The RelationshipsB€twe€nExtracranial Vertebral Artery
Flow and Distortionof the CervicalSDine
BuqiongiirPoca.hrng!M.Sc.
KanohwanTilokkulchoi,B.Sc.(tshnm),Ph,D.'
bj(r Ynh it6 ald syoPbEs
-oicbld hdrhy sbjds Gonrbr
d!rc5 rcop $d I G) oelsrdn.
olFn.nd nnv wbo rh. $bnd,
t, nq, enrtrd rd rddr pdni06, (b) .' d<rfliyn8nn (EMc) d
j nnd G) d
dredd{ by dL{ d(nlds
rh. !rr!(!tur
Yqhb
od or 2s $'Dj*h) ru
nN (trvB
b4h* h tk nudy gnu G6
Dndd (irn n& s %) w3 iiei.Kurri
$qi4rt
a
lbtitiqny
siqniffqd tudfdm or
i dE codror Fm'o Glrn 0,n 0r x
(p < 0.05),
cnendd lnd dn.d
hc *Edtrsr
0o$ d rhc 16 $rtd5
lih
urd {r(td
do{ i rh {udy shjr(
ipoidrbsis pcn dsdto
d 8po tb5i5 Y$ sin[rlr trlid
dy 3aup). Hoh{d! rh. rdlbnl
r} brur th!tr h rbr sbj!.6 nrh mrmd
hrrd-rr-!li,Ninaoa{xafl fiaoil$nLiu!1! E{*-i"r'r v*cbBr Ad.ry ri'uar
no'dN!a!i.rgift nn'idrnD
trri'iu5
.nir"rr lrr
n!tr)rts
'nrnllrdlilntr. flo,otrftirdniffi:rroni, !nrsrni_!!ne6,alltn
drrdir?t
led@6r dd: bdo dob
i!mtrADnt{ii3
nld:riid,ti0itirrdir!ri!]i!!'!dii,!udv
(cNidrspjlr
dkbiio mili1)od$l5riolda ar!ffdori1u!
uirnntui&mm,,ti,iui.-r.irlio
ba ililiqlnrl
ha n! n0mnM:rioDudni{oi kiebn' iic,} 'n$rnoscyi"!iri! !l!irh!
,i{'r, hlioirt $n ii nii'u lo0iidmdu rfli.oi oin ") 1d phd*r"d'i" p"k. *"*. (PPs)isi
ir ' rm,1L e orlr'r. nrri. r'BDii
u r i . . p o r e ' , p , ' 1b i
(EMc) xor t.psius m6de!n1ol{'itrh:
hirn5r d! NU tri!fildrs, b) iana iinii!'io
. De4tudt
of Phrsiatost,Frc t.l
MelieiQ sniruj HasPitut,Mahaat u11nE6i4,Bansk k t07aa
Tte ReladomhiF Betr{
EfttEi'l
Vedhr,l
-) l'sDdordhms5rindlldilhlio!1ifl 1100!cd ianrnoaa! MnGlm'adn
iofinsjir
(P< o-oa)
1n.60d! wrbbdr db,y ioridlro.oitisMo,irinlladlmlq!0dri1i!fii"qn$/66
do* 6wrin
ili b4 illimrni'ix{s{rhhnioo,6oinnd!6rnrirlTin
ho.jlriisr,b
(d ilori bd i!) odNthiliriiiilnNiia (P<.."d) inldlilfivnnlliitrtdi
ii$1!i.j!i1!!!
kn.bnr
xsii:lvn'!flrrlr.,i!!'ion n!nn5ri! NU uBvn!fir!s"iinru'h!u'doil{at1!!1!
aiqy ioNodrddidrdqrxinarinos+ (P<o.oa) rriinioiitotimlni'luliotLJduldrcd!
nn'io.lnii1 :eoludr orlrsriniLimrn{iN l Li! Lir!n5!r d$6$o o1
iia,llidlroioi
hi'ii^dimninirDn6oit{i:u!{0,.s.brrnrrylln.iJri.oNr.n.n',iuiiaqri't0tilLfo
(nild) nir!1!1i,i'idi'!fimi
@di.ar spmdyrosis
rsp{ius flmrinir_mrda'!,oia5filj1'nlii
u,i!fio3onltnarrvndlnn
60 si r'o o! n'i!ir!'t!N b ili ho i
o'j! (iijlrmNn!
