home Analyzes Impaired movement of the left is what it is. Forms of pathological tortuosity. Complaints and symptoms

Impaired movement of the left is what it is. Forms of pathological tortuosity. Complaints and symptoms

People who have hypertension and other work problems of cardio-vascular system, they do not always know the exact cause of such disorders. In some cases, these problems are associated with the development of a special type of pathology - tortuosity. vertebral arteries.

With it, a person’s risk of ischemic stroke increases many times over. At severe consequences a person may experience problems cerebral circulation.

This pathology is characterized by deformation of the vertebral artery, due to which the speed of blood flow supplying the brain decreases. The disease is predominantly genetic in nature. His characteristic feature is the predominance of elastic fibers in arterial tissue.

During the normal development of arteries, their tissues predominantly contain collagen fibers. Elastic fibers are not durable. When they predominate, rapid wear and tear of the vessel walls occurs.

For this reason, they quickly become thin and instantly deform. Thinning of blood vessels against the background of progression of pathology becomes common cause development of ischemic stroke in humans.

Reference. The death of 30% of patients from stroke is associated with the development of this type of disease.

Causes of pathology

Tortuosity and asymmetry of the diameters of the vertebral arteries mainly arises as a result of the action hereditary factors. The pathology may be acquired. IN special group at risk include people suffering from arterial hypertension.

One of the likely factors in the formation of arterial tortuosity is atherosclerosis. Given this chronic disease due to a malfunction in lipid and protein metabolism, cholesterol deposits occur on vascular walls. Risk factors for the development of atherosclerosis and accompanying arterial tortuosity include:

overweight;
smoking;
unhealthy diet;
constant stress;
concomitant diseases associated with metabolic disorders ( diabetes, hypothyroidism).

Symptoms

The disease is similar in its symptoms to a number of other pathologies, including:

stroke;
vascular dystonia;
bulging of the arterial wall (aneurysm);
atherosclerosis.

Important! In the disease there are two specific symptoms, manifested in humans. He may experience sudden paralysis and weakness of his arms, as well as temporary speech impediment.

Possible various symptoms, and treatment for tortuosity of the vertebral arteries will be prescribed taking into account the nature of their manifestation. Associated symptoms pathologies can also be:

The symptoms of the disease depend on the type and form of tortuosity of the arteries:

C-shaped tortuosity of the right vertebral artery, like the left one, in the first stages of its occurrence it does not show any signs. Often, as a result of progressive deformation and kinking of the artery, a disruption of the cerebral blood supply occurs. The symptoms are identical to those of a stroke.
Loop crimp provokes sharp attacks of headaches, signs of stroke and disruption of blood circulation in the brain appear.
Deformation of the artery at an acute angle in some cases, it occurs against the background of a C-shaped tortuosity of the arteries that is already present at birth. A person develops symptoms over a long period of time characteristic symptoms hypertension and atherosclerosis. Associated signs of these phenomena are dizziness, nausea with vomiting and tinnitus.

Diagnostics

The following diagnostic methods are used to recognize the disease:

Treatment

There are several options for treating congenital tortuosity of the vertebral arteries:

conservative method by taking medications to reduce blood pressure and eliminating symptoms in case of malfunction vestibular apparatus;
surgical intervention.

Treatment in the form of surgery is used only in extreme cases at high probability development of acute ischemic stroke in the patient, during which serious damage to the first arterial segment occurs.

The indication for surgery is stenosis of blood vessels, as well as their severe bending. During the intervention, metal awnings are used, fixed in the vessel and preventing it from narrowing again. Balloon-type catheters are also used during operations. With their help, it is possible to expand certain areas of blood vessels in which there is a risk of dangerous narrowing.

Often the operation is performed on a child after birth or during childhood, when the pathology is especially manifested in the form life-threatening cerebrovascular accidents.

If tortuosity is not fatal dangerous threat for the life of the patient, he is prescribed symptomatic treatment.

Drugs are more commonly used to lower blood pressure and prevent stroke. Since the pathology is accompanied by a malfunction in the functioning of the vestibular apparatus, then additionally within the framework drug therapy Medicines may be prescribed to eliminate the manifestations of such disorders.

Attention! Drug treatment does not eliminate the pathology completely, but it can significantly improve a person’s quality of life and reduce the likelihood of developing a stroke.

