Doppler Evaluation of Vertebral Artery in Cervical Spondylosis - A Prospective Study in Rural Indian Set Up.

ABSTRACT

So far, evaluation of vertebral arteries has been done by angiography with a limited data on evaluation with duplex scanning of the vertebral arteries. We wanted to study the radiological features and vertebral artery Doppler characteristics, in patients aged above 35 years with a clinical diagnosis of cervical spondylosis. METHODSThis is a case control study with a total of 120 subjects aged over 35 years (60 subjects were cases with the clinical diagnosis of cervical spondylosis and the remaining 60 subjects were age matched controls). Vertebral artery colour Doppler was performed to record peak systolic velocity, time averaged maximum velocity, diameter of the segment in grey scale in millimetres and flow volume of the vertebral artery. Statistical analysis was done using chi square test, student t test and z test with p values < 0.05 being considered statistically significant. RESULTSMajority of patients in both groups were in the age group 41 - 50 years. Among cases 39 (65%) were males and 21 (35%) were females. Most of cases had vertebral artery diameters in the range of 3.0 - 3.5 mm seen both on right [21{35%}] as well as on left side [17 {28.3%}], and a similar finding was observed in controls as well. No statistical significance was observed amongst cases and control on either right or left side. Most of the cases had vertebral artery blood flow in the range of 51-100 mL/min both on right side [26 (43.3%)] and left side [22 (36.7%). On comparing vertebral artery blood flow in the range of ≤100 mL/min and >100 mL/min, the difference was statistically significant on the left side. On comparing the number of cases and controls according to the vertebral artery blood flow velocity ≤30 cm/s and >30 cm/sec on right side, p value was 0.009 and that on the left was 0.001, both of which are statistically significant. CONCLUSIONSVertebral artery diameter is not a very reliable sign in this degenerative condition. Vertebral artery flow volume is decreased at least in one vertebral artery. Vertebral artery blood flow velocity was significantly reduced in cervical spondylosis cases compared to controls both on right side (p=0.009) and left side (p= 0.001). This makes reduced vertebral artery blood flow velocity as a very strong sign in this condition. To conclude vertebral artery ultrasound is a very useful and reliable tool in evaluation of vertebrobasilar insufficiency cases.