(P< "."a) .
nlnfldldnfilx|laooiltmd0ldrino.ilnhtotjrllnufinErrmi
@nhsr srmdyrosis
crct icdtrdionor bhod aow $ough oi. or
borhof $c vdtbml .neries, r.sulling in r $mk.
H.ne, i. is iDbmtins to havea pElimidy
tow and tno f!.ro^
dra.k, ha rccendybeenrponed ii pdsois who inauencinsrhe fiow in subjc.h who hrvc io
vo( plsccdin a hansing,hctd.hyperextnded aduil raumi, bur who Cddullly dcvelopt'isieir
pciiion ror shanp@ig': The venebal anefts arc
{
cbne (crc:), md rhN ac liiqucly s*ptible
ro re.hmicrl compE$ioi inducd by mck mov*
I4ATERIA.LSAND METIIODS
Mod sudies flaEd Io v{rcbirl mtcry
.g.d bNetr 22 s0 y.as (wfth a fa
aseof 34.1
codpr.$ioi arc msociakd*ith acut occlusion dd shdad diviarion017.6) rcE divide{linb two
suhiis lrcm tauna, which i3 $uarly mo fdi.d
sbups rhe $udy crcup mNisbd of 15 $bjcds
byjJmedjdereurologicdofi.iLi'}FTkE,Elev
ol dizitrsq veniso, tnniruq blurtd vnioi. dMbias
sudiesol sponraneour
andsildml occlusion
rnd pararhGiis. Twdy.{ivc hclkl'y subj{b {itl
resoltinsin inrcmi!tnr or trNieni atrrck ol
rse{nd sx-ndchcd p!4iciplrcd in rhe contol
wA
sroup,-rhsr.di.!l hisroryor eachstrbjecr
atrdsivins Iise to isol.rcd or mmbinedsymproms kken anda physical.xrniidiod dadeby Asso
ad sisnsor diziics, vdriEo, hesiinelNs, spe.ch ciiic Profe$o.,Dr. f,ld,w,n souv,uknti All
d.rccts,diplopia,blured vision,nyiasmur lnd subjcchhadconve ioDalEdiosmphyindudins
venebrcbasilarinsuffi.icncr duinc neck mhtion,
dysphqi, or .ven $mke.l'7rc'a Eiily or plimry
illtr$s rill belp the pariri! by prev.ntins gocr6
ceflical spin. wm pdpand by Asisoit Pmlsor,
sjon to $vere unorabls .lidi$l synprons
Dr. wal?ilux chriyasoo!lrom Dcplnm.nr of
is ! Ftunial
mrrd"xnivilori1'.oi{ia{6aoiitu
vencbd tury i-!nrrno6!!!ain::Enirtn'!$!6a
nii rd, or"!nd,3$M! !d.r
wn.bmr bloodnow (EVBD
d'b of drannid
Bdm iai'ins 'r'. rcodiJ'g, $bjeds vnc
For quahdivc.hsig.s in ceoicalspinc
srotrps.
rdllowedby, (a) ris mesmdei' orexnacinhl
wnebFr b'odd now (E!tsF), in Gms o, ptrkdi.
(PPs){i'h a rime rcNhd of 0.i smnd, p'.
lomed itr ihe sittirs posirioi
RESULTS
ncai a8.s,sx distiburion,bloodprc$uie and
hdr nrc beNeetrthe contol ind sudy smups,a
fiow gobe ws EposirionLdlwo ro d'reetins dil
sG4sol vdtbrl
anery insulficicicy ii rlr ludy
vensbBl{lcry ws obbined.(b) A re.ordi"gor
nurle sp6m, by tl,cins rwo surraccdisccldc
todcs on rhe tapeziusmusclcor rl'e neckrtrd
shdrds wher 'he $bje4 *e sh'rncio a Ekred
posnionwirh rm, back ,nd hip suppoi. Thc
vurieo iid riinirus. None of rhe subiec$srok.d
ci!ar.(s, rcula.ly consumedalcoholoi hrd clini
.al synprors sue€eiive or sroke md tddyst
rcording sirs lge loc&d by nanurl palpation
EVBF
ii orderb rind rhe aruaor 'eMdBs (c) c.Rical
The .mpliru& or thc ;ght andlen EVBF or
sdmr ebieds md,o sudy $bj.ch. Eacho hc
conrol!rcup in all hc.d posiriois0abl. 2). rhc
latenl,lel ob!;qr sndieht obliqusvicse.