Danger of pathology

There are several reasons why tortuosity of the vertebral artery is dangerous:

it leads to a disruption in cerebral circulation;
provokes constant headaches and attacks, accompanied by a sudden loss of consciousness;
leads to the development of sudden ischemic stroke, which becomes a harbinger of lifelong disability or death.

Disease Prevention

Since pathological tortuosity of the left vertebral artery, like the right, more often occurs as a result of the influence of a genetic factor, prevention of the disease includes compliance with a number of rules to alleviate existing symptoms and prevent the development of stroke. For this it is important:

Conclusion

Tortuosity of the vertebral arteries is a hereditary disease and is manifested by numerous symptoms similar to other diseases.

Surgical treatment of arterial pathology is used in emergency cases when there is a risk of the patient developing an ischemic stroke. In other cases it is carried out conservative treatment, which does not eliminate the disease, but helps improve the patient’s condition.

The development of ultrasound diagnostics of vascular diseases of the brain has changed the understanding of the prevalence and significance of pathological tortuosity (PI) of the carotid arteries as a cause of cerebrovascular accidents. As a cause of cerebrovascular accident in adults, pathological tortuosity of the internal carotid arteries (ICA) is second only to atherosclerotic lesions in prevalence.

A feature of the diagnosis of pathological tortuosity of the ICA is the possibility of detection during a standard ultrasound examination.

Currently, there is no generally accepted terminology to indicate violation of the straightness of the ICA. In the domestic literature, the most widely used term is “pathological tortuosity of the carotid arteries,” proposed by E.V. Schmidt in 1975. This designation of violations of the straightness of the ICA has a deep clinical and pathophysiological basis, since it characterizes various options deformations of the ICA from the standpoint of their clinical significance. The use of this term implies not only the designation of the disturbed geometry of the ICA, but also the significance of the incorrect course of the ICA in the formation of cerebral hemodynamic disorders with a certain clinical picture.

There is no generally accepted classification of pathological tortuosity of the ICA. The most widely used classification is pathological forms BCA proposed by J. Weibel and W. Fields. The authors distinguish three types of ICA deformation, designating them as tortuosity, coiling, and kinking. Tortuosity means S- or C-shaped deformity ICA (Fig. 1, 2) without sharp angles and visible blood flow disturbances. The authors consider this type of ICA deformity to be congenital and hemodynamically insignificant.

Rice. 1. C-shaped tortuosity of the inner carotid artery(BSA) in color duplex scanning (CDS) mode.

Rice. 2. C-shaped tortuosity of the ICA in B-mode (a) and CD (b).

Looping (“coiling”) is characterized by a congenital circular deformity with the formation of a loop (Fig. 3), which can lead to impaired cerebral circulation.

Rice. 3. Loop-shaped tortuosity of the left (a) and right (b) ICA in the CD mode.

Kinking is understood as acquired, hemodynamically significant angulation of the ICA with stenosis of its lumen (Fig. 4).

Rice. 4. Loop-shaped tortuosity of the ICA with kinking in the CDS mode (a) and schematically (b).

Color duplex scanning (CDS) allows not only to assess the shape of the tortuous carotid artery, but also to characterize the hemodynamic state in detail. In accordance with this, all types of violation of the straightness of the ICA can be divided into “hemodynamically significant” and “hemodynamically insignificant”.

Implementation in clinical practice modern ultrasonic methods diagnostics indicates high prevalence pathological tortuosity of the ICA. According to F. Koskas et al. , the tortuous course of the carotid arteries occurs in 10-43% of cases in patients with cerebrovascular accidents. It is important that the frequency of detection of pathological tortuosity of the ICA in adults ranked second after atherosclerosis of the carotid arteries. A study conducted by V.P. Kulikov et al. showed that among the patients in whom pathological tortuosity of the carotid arteries was identified based on the results of CDS, there were slightly more women (56.1%) than men (43.9%), pathological tortuosity of the right ICA was more often diagnosed (42.3%) Compared to the left (25.1%), 32.6% had bilateral tortuosity. Thus, it was shown that pathological tortuosity of the ICA is a common pathology not only in patients, but also in the population.

The etiology of pathological tortuosity of the ICA has not been definitively established. Today, there are two points of view on the causes of pathological tortuosity of the ICA - both congenital and acquired pathology.

