degeneration of the cervical vertebrae and paravertebral structures serves as a predisposing factor for ischemic processes by disrupting hemodynamics in the posterior system through mechanical effects on the vertebral arteries. Material and Method: We conducted a retrospective analysis of 180 patients who underwent various imaging tests between January 2017 and October 2023. These tests included cervical magnetic resonance imaging (MRI), cervical computed tomography (CT), carotid-vertebral neck CT angiography (CTA), cranial CT, and cranial MRI. Of the 180 patients, 90 had mild degeneration or no significant degeneration, with a mean age of 58 years, and 90 had significant cervical spondylosis (CS) with a mean age of 64 years. The radiological findings were statistically analyzed, and a p-value of less than 0.05 was considered statistically significant. Results: There was no significant difference between age and parenchymal density in the control group (p=0.09). There was no statistically significant difference between the age and parenchymal density in the CS group (p=0.07). As CS became more severe, there was a statistically significant increase in the incidence of atrophic enlargement of the cerebellar folia and loss of density in the posterior fossa (p=0.03) and posterior circulation infarcts (POCI) (p=0.04). Conclusion: When severe, CS can adversely affect vascular hemodynamics in the posterior system, predisposing perfused neural parenchyma to ischemia.

Anahtar Kelimeler

• Paravertebral structures
• posterior circulation
• vertebrae degeneration
• vertebral artery

Kaynakça

1. Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383:159-68.
2. Jitin B. Cervical spondylosis and atypical symptoms. Neurol India. 2021;69:602-3.
3. Naderi S, Ozgen S, Pamir MN, et al. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery. 1998;43:43-50.
4. Bogduk N, Mercer S. Biomechanics of the cervical spine. I: Normal kinematics. Clin Biomech (Bristol, Avon). 2000;15:633-48.
5. Sharma R, Garg K, Agrawal S, et al. Atypical symptoms of cervical spondylosis: is anterior cervical discectomy and fusion useful? - an institutional experience. Neurol India. 2021;69:595-601.
6. Swagerty DL Jr. Cervical spondylotic myelopathy: a cause of gait disturbance and falls in the elderly. Kans Med. 1994;95:226-9.
7. Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am. 1992;23:487-93.
8. Ullberg T, Zia E, Petersson J, Norrving B. Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke. 2015;46:389-94.

9. Ng SC, Weiss JB, Quennel R, Jayson MI. Abnormal connective tissue degrading enzyme patterns in prolapsed intervertebral discs. Spine (Phila Pa 1976). 1986;11:695-701.
10. Caldemeyer KS, Carrico JB, Mathews VP. The radiology and embryology of anomalous arteries of the head and neck. AJR Am J Roentgenol. 1998;170:197-203.
11. Weder ND, Aziz R, Wilkins K, Tampi RR. Frontotemporal dementias: a review. Ann Gen Psychiatry. 2007;6:15.
12. Wondergem R, Pisters MF, Wouters EJ, et al. The course of activities in daily living: who is at risk for decline after first ever stroke?. Cerebrovasc Dis. 2017;43:1-8.
13. Ekker MS, Boot EM, Singhal AB, et al. epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790-801.
14. Rahme R, Moussa R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29:838-42.
15. Ofiram E, Garvey TA, Schwender JD, et al. Cervical degenerative index: a new quantitative radiographic scoring system for cervical spondylosis with interobserver and intraobserver reliability testing. J Orthop Traumatol. 2009;10:21-6.
16. Mesregah MK, Repajic M, Mgbam P, et al. Trends and patterns of cervical degenerative disc disease: an analysis of magnetic resonance imaging of 1300 symptomatic patients. Eur Spine J. 2022;31:2675-83.
17. Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther. 2022;30:139-53.
18. Baldarçara L, Currie S, Hadjivassiliou M, et al. Consensus paper: radiological biomarkers of cerebellar diseases. Cerebellum. 2015;14:175-96.
19. Duan S, Lv S, Ye F, Lin Q. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J. 2009;18:1102-8.
20. Gülsün M, Saatci I, Akata D, et al. Radiologic investigation of vertebrobasilar insufficiency and quantification of vertebrobasilar flow with magnetic resonance imaging. Tani Girisim Radyol. 2003;9:279-86.
21. Lin SY, Lin CL, Chen DC, et al. Risk of posterior circulation stroke in patients with cervical spondylosis: A nationwide, population-based study. Atherosclerosis. 2018;277:42-6.
22. Chen CC, Chung CY, Lee TH, et al. Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis. Neuropsychiatr Dis Treat. 2015;11:273-8.
23. Denis DJ, Shedid D, Shehadeh M, et al. Cervical spondylosis: a rare and curable cause of vertebrobasilar insufficiency. Eur Spine J. 2014;23:206-13.
24. Vierunen RM, Haapamäki VV, Koivikko MP, Bensch FV. Ankylosis of the cervical spine increases the incidence of blunt cerebrovascular injury (BCVI) in CTA screening after blunt trauma. Emerg Radiol. 2022;29:507-17.
25. Lin WS, Huang TF, Chuang TY, et al. Association between cervical spondylosis and migraine: a nationwide retrospective cohort study. Int J Environ Res Public Health. 2018;15:587.
26. Okuno S, Touho H, Ohnishi H, Karasawa J. Cervical infarction associated with vertebral artery occlusion due to spondylotic degeneration: case report. Acta Neurochir (Wien). 1998;140:981-5.
27. Nishikawa H, Miya F, Kitano Y, et al. Positional occlusion of vertebral artery due to cervical spondylosis as rare cause of wake-up stroke: report of two cases. World Neurosurg. 2017;98:877.e13-877.e21.
28. Fleming JB, Vora TK, Harrigan MR. Rare case of bilateral vertebral artery stenosis caused by C4-5 spondylotic changes manifesting with bilateral bow hunter's syndrome. World Neurosurg. 2013;79:799.E1-5.
29. Secomb TW. Hemodynamics. Compr Physiol. 2016;6975-1003.
30. Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity. Stroke. 1996;27:441-5.
31. Gomolka RS, Chrzan RM, Urbanik A, et al. Quantification of image contrast of infarcts on computed tomography scans. Neuroradiol J. 2017;30:15-22.