The role of a multidisciplinary approach in the diagnosis of vertebral artery compression syndrome

Vertebral artery compression syndrome is a clinically significant but diagnostically challenging cause of vertebrobasilar insufficiency because its manifestations are determined not only by morphological changes in the cervical spine but also by positional hemodynamic disturbances. The aim of the study was to substantiate the role of a multidisciplinary approach in the diagnosis of vertebral artery compression syndrome with emphasis on the integration of clinical, hemodynamic, and neuroimaging criteria. The study had a clinical and instrumental observational design. A total of 372 patients with manifestations of vertebrobasilar insufficiency and degenerative-dystrophic lesions of the cervical spine were examined. The findings showed that the clinical significance of the syndrome was determined not by isolated morphological alterations, but by their functional realization under positional compression. In ultrasound verification, the most informative markers were changes in volumetric blood flow, primarily in the V1 segment, where the correlation between ΔVvol and clinical severity was ρ=0.84; p=0.001. Positional changes in volumetric blood flow at the V1–V2 junction were more pronounced on the left side, reaching 44.9±1.12 mL/min compared with 17.9±1.04 mL/min on the right side. The sensitivity of magnetic resonance angiography without positional tests was 67.0%, whereas positional assessment increased it to 85.4%, and 3D modeling in a selected subgroup reached 92.3%. The sensitivity of the optimized multislice CT angiography protocol was 93.9%, while the combined use of duplex ultrasound with positional orthopedic tests and multislice CT angiography provided the highest value of 98.8%. The results confirmed that the highest diagnostic effectiveness was achieved through the integrated use of clinical neurological, neuro-orthopedic, ultrasound, and neuroimaging approaches. The multidisciplinary algorithm appears to be the most substantiated model for verifying vertebral artery compression syndrome.

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