Congenital genesis is supported by the discovery of deformed carotid arteries in patients young in the absence of atherosclerotic process in the vessels, frequent bilateral damage to the carotid arteries.

In favor of acquired character pathological deformation ICA may be evidenced by the high frequency of detection of this pathology with age and the dependence of the severity of the carotid artery bend on age and level blood pressure.

Pathological tortuosity of the ICA in clinical manifestations resembles the symptoms of atherosclerotic stenosis of the ICA and is manifested by signs of cerebrovascular accident. Most often, deformation of the carotid arteries is combined with arterial hypertension and atherosclerosis. Generally clinical manifestations pathological tortuosity of the ICA is not very specific. Local signs of pathological tortuosity have some specificity, including pathological pulsation in the neck, signs of compression of the hypoglossal, accessory and vagus nerves.

However, most symptoms and syndromes are nonspecific. The most common pathological tortuosity of the ICA is motor impairment, blurred vision, headaches, speech impairment, dizziness, loss of consciousness, noise and ringing in the ears, pain in the neck, and epileptiform seizures.

Lack of specific clinical signs pathological tortuosity of the ICA significantly complicates the identification of this pathology based on the results of a clinical examination.

Detection of pathological tortuosity of the ICA in connection with its low-specific clinical manifestations is possible only with the help of specialized instrumental methods diagnostics Given the limitations of radiocontrast angiography and magnetic resonance angiography, the main method for detecting ICA deformity is CD. This method combines the ability to visualize vessels and blood flow in them with the study of the nature and quantitative parameters of blood flow.

Ultrasound criteria for hemodynamic disturbances in pathological tortuosity of the ICA are recorded by Doppler methods locally - in the zone of vessel tortuosity. These violations can be recorded using different options and in .

Typical picture of pathological tortuosity of the ICA various shapes in the CDS mode is shown in Fig. 3-6. The CDS method makes it possible to characterize in detail the shape of tortuosity, its localization and identify disorganization of blood flow. The criteria for the local hemodynamic significance of pathological tortuosity of the ICA are: gradient of peak systolic blood flow velocity between the proximal and distal sections of the vessel in relation to the site of tortuosity with a decrease in velocity in the distal direction by 20% or more; an increase in peak velocity at the site of angulation compared to the proximal portion of the ICA by 30% or more; disorganization of blood flow in the tortuosity zone, manifested by an increase in spectral expansion and disruption of the blood flow pattern in the mode; the presence of asymmetry in the peak blood flow velocity in the distal section of the tortuous artery compared with the same section of the unchanged contralateral ICA. Thus, from the data presented above it follows that one of the links in the pathogenesis of cerebral circulatory disorders in pathological tortuosity of the ICA is a local disturbance of hemodynamics in the tortuosity zone with a decrease in blood flow in the distal direction.

Rice. 5. Loop-shaped with kinking tortuosity from the mouth and highly located S-shaped crimp BCA in CDS mode.

Rice. 6. S-shaped pathological tortuosity of the ICA in the CD mode (a, b).

A retrospective analysis of the medical records of 36 patients at the clinic with pathological tortuosity of the ICA subsequently diagnosed according to the CDS data showed that neurologists in outpatient setting the clinical diagnosis of chronic cerebrovascular accident was established in 18.9% of cases, acute cerebrovascular accident - in 6.7%, cerebral angiodystonia - in 16.4%, cervical osteochondrosis- in 10.1%, consequences of traumatic brain injury, intracranial hypertension, cephalalgia, hypertension - in 18.2% of cases. Patients referred for examination without clinical diagnosis, in whom pathological tortuosity of the carotid arteries was discovered during CDS, amounted to 29.7%.

Moreover, to assess the informativeness of CD in diagnosing pathological tortuosity of the ICA, we analyzed the medical records of 9 patients who underwent angiography and surgical treatment. Concordance of the results regarding the presence of pathological tortuosity of the ICA was noted in 100% of cases. However, discrepancies were also found in the assessment of the shape and location of tortuosity. Obviously, the reason for the discrepancies is the lack of a generally accepted classification of pathological tortuosity of the ICA and clear assessment criteria for both the form and localization of tortuosity.

Currently, pathological tortuosity of the ICA can be the cause of transient and persistent cerebrovascular accidents. With modern ultrasound equipment, diagnosing pathological tortuosity of the ICA is not technically difficult and the main method is primarily CD.

