MRA Classification And PLDD Treatment Of Cervical Spodylosis Of Vertebral Artery

Cervical spondylosis (C.S.) includes radiculopathy of C.S., cervical spondylotic myelopathy, sympathetic C.S. and cervical spondylosis of vertebral artery (CSA).One type is often mixed with other types. the middle agers and the elders are susceptible to CSA. CSA has many complicated clinical symptoms. There are many items similar to sympathetic C.S. Now the etiology and the pathogenesis are not known clearly. There used to be lack of effective diagnosis and treatment means of CSA. When we treat cervical disc herniation with PLDD, we unexpectedly find some patients' cervical vertigo symptoms are relieved or even disappear immediately but there are no explanations about the curative mechanism in domestic and abroad literatures. This project performs cervical spine MRI and vertebral artery MRA used more and more widely in clinic to diagnosis and classify CSA. The project' aim is to study curative effect and application scope of PLDD as a new mini invasive spine surgery skill and further to explore the curative mechanism. The study objects are the 66 patients that are confirmly diagnosed CSA and treated with cervical spine PLDD in our department in from March 2001 to October 2003. Male 29, female 27, ages ranging from 30 to 67,average 49.19. All the patients have cervical vertigo. Symptoms arising is correlated to position changing of cervical spine. All neck turning test are positive. X-ray radiographys show cervical spine instability or uncovertebral joint hypertrophy . Vertigo resulting from eye and ear diseases is excluded. The cases accompanied by headache 41, chronic pain of upper limbs 27, weak lower limbs13, tinnitus 34, hearing decrease 27, nausea or vomit 15, eyesight decrease 22, insomnia or forgetfulness 19, chest discomfort or palpitation 12, damping off 4, hypertention 9, diabetes 3. All the patients have cervical spine MRI and vertebral artery MRA examines before operation, which show cervical spine degeneration and vertebral artery abnormal appearance.Study method is classifying the patients with PLDD treatment according to pre-operation MRA and MRI and clinic features. The 4 types:Ⅰvertebral artery compression type,Ⅱvertebral artery spasm type, Ⅲvertebral artery anteriosclerosis type,Ⅳcongenital hypoplastic vertebral artery incompensation type.According to preoperation cervical spine MRI ,to select 1 or 2 cervical disc comparatively serious to perform PLDD. Evaluate curative effect on the basis of Nagaseima' evalution criterion after operation immediately and 6 months after operation. Use contingency form to perform X2 test by SPSS 10.0 and compare the difference of curative effect among 4 types.Statistical datum show that there are no significant difference among the 4 types(P>0.05). The curative effects of all types of CSA with PLDD are good. Post-operation general excellent and good ratio is 87.88% and 86.36% after 6 months. In the curative progress, we find the patients' vertigo, headache, tinnitus, blurred eyesight, chest suffocation etc symptoms are relieved or disappear several minutes after operation. The curative mechanism is absolutely impossible that the compression of vertebral artery is removed. Now the etiology and the pathogenesis of CSA is mainly regarded as inflammation irritation of nerves around vertebral artery resulting from cervical spine' instability and degeneration. Dd:YAG laser we used has a great hot penetration in human tissue. The laser can make the temperature around the disc 2℃higher according to revolved literatures. PLDD evaporating nucleus pulposus can effectively depress the intervertebral discs and relieve irritation of nerve and peripheral receptor.To summarize, we can draw the following conclusions:1 The curative effects of all types of CSA with PLDD are good. Post-operation general excellent and good ratio is 87.88% and 86.36% after 6 months. 2 The instant curative effect of PLDD maybe involves the local high temperature relieves the tissue dropsy near the spine and sympathetic nerve irritation.3 The lasti...