lowsr mpliiudc or EVBFum loundrhen rhc
ID o,nq ro plove rhe reliabilny ol tho prc.
h.sd {as flexedandotarcd to rl'c contrlareul
*nn $e valus meisursdby r sdd*d iosmm.n!
{se omparcd in iidivjdMr $bjed' ab ' 'wo
rhndsof,rE $bjeds (1?r5 ) il 'he ntrdyercup
soios 1,000,Hc{trr
colou Echocirdiography.
had dplitode dm{en@ hy flot rhatrs0 p$.cil
bdwcm the right rnd l.lt EVBF i ho{everthf
which*d. crldlatd hon dah obtainedfiom rh.
dincmc {a roundorly in oitdnd
0r5) or tho
rwomdhodi vereloundb beequalro 1ad 075
ndisricd'r .iairisd
is rtli$te eiougnb 6c ii $udyiis v.nebraladuy
(P < 0.05). Mo6fr.
dd.
wdd sigiificmdy mde (P < 0 05) $bj.ds in rh.
sudy Eroup(17125)
who h.d lovr rishr EVBF
The r!ensc of rhc righr :nd ler' FvBF
fieRe'rdomhiFeftel'rftaalj'lvefuhnl
eryFlNedDlsb'donoftle€Ni€lsp'ne
Tabh r. didel
ddi of'he cuiru
TlbL ,. Tre m ,nd rignt E\EF in rhe .ditol ,id sody e'oups
A1l dae de *pres.d I n.m ! sD ', sa$rically sigiificad, p < 005
Tdbhs'Itjc]'ll.flE\,tsFdiff.fi'e
', sbtisie[y
riglified,
p < 005.
ilrxd-xnitr;!arirrio.{ia$6aodlBsdd
! EtulqnDd
vcft bml^turyiiuh:no!6s$oro:3!fl t"!6i!dru.a
nu /?. c,nn e. ariri! 6d-i
TrbE 4 conpirison or rhe len an
R = nishi i L = kfr. All dah 3ie .xpl.sed 4 n6i ! sD " idislielty
diffsr signiricanily, In rhc $udy sroup, howwer,
'll.c w$ siEiin4.r diftcd@ (P < 0.0s)bck*n
significanr,p < 0.05
sid.'Tl'cEvlFoillldcoltllalenlsidc*ill
dsrc$e norc rhedoi $. ipsirlbdr sid! whenrbc
h.!d $ Dhrd. Hne, ifrhe $bjed rd a dshr
posi|ion'synplonsorvenebaldtiyidsufl.i.i.l
d nhFd b ihe dsh ('r$b 3).
.xr
fry orccipnd. duringlefr rhriotr.