Literature

Vascular diseases nervous system/ Ed. E.V. Schmidt. M.: Medicine, 1975. 663 p.
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. I Etiology and radiographic anatomy // Neurology. Minneap, 1965. V. 15. P. 7-18.
Koskas F., Kieffer A., Kieffer E. et al. Loops and folds of the carotid and vertebral arteries: indication for surgery // J. Malad. Vascul. 19 Supl. A. 1994. P. 51-54
Kulikov V.P., Khoreyev N.G., Gerasimenko I.N. and others. Color duplex scanning of vessels in the diagnosis of pathological tortuosity of the carotid arteries // Echography. 2000. N 2. S. 147-154.

Non-straightness of the vertebral arteries is a disease that occurs as a result of pathologies of the cervical spine such as curvature, osteochondrosis, scoliosis, and so on. Physiologically, the vertebral arteries pass in the protected area of the cervical spine. As a result of its destruction, they shift or narrow, reducing blood permeability and further pathologies of the brain.

The vertebral arteries are the main suppliers of blood to the brain. Statistics show that more than 50 percent of strokes occur due to pathologies associated with the vertebral arteries. For this reason, they must be treated with full responsibility and if symptoms of illness occur, seek medical help immediately.

Timely identification of the problem can significantly speed up the diagnostic and treatment processes. For this reason, it is worth remembering a number of symptoms, if they occur, you should contact a neurologist and orthopedist.

Frequent headaches in the back of the head;
Neck pain;
The appearance of a pre-fainting state with sudden movements;
Increased intracranial pressure;
Constant or intermittent weakness in the arms, legs, or fingers;
Spontaneous attacks of nausea;
Loss of coordination and problems with the vestibular system;
Systematic visual impairment.

These symptoms do not directly indicate that the problem lies specifically in the vertebral arteries, they just indicate. However, it is often associated with the vertebral arteries.

The non-linearity of the course means that instead of the direct and shortest path to the brain, the artery is located along a tortuous path. To correct the pathology, it is necessary to act not on the arteries, but on the primary problem - the cervical spine. Let's look at the causes of the disease in more detail.

Causes

Modern medicine shares the causes of non-straightness of the arteries in cervical spine spine into 2 categories – vertebrogenic and non-vertebrogenic.

Vertebrogenic causes are associated with pathologies of the development of the spine or changes in its structure, both in children and adults. In children this pathology may occur for the following reasons:

Cervical spine injuries. They can occur at any age, including birth process, which is quite dangerous for a child;
Pathological muscle spasms. Often droops as a result of hypothermia. Changes in the tone and location of the muscle affect the position of the artery, as a result of which the capacity of the latter decreases.

Vertebrogenic causes of pathology in adults arise for other reasons, among which the main ones are the following diseases:

Swellings of the cervical spine or occipital part of the brain;
Osteochondrosis;
Ankylosing spondylitis;
Trauma, as in children, can also affect the condition and location of the artery.

Interesting read:

Among non-vertebral causes, it is worth noting the following groups of diseases:

Inflammation, atherosclerosis, embolism and other diseases, causing loss artery of elasticity and tone;
Diseases affecting the shape of arteries, kinks, etc.;
Pathologies associated with changes in the shape of arteries as a result of compression. Among the reasons are abnormal position of the ribs, scarring of tissue as a result surgical intervention and so on.

The danger of the non-straight course of both arteries is that it increases the likelihood of ischemic attacks in various parts of the brain. If you ignore the symptoms of the disease, there is a risk of cerebral stroke. Rehabilitation after a stroke is not always possible, and complete correction of its consequences is impossible.

Diagnostics

At the first onset of symptoms, you should contact your doctor for initial examination. After this, he gives a referral to a neurologist, who is engaged in further diagnosis and treatment of the disease. Most effective diagnostic methods when this problem occurs are:

Ultrasound Dopplerography. Using this method, both vertebral arteries are examined for the speed of the blood flow wave in order to determine the effectiveness of cerebral circulation and its reserve;
MRI of the vessels of the cervical spine and brain. MRI allows you to determine the presence of aneurysms and inflammation in the arteries, including places where blood flow is disrupted;
An X-ray of the cervical spine is also necessary, since with this method it is possible to see the condition bone tissue, the position of the vertebrae and processes, on the basis of which conclusions are drawn about the possible;
Usage contrast agent, which is entered into subclavian artery injection method. This method called vascular angiography. It allows you to determine the presence of kinks or changes in the position of the arteries.

