M Salkov1, V Tsymbaliuk2, L Dzyak3, A Rodinsky4, Y Cherednichenko5, G Titov6. 1. Dnepropetrovsk Medical Academy; Neurosurgeon of Spinal Department of Communal Institution, Dnipropetrovsk Regional Clinical Hospital named after l.l. Mechnikov, Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine. salkov@ua.fm. 2. Restorative Neurosurgery Department, The Institute of Neurosurgery named after A.P.Romodanov, 32 Platona Mayborody St, Kiev, 04050, Ukraine. 3. Department of the Neurology with Neurosurgery, Dnepropetrovsk Medical Academy, Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine. 4. Department of Physiology, Dnepropetrovsk Medical Academy, Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine. 5. Neuroradiology Department of Communal Institution, Dnipropetrovsk Regional Clinical Hospital named after l.l. Mechnikov, Govtneva sq. 14, Dnipropetrovsk, 49005, Ukraine. 6. Department of Communal Institution, Dnipropetrovsk Regional Clinical Hospital named after l.l. Mechnikov, Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine.
Abstract
PURPOSE: The purpose of this study is to justify a new concept of the pathogenesis of secondary changes in the cervical spinal cord, and its correlation with the depth of development of neurological disorders in spinal injury. METHODS: Standard magnetic resonance imaging examination and angiography of the cervical and vertebral arteries of four patients were performed to diagnose the prevalence rate of ischemia and edema, and examine the spinal cord vasculature. Correlation of the data obtained with the neurological status was performed. RESULTS: Collateral circulation is most apparent in the upper-cervical region, above the C4 vertebra. Following occlusion of the vertebral artery, the circulation above the C4 vertebra is performed by collaterals of the ascending cervical artery. With extensive damage to the spinal cord, the intensity of edema and ischemia can be regarded as the effect of damage to radicular medullary arteries, which are injured in the intervertebral foramen. Secondary changes of the spinal cord are most apparent by impaired circulation in the artery of cervical enlargement. CONCLUSIONS: Collateral circulation is a significant factor that limits the damage to the cervical spinal cord. Impaired circulation in the artery of cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.
PURPOSE: The purpose of this study is to justify a new concept of the pathogenesis of secondary changes in the cervical spinal cord, and its correlation with the depth of development of neurological disorders in spinal injury. METHODS: Standard magnetic resonance imaging examination and angiography of the cervical and vertebral arteries of four patients were performed to diagnose the prevalence rate of ischemia and edema, and examine the spinal cord vasculature. Correlation of the data obtained with the neurological status was performed. RESULTS: Collateral circulation is most apparent in the upper-cervical region, above the C4 vertebra. Following occlusion of the vertebral artery, the circulation above the C4 vertebra is performed by collaterals of the ascending cervical artery. With extensive damage to the spinal cord, the intensity of edema and ischemia can be regarded as the effect of damage to radicular medullary arteries, which are injured in the intervertebral foramen. Secondary changes of the spinal cord are most apparent by impaired circulation in the artery of cervical enlargement. CONCLUSIONS: Collateral circulation is a significant factor that limits the damage to the cervical spinal cord. Impaired circulation in the artery of cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.