lie {9r ad lefr !\tsF in the odml goup
courdpo$jbryb0 caused
by conpresiotrdue ro
ed or iobred ro rhc lefr or dshr mmp,ied 10
The lwel of:udrircd mtr$le contuion or mNdc
rheneucr pGriotrGabr. 4). How*rt, id rh. $udy
ft.Relat'ondnFsBefuhEhguJalvefubml
dE,ulioi nay rc$r in sbicds omphin'r of
ou'd baveEsur'edfromtuscrc span (rabb 5)
Rcdudiotror ev€ncc$lrion or flow rbrcugh
codpnison ol nc diglneb. of .beenior slttr
Chansesin lhe dorml aligidedr ol rhe
dic,r spinq s c'ical spie dhbnion' mayled
to mnpre$ioi ol a wtubol 3iery, Esuxlis h a
r ccdi.al spotrdy'o,n
rn!.dotr in vetbrd nN.5
*tr sss.d nom bddic m9., ob!m, mm{itrs of idrcreitebraldis. spaceatd uiio*'rg
ofrhe iman'Ebal rosnen. sixlcci our of40
$bje.6 hid m d edicir spodyrGis ; sij. wcc h
insuni
pir.ipir{e rho synptom of vsthiobdil
.i.trcy, when(he .llibrc of rhecontlrftrar vdtbrd aderyand rhc ,naiomosiswirh rh. camrid
anery, h.ad roktiotr may iestrli
in 3yrproms ad sis$ o{ v.rtebd inory iisuffi_
in i vrtbrl
spdidrrd,i' : In lne 2a $bjeds *ith a mrnd cts
vjcal spine tha nean ol rha iisbr ind bn EVBF
TIE pi*mt dldy b,s shownthd siEdifiqd
wrs signifi.rnrlybiehd (5.6: 1.99,4.36t 19s)
$m in thc cnic.l spondylosis
sroup(3.??I 143,
Canpticotiot dutinc heaa rcbtior : au
subjc.6 in both gioupcould pedom s[ r've bcld
posnion v hout aiy hrnful side elLcb. In rhc
dntol crcup,only one orrhc $bj.d hd re*
rEadmwcdor t' hdlmy $bFd, did m' prcduc
6y sigDsandsynptom of verbbdl ddy insur6_
ciercy. However.in subj4b in 'h. vedebnl dsv
iGtrfiicioicy srotrpwho innilly had low vsebnr
paii, wheEas100 perceniof th. nudy group
sympronsnighi repcdedlyoccn' during i.ck
iohrion or cxttrsion. as hasbeedsusseicd, tn
paio,shodderpain,dizzides or blun.d vkion
ere mechrnismor nomal iedudioi ol vdrebnl
DISCUSSION
surficienrb caus ischemiaor ii&djon in pdidb
wnh bodedino bnin*ren blood supplyor ihpair'
nidihss demondoied rha$hc
*ud! snbiecb{no badno appri.di nauna aid
who had smdually d.velopedsi$s atd symptom
Thc ses
rtrlrcd ro rcn€btubxsils insufhcici'ry,had significanrlow v{t?brl blood llo$ { rcs Fudh(
reducrionin lvBF ws found {hei rhc h.ad w6
ncicd, exrendedlid roraredto the opposiresi&
tius syn.lgisric .ffecb of vencbml an{y now
fdi
of vencbsl srteryaov.1
hvpopcdusion,
aficdiic thc ccr6dllnd, bditr{er
md spinal @d, cusd tansni ischenit aftcks
ad rsulrodin venigoaraxiadizio*i sviote
visuil dirublnc. { n a3r5 \'rhed snchsvnptoms
dcDtr.d taisi.idv in sociatid *iin headnove
menft, rhe &a or pimrry suspicionshouldbe dre
flr!d-!ni{iaarir:io.!i,!,f,
roiilbild
! Fahcn;d
veft bd ^ery niunTno!5s!"aritr.ndr"!ri_!dr!Fa
prsu4, up$r {tilnmed andsuse
incrcasejoitrr
omprcsive degeFrarion.Hcic, in cises whde
r[*e is I loig,sbdirg hnbry ofepisodicne.k
?trd/or&f p,ii, i..k $iirne$ atrdnuscle spam,
ddairsor par R.id.ft !c roqunedtor considds
rioi ol cdvi.al mtrsul,rm '1
rhc osed res'lr
srrnrdn odh by nfiNrr e,hdioi dd EMa
divi',
md 'he di,ninurioror vskbml no*
rheenicrr spim rtrqrd\
i' sLbjcdswirh vcncbraltury in$rficiemy syrp'
nuscrcspam on oF side)adddecnas physicil
deu6 deciaGd virh
Lhrins muschiDbaranc.in rbc rpine(duc ro
,divni8. suchdisronion
is Fomord by divnies
dd dsmlgc pc,ucr abrcrm:ri'iesG.c.,eid,
ktrsed dron d a eiven job) fd frcquen y
becofes rixcd throughnuscteand soir rissu.