Pathological tortuosity (kinking) of the carotid arteries is one of the least studied and mysterious diseases. The role of pathological tortuosity in the development of symptoms of cerebrovascular insufficiency is still being studied, but it has been established that every third person who died from a stroke had pathological bends of the carotid or vertebral arteries. In 16-26% of the adult population, various variants of elongation and tortuosity of the carotid or vertebral arteries in the neck are detected. Pathological tortuosity is an uneven course of the artery with the formation of bends, loops and twists, which affects the nature of blood flow through the artery and can contribute to the development acute disorders cerebral circulation.

Advantages of treatment at the Innovative Vascular Center

Vascular surgeries at our clinic have significant experience unique operations on the carotid arteries with pathological tortuosity. The main problem for surgical treatment is to determine clear indications for surgical treatment. Our clinic has developed a clear diagnostic protocol that allows us to determine clinical significance one or another tortuosity and the degree of its influence on cerebral blood flow. The experience of successful operations in our clinic for pathological tortuosity exceeds 200 cases.

Causes and prevalence of pathological tortuosity

Pathological tortuosity always develops due to the elongation of the internal carotid artery, which is forced to fold into bends or even loops. Excessive length of the internal carotid artery is often formed during embryonic development, that is, the tortuosity of the artery is most often congenital. With age, further twisting of the redundant carotid artery into a loop may occur. According to some researchers, pathological tortuosity may be the cause of neurological and intellectual problems in children of preschool and primary school age.

Lengthening of the internal carotid artery can also develop as a result of neglected hypertension, when persistently high blood pressure causes changes in the artery wall and its bends. Such tortuosity rarely affects cerebral hemodynamics and is more often a phenomenon detected incidentally by ultrasound of the great arteries.

Pathological tortuosity of the carotid arteries was detected in 16% of patients who died from ischemic stroke, more than 23% of children who suffered ischemic stroke had pathological tortuosity. When examining patients undergoing treatment for cerebrovascular accidents, pathological tortuosity was detected by ultrasound angioscanning in 12%. Various disorders of the internal carotid arteries, according to pathological studies, were identified in 40% of people.

Clinical forms

Lengthening the artery. The most common is elongation of the internal carotid or vertebral artery, which leads to the formation of smooth bends along the course of the vessel. An elongated artery is rarely a cause of concern and is usually discovered during random examination. Important Lengthening the artery is of concern to ENT doctors, since the wall of the artery may be abnormally close to the palatine tonsils and may be accidentally damaged during tonsillectomy. With age, the elasticity of the arterial wall changes and smooth bends of the artery can become kinks, with the development of a picture of cerebral circulation disorders. When lengthening the arteries without kinks during ultrasound examination blood flow disturbances are not determined.

- bending of the artery at an acute angle. Kinking can be innate when early childhood cerebrovascular accidents are determined and develop over time from the elongated carotid artery. The formation of kinks is promoted arterial hypertension, progression of atherosclerosis in the internal carotid artery. Clinically, kinking of the internal carotid artery manifests itself transient disturbances cerebral circulation. With kinking of the vertebral artery, vertebrobasilar insufficiency develops. Detection of kinking with brain symptoms the question arises about surgical correction tortuosity.

- formation of an artery loop. Despite the smooth movement of the loop, changes in blood flow in it are very significant. The nature of the bends during coiling may change depending on body position and blood pressure. A chaotic nature of the blood flow is observed, which leads to a decrease in blood pressure after the loop and, accordingly, to a decrease in blood flow through the cerebral arteries. If a person has a well-developed circle of Willis on the lower surface of the brain, then he will never know about the existence of a loop or inflection. The appearance of symptoms of cerebral circulatory failure indicates disturbances in blood flow compensation and dictates the need for detailed examination and treatment.

Complaints and symptoms

Manifestations of pathological tortuosity are varied, the most common are:

A picture of transient ischemic attacks in the blood supply of a tortuous artery with temporary paralysis of half the body or arm (hemiparesis), speech impairment, etc.);
Temporary blindness in one eye;
Noise in the head;
Dizziness;
Flashing before the eyes;
Headaches without clear localization;
Short-term loss of consciousness;
Falls without loss of consciousness;
Temporary imbalances;
Migraine-like attacks.

