The Exploration For Iteology, Pathogenesis, Diagnosis, And Therapy Of Cervical Vertigo.

Objective:Barre-lieo syndrom show a series symotoms as vertigo dizziness,tinnitus ,deafness, nausea,vomiting,headache ,neck pain.these are Induced by vertebral artery insufficiency (VBI),which is called VBI syndrom,or cervical vertigo in our country.Its ideology remain controversial.It used to be considered that vertebral artery were compressed by prolapsed cervical disc or hypertrophy of luschka joints,so VA became tortionedand induced inbalance of cervical vertrbrae.But it became clear that its pathogenesis should be VA circulation disturbance can be caused by stimulus on VA's peripheral nervous plexus not by compression on itself.and how it can be induced remain unclear.Vertigo and dizziness are very common ,they may be otogenesis,cardiovascular genesis,from intracanial tumor,cervical disease.Vertigo is named as illusion of mobility,including rotation,rolling,leaning ,fluctuation,sunk and rising;Diziness doesn't show any sensition of movement .Cercical vertigo show all the above two .How to understand their relation,how to differentiate their causes remain waiting orthorpaedic doctors to resolve.We have used electro-stimulus on peripheral nervous plexus of VA to observate their circulation change,and analyzed clinical manifestation,image, therapeutic effects of 180 cervical vertigo patients,explore dignostic value of dynamic axial rotational cervical X-ray to find its ideology and pathogenesis.Method: I . Twenty healthy rabbits were anesthesied by intraperitoneal injection of 2% pentobarbita with 45mg per kilogram. After annterior cervical approachdissection,the electronic stimulating probe was placed around the left lateroposterior C5/6 intervertebral disc,where the left vertebral artery and its peripheral nerve plexus. The blood flow of bilateral vertebral arteries and basilar artery was recorded with color transcranial doppler ultra sound(TCD) around the corresponding vessels.With the same method, the blood flow of vertebrobasilar arterial system was monitored after the nerve plexus around vertebral arteries was blocked with 1% lidocaine. All he results of the different groups were tested with analysis of variance Q and T-test. II. 180 patients (76 male, 104 female ) with a mean age of 60.3year (range 28 to 71 years) were examined and treated from 1990 to 2003. The average course was 17.7 months(range 6 to 108 months). Recurrent episode of vertigo and dizziness was the main complainments in all patients .180 patient was divided into two groups(below 50 years old and above 50 years old_),The main and the most significant clinical manifestations, imaging features(include dizziness,vertigo, nausea, vomiting,cataplexy, tinnitus,deafness,cervical circumflex, cervical flexion and extension, compressive myelopathy,cervical anticurvature, unstable in saggital and axial posture) were evaluated in both group.5 cases received lushka joints resection and transverse foramen decompression and graft fusion; 16 cases received anterior decompression and graft fusion; 12 cases with instability received anterior cervical intervertebrea disc resection, graft fusion; 11 cases CDH, anterior cervical intervertebrea disc resection; 16 received stellate ganglion block;33cases received block around transverse process;Other cases received vascular dilation,antiblood viscosity treatment and herb medicine,unsteroid antiphlogistic medicine,and immobilization by cervical collar, massage, physical therapy and block. IH. 87 cervical vertigo patient were analyzed on routine, dynamic sagittal and dynamic axial radiography.Result: I. The mean velocity(Vm) ,pulsile index(Pi) and resistent index(Ri) of the blood flow of bilateral vertebral arteries and basilar artery increased after left vertebral artery and its peripheral nerve plexus were stimulated with electronic stimulating probe,.All the index did not change after fter the nerve plexus around vertebral arteries was blocked with 1% lidocaine(P>0.05). II. The dignostic clinicalmanefestation and image;(l)Dizziness(45%),Above 50years old(63%),Below 50Yeas old (15%),(P<0.01)(2) Vertigo (85%),no significanct difference betweentwo group.(3) neck shoulder occipital pain (94%), no significanct difference betweentwo group.(4) Tinnitus deafness(45%): no significant difference between two group. (5)Nausea (58%), Below 50Yeas old(37%) ,Above 50years old(72%),(P<0.01)(6) Vommiting(50%), Below 50Yeas old(21%) ,Above 50years old(69%), (P<0.01)(7) Cataplexy (17%), no significant difference between two group.(8) cervical flexion sign(23%),cervical rotation sign (32%) no significanct difference between two group.(P>0.05)(9) Compressive myelopathy(16%) ,no significant difference between two group.(P>0.05)(10) cervical antiflexion (72%), no significant difference between two group.(P>0.05)(11) Instabality in sagital posture (66%), no significant difference between two group.(P>0.05)(12) Instabality in axial posture (52%), no significant difference between two group.(P>0.05)(13) cervical hypertrophy(62%), more obvious in Above 50years old group,(p<0.01)(14) Intervertebral foramen stenosis(55%), (p<0.01) more obvious in Above 50years old group.(15) cervical prolapsed disc(57%) no significant difference between two group.(P>0.05)(16) Low TCD speed of blood flow(46%),(p<0.01); more obvious in Above 50years old group.(17) Rapid TCD speed of blood flow(68%),((p<0.01), more obvious in below50years old group.According to Nagashima' standard about therapeutic effect,32 cases convalescene completely; 12 cases convalescene almostly with some residue symptoms; No case show almost no improvement or even worse .In 16 cases who had received stallite ganglion block, 10 cases show no symtom anymore ,6 cases improved, 14 cases occurred relapse; 3 3 cases received block around transverse process,23 cases show no symtom anymore ,10 cases improved; 27 cases occurred relapse.(p>0.05).Other 87 cases had received general treatment ,65 cases occurred relapse. HI. 141 cases with lower cervical instability in 180 cases(78%), 119 cases with sagittal instability(66%), 95 cases with axial rotatory instability(52%). The sagittal and axial instability were both found in 73 cases. 12 cases with instability received anterior cervical intervertebrea disc resection, graft fusion; Other cases received unsteroid antiphlogistic medicine, massage, physical therapy .block and immobilization by cervical collar,Conclusion: I .1. Synergy reflex exists between bilateral vertebral artery and basilar artery.2. Stimulation of sympathetic nerves around vertebral artery is the main factor for vascular spasm of vertebrobasilar artery . 3. Cervical vertigo can be induced by the stimulation of vertebral artery and its surrounding nerves with extensive vascular spasmAAll the therapys that reduce the stimulation of vertebral artery and its peripheral nerve plexus are effective for the control of the attack and alleviation of the symptom of cervical vertigo.II. 1 .PathogenesisrCervicaldegeneration (Hypertophy, instability,prolapsed disc ) is main cause of cervical vertigo,these pathological changes may induce inflammation,and increase excitability of sympathetic nerves,make vertebral basal artery spasm,so bring about vertigo,especially when based on sclerosis of basal artery ,VA abnormality,dystrophy,As and so on,patients can be easier to suffer from vertigo and dizziness.2.Clinical manefestation:In below 50years old group,vertigo and dizziness are main symptoms,ofteon accompanied by nausea vomiting ,tinnitus,deafhess,especially...