rdiprive shondiiig J spondyloricconprc$iotr oJ
v*rebnr ilrcri8 hs bc.om. appaienr
ovrt rtr
pisr 20 yem.!rsr!4
Cawicrlspondytosis
A
dq, dbow rd w ' dissd{s rnj,trym (srr
synp'dm'i. rtrbrccb(10,20)andasyfpron&ic
sbFds (6/20)had fird .dviclr ,pondylo:is.
npid robrion.nnior lllLs,.tumobilc rccidcdsj
tkrce. rr'c obs. dioi w^ simirr ro previotrs
yos!, glmrlnic cMcrsc, lvcn proronsedcffofl d
. gid job rc+iiDs rormsed enicd qbBion,
rcpois rrrr io corolarion
fdiorosic frsiLndions andclidcat symprm dd
spordyrosis
s,bjedswassisiiri.hdy 'osd rhm
p.oprc
iijury, do!
h.d rlpidry !rd b0comc 'bd h 're sbjeds si'h r ldmar e$icir spine.
Thismtrrdposiblyinpry rhd r.dldion in EVBF
ispinlyflatdbdnbii.ioflhgcNi.a|spj.e'
bbLe.Thn big.L(irs cLTo4n tlketyro occr it
v!1!b.at Allial
Aslnher, : lne w're
orsolnsio.ncptoi.nd hfllnmdion,or frncrionil brobNirft:nei,l syscn is kno{n ro havea high
r.ry8
rysoD (rEriA{Jr relmFihr.
N{rcpi'hy
ii.rtases ntrsck ron. GprsE) rnd concurcnr
nns.le sho eiiig. Musclc.shoncnins
pub me-
beetrrcpoirdborhin hcdrhy.d!xs.ndin pdienb
chlnicalirc$ on tendons
andrh.ir arichnEntj
md shonmingin nsds rhd e' m a joinl sn
furiosnphic $udiossrrnd . her indtedry by
obbitred dn.crry frof .i!ronical *udies or
srimarionfron compured
romosnphi.sh{
or
,&iqnsedDtsbrto'o''Eceddspine
origiides lrcm r{o venebd ancn.s, s nrkod
asymnery of i vad.bral d.ry fry sistrilisntry
infirn€
or venebnl etery asynnety on bsilar
sp.culatioow6 suppoiedby or fndiigs ltr rho*
$udy subje* wio had ka rcdobi'r ,it'y doni
md'mdwhG.rcktion|olhe4h'sho*€dsig.
iiri.ani rdudioi in left vedebnl flo* sicnifial
rhd the t.qoeDcy of vdcbd anery Nvnddrv
% sjglnmdy hishd in ihrcnbotic bdjln rirerv
G.rlsiod (13 our ot 21 cs*) than in rhe conrrcl
ssop (r5 od or roe 6*). Bs s dsy *rcD$s
$ynncty Fteh thanin th. veiebral mlsv
nomal pdM Ir thedorc sugs.sbd$ ved.bnl
andy synncty @uldbe oNidfted s one ol $c
now in r sndl smw or $bjab by snc a sinpl.,
rc.bniqnerverled *ve6l
ctudp sd Don-invasivo
ujig,sbnddpoenftqsuch$gh@dio8l,'hy
d Dopplerulr4$mgmphy. Hse, rnnntr studies
h o er b soblish $andard
nrk ldoB lor bdild dely o.cltrsion,andthd .hc
d.srceol vencbralan*y dyrmdry mishrbc s
posibrc iidicator in predjcrinsrhc scventvoI
would be ol intns
vdbbnl adry iNnicicncyj'
Recnr sbdics weE etrid
out wirh tranF
suspeed b hrve sietr andsydpromsol vcnebFr
otry iGutricioncyitr differcnt asd grcups sine
in 53 snbjcdsio
cnnillDoppl.r uxdsonognphy
F.*rc blood no* velociti.s ii tlE bisilrr snerv
rlis ndhod is cherp,mn.invdve and easy10
us, il nighr be Nelul ro ,pply tbis merhodid
rhatobrion ol the hsd susd sisdfi.&r Edudion
ol rhe mon no* rcbcny in rhe b6i1{ an.iv in
ihoe $bFcb vnh mde thm 75 pd cnt 6ym'
mry of rhevctub'al anoios.Tn. deljne @!ned
b $. h]?oplanicv.nebd anoryo'Jy :ner mbrioi
pdlcnofven.bralatelyf.lowolvenebia|an.Iy
6ym.'ry h nomal he,uhy subj4b aid strbr.cb
scrcuiing$eBcbddelynowinpa|icd6wnh
sNpecredvcirb*l ,iery insufticieicy,beforc
refercd p,rids * h only row vdebnl aderr t!o*
expensivc,sophisricded.qujpnen. suchs MRr,
echosrdiogQhy or Dopplcrul!*onoglaphy.
