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

Yıl 2024, , 266 - 273, 16.05.2024
https://doi.org/10.37990/medr.1444649

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.

Kaynakça

  • Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383:159-68.
  • Jitin B. Cervical spondylosis and atypical symptoms. Neurol India. 2021;69:602-3.
  • Naderi S, Ozgen S, Pamir MN, et al. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery. 1998;43:43-50.
  • Bogduk N, Mercer S. Biomechanics of the cervical spine. I: Normal kinematics. Clin Biomech (Bristol, Avon). 2000;15:633-48.
  • 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.
  • Swagerty DL Jr. Cervical spondylotic myelopathy: a cause of gait disturbance and falls in the elderly. Kans Med. 1994;95:226-9.
  • Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am. 1992;23:487-93.
  • 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.
  • 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.
  • 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.
  • Weder ND, Aziz R, Wilkins K, Tampi RR. Frontotemporal dementias: a review. Ann Gen Psychiatry. 2007;6:15.
  • 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.
  • Ekker MS, Boot EM, Singhal AB, et al. epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790-801.
  • 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.
  • 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.
  • 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.
  • Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther. 2022;30:139-53.
  • Baldarçara L, Currie S, Hadjivassiliou M, et al. Consensus paper: radiological biomarkers of cerebellar diseases. Cerebellum. 2015;14:175-96.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Secomb TW. Hemodynamics. Compr Physiol. 2016;6975-1003.
  • Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity. Stroke. 1996;27:441-5.
  • Gomolka RS, Chrzan RM, Urbanik A, et al. Quantification of image contrast of infarcts on computed tomography scans. Neuroradiol J. 2017;30:15-22.
Yıl 2024, , 266 - 273, 16.05.2024
https://doi.org/10.37990/medr.1444649

Öz

Kaynakça

  • Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383:159-68.
  • Jitin B. Cervical spondylosis and atypical symptoms. Neurol India. 2021;69:602-3.
  • Naderi S, Ozgen S, Pamir MN, et al. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery. 1998;43:43-50.
  • Bogduk N, Mercer S. Biomechanics of the cervical spine. I: Normal kinematics. Clin Biomech (Bristol, Avon). 2000;15:633-48.
  • 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.
  • Swagerty DL Jr. Cervical spondylotic myelopathy: a cause of gait disturbance and falls in the elderly. Kans Med. 1994;95:226-9.
  • Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am. 1992;23:487-93.
  • 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.
  • 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.
  • 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.
  • Weder ND, Aziz R, Wilkins K, Tampi RR. Frontotemporal dementias: a review. Ann Gen Psychiatry. 2007;6:15.
  • 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.
  • Ekker MS, Boot EM, Singhal AB, et al. epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790-801.
  • 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.
  • 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.
  • 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.
  • Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther. 2022;30:139-53.
  • Baldarçara L, Currie S, Hadjivassiliou M, et al. Consensus paper: radiological biomarkers of cerebellar diseases. Cerebellum. 2015;14:175-96.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Secomb TW. Hemodynamics. Compr Physiol. 2016;6975-1003.
  • Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity. Stroke. 1996;27:441-5.
  • Gomolka RS, Chrzan RM, Urbanik A, et al. Quantification of image contrast of infarcts on computed tomography scans. Neuroradiol J. 2017;30:15-22.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Radyoloji ve Organ Görüntüleme
Bölüm Özgün Makaleler
Yazarlar

Süheyl Poçan 0000-0002-3932-2272

Levent Karakaş 0000-0001-5485-9337

Yayımlanma Tarihi 16 Mayıs 2024
Gönderilme Tarihi 28 Şubat 2024
Kabul Tarihi 5 Mayıs 2024
Yayımlandığı Sayı Yıl 2024

Kaynak Göster

AMA Poçan S, Karakaş L. Investigation of the Relationship Between Cervical Vertebral Column Degeneration and Posterior Circulation Perfusion Area Ischemia. Med Records. Mayıs 2024;6(2):266-273. doi:10.37990/medr.1444649

 Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey

Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye

E-mail: medrecsjournal@gmail.com

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