Musculoskeletal Uitrasound Observation: Luschka joint and vertebral artery

摘要

Background: There are various methods used these days to investigatecervical spondylosis ofverlebral artery type, for instance few of them beingX-ray, CT-Scan, MRI, etc. For the past decades Musculoskeletal Ultrasound(MSUS) has been shown to have several advantages over the other methodsin investigating musculoskeletal diseases. Some ofthe advantages being costeffective, gives real-time dynamic images, can be used repeatedly, notcontraindicated in patients with metal implants and is portable. So farLuschka joint hyperplasia has been found to be one of the causes forvertebral type of cervical spondylosis by using other methods. Thus it wasquite reasonable, having so many advantages as cited above, to use MSUS toobserve Luschka joint hyperplasia and also its effect on blood flow in thevertebral artery with rotation of neck.
　　 Aim: To explore the application of Musculoskeletal Ultrasound toassess Luschka joint and to observe its effect on blood flow in vertebralartery with neck rotation.
　　 Materials and Metbods: Musculoskeletal ultrasound was used to findLuschka joint hyperplasia in a sample of 23 patients complaining ofdizziness. All the patients were clinically diagnosed as cervical syndromevertebral artery type. The patients were informed about the trial and thenwritten consent was obtained. Comparison between the right and the left sideof Luschka joint hyperplasia was made. The presence of Luschka jointhyperplasia in different sections was also compared. X2 test was used in bothcases to compare the difference among the different groups ofLuschka jointin the cervical spine. Along with MSUS Doppler sonography was also usedto observe the blood flow in the vertebral artelry with neck rotation. Therelationship between Luschka joint hyperplasia and vertebral artery wasnoted.
　　 Results: It was found that there was no sigruficant difference betweenleft and right side of cervical vertebrae for the presence of Luschka jointhyperplasia ( proliferation rate: Rt side=27.17％, Lt side= 32.61%, X2=0.648,p >0,05). But Luschka joint at different levels of cervical vertebrae wasfound to be significant (C2/C3=4%, C3/C4=16%, C4/C5=35%, C5/C6=45%,X2=28.086, p<0.05). C2/C3 Luschka joint hyperplasia indicates spur presentin between C3 and C2. The spur is from the upper part of C3 vertebra and isproliferating towards the lower part of C2 vertebra. The same goes for theothers for instance C3/C4, C4/C5 and C5/C6 Luschka joint hyperplasias.Velocity of blood flow in relation to neck rotation could not be calculateddue to lack ofrequired data. Only simple observation did show insignificantchange in blood flow in the presence of Lusclrka joint. Even in few caseswhere there was considerable hyperplasia ofLuschka joint almost negligibledecrease in velocity ofthe blood flow could be observed on neck rotation.
　　 Conclusion: Musculoskeletal ultrasound could be used to find Luschkajoint proliferation and its significance at different sections of cervicalvertebrae and as well as its insignificance on comparing bilaterally. C5/C6has been found to have more Luschka joint hyperplasia compared with theothers and C2/C3 has less. Tlie presence ofmore luschkajoint hyperplasia inthe lower cervical spine than the upper cervical spine may be due to moredamage caused by movement of the lower part of cervical spine, C5/C6 aremore flexible and due to excess movement at this level more damage happenleading to spur formation. Though there are no such articles for this findingthat is about Luschka joint hyperplasia but then the explanation about thisfinding does correlate with other authors findings. Together with MSUSColor Doppler ultrasound is useful to measure the velocity ofblood flow onneck rotation but then a larger sample is needed to get valid results. Furtherstudies are needed to show the close relationship between vertebral arterytype ofcervical spondylosis and Luschkajoint hyperplasia.