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Is surgery mandatory for thinner vertebral artery?

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Posted on Sat, 14 Jun 2014
Question: Hi, my name is XXXX. My sister has dizziness frequently. Some time she loss her consciousness.

Then the diagnosis traced down to cervical spondylosis, the MR image
shows:
C3-4, C4-5, C5-6 cervical disc herniation, C4-5 spinal stenosis,
vertebral degeneration,
left vertebral artery is thinner than the right one.

My question is:
Does she has to go through surgery? I heard there is high risk doing surgery in
spine.

Thanks
doctor
Answered by Dr. Mukesh Chugh (2 hours later)
Brief Answer:
Reduced blood supply to brain may be a cause

Detailed Answer:
Hi
Thanks for posting
I have gone through carefully your sister’s suffering, the cause of her loss of consciousness and dizziness seems to be reduced blood supply to brain because of thinner vertebral artery as you have mentioned. This may be confirmed by Doppler study (Blood vessel study) of artery supplying the brain that is carotid artery. The further decision is based on the report; please share it when you have it.
The symptoms of cervical spondylosis and associated slip disc (pinched nerve) leads to radiating pain in upper limbs, numbness and tingling sensation with weakness of grip, does she has it? Please share it in follow up query.
This surgery if required are very safe and done routinely.
Hope this information suffices and I shall be glad to answer any further query.
Take care
Dr.Chugh, Orthopaedic surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mukesh Chugh (2 hours later)
Yes, she has numbness in upper limb and randomly is weak of grip.

TCD:

name depth Vs Vm Vd PI RI S/D direction

LMCA 52 107 72 55 0.72 0.49 1.95 Toward
RMCA 52 102 66 48 0.81 0.53 2.11 Toward
LACA 62 111 75 58 0.71 0.48 1.92 Backward
RACA 62 102 66 49 0.81 0.52 2.10 Backward
LPCA 67 88 59 44 0.75 0.50 2.00 Toward
RPCA 67 91 61 47 0.73 0.49 1.96 Toward
LVA 75 82 57 45 0.65 0.45 1.83 Backward
RVA 75 86 58 44 0.74 0.49 1.98 Backward
BA 90 95 64 48 0.73 0.49 1.97 Backward

TCD description:
Intracranial vasculars blood flow velocity increase generally. Blood flow directions are normal.
doctor
Answered by Dr. Mukesh Chugh (1 hour later)
Brief Answer:
Thromboembolic phenomenon may be the cause

Detailed Answer:
Hello
It’s good to see you

After going through the whole discussion and vascular Doppler study, she needs neurologist help to find out the cause of her dizziness and loss of consciousness and I suspect a thromboembolic phenomenon, in this small blood clot travelling via blood vessel leads to obstruction in the blood supply to brain at some interval.

The decision regarding surgery for cervical spondylosis is based on the severity of weakness and pain in the upper limb. This needs physical examination of patient.MRI report alone is never an indication of surgery. If at all required this surgery is safe most of the times.

Hope this helps
Take care and wishing her good health
Dr.chugh


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mukesh Chugh (7 hours later)
regarding thromboembolic possiblity, she had a brain CT and showed it's normal. Can this eliminates the blood clot possibility? If not, does she need more test like brain MRI? The MRI result I showed you before is only in neck area of the spine.

Thanks
doctor
Answered by Dr. Mukesh Chugh (1 hour later)
Brief Answer:
3D Echo of heart to find out source of emboli

Detailed Answer:
Hi
It’s good to see you
After going through the whole discussion and various investigations, our main concern should be to find and treat the cause of frequent loss of consciousness and dizziness.
My advice would be –1.To find out the factors which may alter the properties of blood making it more vulnerable to clot. These tests are for lipid profile, Bleeding, clotting time and Prothrombin time (BT, CTand PT) to assess the clot forming capacity of blood, complete blood count with Erythrocyte sedimentation rate (ESR), blood sugar level. If not done get it done and share them.You may start aspirin as it is safe.
2.Showered calcify emboli-These emboli which get detached from the parent site like from heart to the neck vasculature from time to time leading to fainting and loss of consciousness. The attributed sources for cerebral emboli are aortic valve, origin of the left vertebral artery, atherosclerotic aortic, cardiac thrombus, and calcified mitral valve. You may get Echocardiography of heart done to rule out heart as a possible origin of emboli.
These points may be discussed with the treating doctor (Neurologist/Cardiologist) and MRI of brain can be done afterwards.

Hope this helps to reduce your sister’s suffering.
Take care
Dr.chugh

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Mukesh Chugh

Orthopaedic Surgeon, Joint Replacement

Practicing since :1997

Answered : 1619 Questions

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Is surgery mandatory for thinner vertebral artery?

Brief Answer: Reduced blood supply to brain may be a cause Detailed Answer: Hi Thanks for posting I have gone through carefully your sister’s suffering, the cause of her loss of consciousness and dizziness seems to be reduced blood supply to brain because of thinner vertebral artery as you have mentioned. This may be confirmed by Doppler study (Blood vessel study) of artery supplying the brain that is carotid artery. The further decision is based on the report; please share it when you have it. The symptoms of cervical spondylosis and associated slip disc (pinched nerve) leads to radiating pain in upper limbs, numbness and tingling sensation with weakness of grip, does she has it? Please share it in follow up query. This surgery if required are very safe and done routinely. Hope this information suffices and I shall be glad to answer any further query. Take care Dr.Chugh, Orthopaedic surgeon