coNcLUsloNs
indidcd a similr fiidins in thar $d ftequ.ncJor
v.nebral mtcry Aymnelry (by noie rha! 50 pd
en, w* signilicantlyhieberin rhc v-iebral
sndullly devdop sympronsatrd signsEl.lcd ro
vnrbnl an*y iisdriciercy (vAI) h,ve sicniri_
rery iisumcien.y gloup thin in rh. ontor srcuo.
Rohriotr alonc c.n cau$ sisnifica 'educrionor
vd.b'al aery now.t11r0'Llrri6/1tt ltowwr, il
hdrrhy $bjc4s n aI had posnioN. Frthq
rducrioD of vcitebal nos dunncheadnovencls
in vAI s[bj..h couldplc.ipirer. synpronsoi
61u6irr"x$Nnri'nuar6a6njl6iad1tl!
Efr ft md
vdbd
^rbe ri'umrn0!6o{narn:yi0.-!ral!drxia
ACKNOWLEDGEMENT
renebEr aibry Nynndry (by nde 'bm 50 ptr
cio n sictrif,c,firy bidel in ihc vr'ir s{up rhn
wc{dldlikebqprcsdlgcdEtilude
!o Aso, Prcf. Dr. hdaum souvamkirti for hcr
smr hcrpin m*ing physicalexmiiaiidi i A3siJ.
Prcr Dr SnichaiAg\lnri{ons for hetpin 6.aur.
of rh. r,p.ziN nlsch xnd p!.ry 'cr!!.d ro
phy dd las, bnr nor lest a sp.cirl app.ciarionb
Pror. Dr. NiphonPounclrin tor bis vallabt.
audjh Es, n*dy wc, Lhdrs Dw, rhn4
RePond ffw $6.
riM
!e3i 26cGO, 'sr.
Mri{ Dq Bftk BE,Fri \rr. v'Gbi.r drry
ciEhs N, F,on.i' c, Ro& c, d d. vdiso id
€E6dl&inq€[.db'di*didtrd!vcfubd
5T@hr,ftdss'IduqedhcdpsihlPl
cflid
tucar b|id. Aii srg 1e6; r$o):
shpio sK rqrcs F. Bnin iijuiy 6ne1i.&b3
whPblh njuds. MhBob M.d 1s0:4i: 473i.
rcd s*c by 4f,i&i.ddbq
e
crcsmi
& tuvn R
brbdl
iojrd6. r
Posiioid @rlsii
vhirh$ jiju4 tuch Ncuor 1s1; s: 4G7.
oi dc
iicry hj!ry md dftbdhr sdkc rhh svhEhs
'2
bridi MB, Reimdi oM, Rddv RE.sbk du
b rcnrbFrln,ry ij!!y. Aich Norer 1e35;4r'
l]c{pok|sh]'urydrcck6a!$dricbE|
coluek.P,sc|l6nis'rhjliP!T,ddvqtbd
dery siury : DbsGb dd ims.ndr
r rbrEa
BuDioodnPc*heid, d d.
702
dnh*riois J Borcrohr sus rteoi 71.3(4)l
sductqr.'cGdxH,TrctrJA'Bl@dwssL
tr&s! rorovii3 hcd lDd nek ijlrns dh
thc rcnsnr
nrry
Brcis a, rrdlrr
n d. dlld@ft'
I.4sr*
joii'
o. Er.Ek d Er
wnlb'r dbrr tdi hrF!4t66o
iiiurv b rhc
kaLis'(!rymaY.Nldbnilj'dJeiindbo
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