There is a vertebral artery on each side of the cervical spine, they are issued from the subclavian artery on both sides, starting from the transverse foramen of cervical 6 on both sides, going up along the transverse foramen of cervical 6~cervical 2 on both sides parallel to the atlanto-axial vertebral artery sulcus which is at the atlanto-occipital joint to enter the cranial cavity, entering the cranial cavity and synthesizing the basilar artery to nourish the cerebellum and inner ear.
The vertebral artery travels in the cervical segment at the lateral side of the hook vertebral joint and vertebral body. When the vertebrae of normal people move, the four walls of the transverse foramen can make the internal vertebral artery be stretched or squeezed, and when the head is tilted or twisted to one side, the vertebral artery on its ipsilateral side is squeezed and the contralateral side is stretched, and even the blood flow of the vertebral artery is reduced when the head is extended backward, but there are no symptoms. In normal people, even if one vertebral artery is compressed or even completely blocked, it does not cause insufficient blood supply to the vertebral basilar artery system.
However, if one vertebral artery has some kind of pathology (such as vertebral artery malformation, bone spur compression, thrombosis or arterial stenosis, etc.), and when the head and neck are rotated, the bone spurs of the cervical hook vertebral joint and the synovial joint may stimulate or compress the vertebral artery on the opposite side, or stimulate the sympathetic nerve around it to make the vertebral artery twist or spasm, the lumen becomes thinner and the blood flow decreases, thus causing insufficient blood supply to the basilar artery of the brain, and a series of This is the pathogenesis of vertebral artery type cervical spondylosis.
Since the location of the transverse foramen and the length of the transverse process are closely related to the occurrence of vertebral artery cervical spondylosis and the severity of symptoms, the occurrence of vertebral artery cervical spondylosis is influenced by inter-individual anatomical differences. Therefore, in a few cases of variation, such as stenosis of the vertebral artery or stenosis of the transverse foramen, etc. are also responsible for this type of cervical spondylosis. The vertebral artery and the cerebral basilar artery system are collectively referred to as the vertebrobasilar artery, due to the wide range of innervation of the vertebrobasilar artery. Therefore, when there is insufficient blood supply to the vertebrobasilar artery, it can lead to more complex clinical symptoms. The symptoms of inadequate basilar artery supply are episodic and intermittent in onset, with head rotation causing episodes of symptoms being an important feature of the disease. Symptoms often occur during hyperextension and hyperflexion of the neck or when rotating to a particular orientation. Most of these episodes occur when the neck is occasionally turned while walking (e.g., when crossing a street and looking left or right). The reason for this may be the irritation or compression of the vertebral artery by the enlarged hook vertebral joint when turning the head, resulting in insufficient blood supply to the vertebrobasilar artery and sudden ischemia in the brain.
The typical manifestations of vertebral artery type cervical spondylosis are.
(1) vertigo
Vertigo is a common symptom in patients with vertebral artery-type cervical spondylosis. Patients induce vertigo symptoms by changing position due to extension or rotation of the neck. Vertigo caused by ischemic lesions of the vestibular nerve nucleus usually lasts for a short period of time, disappearing in a few seconds to a few minutes, and the patient may have mild disorientation and movement disorders at the onset, manifesting as unstable walking or tilting to one side; vertigo caused by ischemic lesions of the vestibular nerve is not accompanied by impaired consciousness. The vertigo caused by vestibular neuropathy is central vertigo; the vagal ischemic lesion is peripheral vertigo. Some patients have nausea and cannot raise their heads during acute attacks, and a few patients have diplopia, eye tremor, tinnitus and deafness.
Some patients can hear murmur of vertebral artery due to distortion and obstruction of blood flow on the affected clavicle. On palpation of the thumb in the posterior neck, the affected vertebra is rotated and displaced to one side, and there is obvious pressure pain in the spinous process and the displaced articular synapse.
(2) Headache
In patients with vertebral artery type cervical spondylosis, headache and vertigo are usually present at the same time. Occipital neuropathy is the main cause of headache. Because the occipital artery, a branch of the vertebral artery, supplies the occipital nerve, clinically, spasm of the vertebral artery causes ischemia of the occipital nerve and headache symptoms appear in the occipital nerve innervation area, which is intermittent throbbing pain radiating from the back of one side of the neck to the occipital area and half of the head, with a burning sensation. In addition, the rhomboid muscle, which is innervated around the paraspinal nerve, can cause spasm of the rhomboid muscle after root lesion or trauma to this muscle, and the occipital nerve branch that penetrates from the rhomboid muscle is squeezed to induce clinical symptoms. Displacement of the atlantoaxial or pivotal vertebrae can also stimulate the occipital nerve that passes through it and induce headache.
(3) Visual impairment
Due to spasm of the vertebral_basilar artery system caused by cervical spondylosis, secondary ischemic lesions of the visual center of the occipital lobe of the brain may occur in a small number of patients with reduced visual acuity or visual field defects, or even blindness in severe cases.
(4) Sudden fall
When the patient’s neck is rotated, he suddenly feels weakness in the lower limbs and falls down. The clinical characteristics are: the patient is conscious at the onset and can get up by himself or even walk within a short time. It is different from other cerebrovascular diseases.
(5) Root symptoms
Due to the local anatomy, patients with vertebral artery type are also often accompanied by neurogenic symptoms.
Physical examination: When the patient’s neck is passively twisted, the above symptoms can be induced, and it is called a positive rotational neck sign. X-ray examination: X-ray plain films of cervical degeneration are generally seen, but are not specific, including: orthopantomographs show hyperplasia of the hook joint; lateral X-ray films show stiffness of the cervical spine, loss of cervical physiological anterior convexity, narrowing of the intervertebral space, osteophytes at the anterior and posterior edges of the vertebral body, and calcification of the collateral ligament; lateral films of hyperextension and hyperflexion show instability of the diseased segment and excessive movement of the diseased segment during flexion and extension; oblique films show intervertebral segment and so on. Oblique radiographs may show small intervertebral foramina.
Selective vertebral artery angiography or digital subtraction vertebral artery angiography can clearly show abnormalities such as compression, distortion, spasm or occlusion of the vertebral artery. In recent years, the specific operation method of MRI can reflect the visualization effect of the arterial system, called MRI arteriography, or MRA for short, which is better than arteriography and is a non-invasive examination, therefore, it is more valuable for the diagnosis of vertebral artery type cervical spondylosis. In recent years, the development of ultrasound technology and equipment can use ultrasound to check whether the vertebral arteries are open bilaterally, which makes the examination of vertebral arteries easier.
The disease should be differentiated from ophthalmogenic and otogenic vertigo such as internal auditory artery embolism and Ménière’s disease; it should also be differentiated from upright hypotension (postural cerebral anemia), neurosis and intracranial tumors; it should also be differentiated from congenital vertebral artery stenosis, occlusion and subclavian artery occlusive vasculitis.
For the treatment of vertebral artery cervical spondylosis, like sympathetic cervical spondylosis, conservative treatment is also preferred. The first is bed rest and the second is cervical collar braking protection. Bed rest, cervical collar brake protection and cervical traction can make the neck muscles get sufficient rest, relieve the spasm of the cervical collar muscles, increase the vertebral space, reduce the relative friction and stimulation between the vertebral artery and the compression, cervical brace and collar can limit the excessive activity of the cervical vertebrae, and gentle massage and physical therapy can accelerate the inflammatory edema, relax the muscles and improve the local blood circulation. Cervical traction is also more commonly used, the main purpose of this therapy is to limit the activity of the cervical spine, reduce weight bearing, so that the pressure on the vertebral artery is reduced or relieved.