Physiatry -- The Practice of Physical Therapy by a Physician
By R. Vincent Davis,DC,PT,DNBPME


Management of Vertebral Artery Syndrome: A Conservative Approach
Vertebral artery syndrome is considered synonymous with vertebral artery compression syndrome and vertebral-basilar artery insufficiency, and presents with recurrent transient episodes of cerebral symptoms, principal among which are dizziness, nystagmus, with sudden postural collapse without unconsciousness. These symptoms may be precipitated by rotation and hyperextension of the cervical spine which may result in temporary occlusion of the vertebral artery following which there is relative ischemia at the base of the brain. This syndrome commonly presents with a combination of cerebrovascular arteriosclerosis and cervical spondylosis as fundamental clinicopathological components.

To be brief, relative to this arterial anatomy, the vertebral artery ultimately supplies components of the brain via the basilar artery, and also provides for twigs to the cervical nerve roots which anastamose with the anterior and posterior spinal arteries. Since the internal carotids and vertebral arteries are the main tributaries to the basilar artery, occlusive arterial disease would gradually reduce arterial flow to a critical point at which further reduction in vascular caliber, prior to the development of an adequate collateral supply, would result in cerebral ischemia with respective clinical symptoms.

Normally, hyperextension with rotation of the cervical spine results in compression and occlusion of the vertebral artery on the contralateral side at the level of the atlas and axis. Occlusion may occur when vessels are subject to atheromatous disease and compression by osteophytes. If collateral blood flow is insufficient, symptoms develop with transient vertebral artery occlusion following rotation and/or hyperextension of the cervical spine. Symptoms are transient and subside as the arterial compression is released and blood flow is re-established. With degenerative disease of the cervical spine, arterial compression is increased due to encroachment by osteophytic projections at the level of the intervertebral foramina on the contralateral side during rotation/hyperextension movements. C5/6 is the site most often subject to osteophytic compression. With advanced degenerative disease, only a limited degree of motion may be necessary to produce complete vertebral artery compression. If the degenerative pathology develops slowly enough, the effects of vertebral artery stenosis may be offset by the formation of sufficient collateral circulation distal to the obstructive site to maintain adequate basilar arterial flow.

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