Course and complications

If tortuosity of the carotid artery becomes symptomatic, then it is quite painful for the patient. Minor signs and symptoms of the disease gradually intensify and lead to decreased ability to work. The presence of pathological tortuosity can lead to symptomatic hypertension, which in turn contributes to the progression of tortuosity and the formation of kinks. In places where the carotid artery is bent, adhesions can form, which further disrupts the nature of blood flow, making it turbulent. As a result, these processes can lead to transient ischemic attacks or stroke.

Pathological tortuosity of the vertebral arteries causes problems in the body. An analysis of such a painful condition and recommendations for its relief in response to this letter...

Hello!
I fell from the tree on the back of my head and there was a brief loss of consciousness. I didn’t go to the hospital, after 5 years the attacks began, at first the objects I was looking at partially disappeared, then severe headache. Subsequently, he prevented the onset of an attack by taking lingonberries. After some time, my mother brought a grayish-brown powder, which I sniffed and then sneezed for a minute. I don’t remember how long I did this, but there were no more attacks.

Already as a student, after I inflated several balloons, the attack occurred again, I was lucky - I found lingonberries. Until I was 57 years old, there were no attacks, but for 3 days in a row everything is fine in the morning, at 10-11 o’clock the attack begins, I take lingonberries, there are no severe headaches, my head is heavy all day.

Dear Vladimir Stepanovich! Due to the fact that the town is small, therefore there may not be any competent specialists, I ask you, tell me: what is the algorithm for my actions to cure this phenomenon?

- Evgeniy Nikolaevich Zverkov

Hello, Evgeniy Nikolaevich!

The fact that you lost consciousness indicates that you then suffered a concussion. Most likely, at that time you had both nausea and retrograde amnesia (you may no longer remember this now). And then your body gradually coped (not fully, of course) with this situation... And there was a lull until pathological tortuosity of the vertebral arteries arose... However, let me tell you everything, Evgeniy Nikolaevich, in order... So...

Pathological tortuosity of the vertebral arteries: analysis of the condition

What is happening to you now, Evgeniy Nikolaevich, can happen according to various reasons, as extracerebral (narrowing or complete closure-occlusion of the brachiocephalic or vertebral arteries - the so-called vertebral artery syndrome, or chronic disorder cerebral circulation in the vertebrobasilar region), and intracerebral (discoordination in the activity of the circle of Willis, sclerosis of intracerebral arteries, etc.). You can write a lot about this for a long time.

Perhaps the most common cause of noise in the head, a feeling of heaviness in it, dizziness, an anxious and suspicious state (the state of the so-called “floating anxiety”) is “vertebral artery syndrome”... What is it? But here's what... As the intervertebral discs in the cervical spine are destroyed, their height decreases, which leads to pathological tortuosity of the vertebral arteries, which pass in the transverse processes of the cervical vertebrae (with the exception of the 7th). This leads to a deterioration in the blood supply to the brain, especially its stem structures and the cerebellum... In response to this, the brain responds with heaviness in the head, noise in it, dizziness and headache... And with all this, compression (compression) of the sympathetic cervical nerve plexus, which leads to pain in the neck muscles, to the so-called myogelosis of the neck muscles, that is, to their excessive tension, as well as to a feeling of numbness in the hands...

A treatment plan should be drawn up with alternating medications between each other (no more than 2-3 at a time).

Should carry out 4-5 courses of treatment with gelatin 1 month with breaks of 3 weeks.
Portion edible gelatin(4 - 5 grams) pour lukewarm boiled water(80-100 ml, i.e., about half a glass) and cover. In the morning, add the same boiled water to a full glass and stir to drink. You should start taking edible gelatin with daily dose at 2-3 grams, gradually increasing to 4-5 grams.

And it’s also very important...

Necessarily use an orthopedic soft cervical brace(Shants collar) and orthopedic silicone insoles in any shoes (including house shoes - don’t forget to change them!). And also beautiful gel "Doctor Khoroshev" with amaranth oil for the spine and joints.
High Quality orthopedic insoles, an excellent cervical brace and Doctor Khoroshev gel can be ordered by phone: 495-744-33-66.

And one more thing... If you are a believer, I would advise you to painful condition this is the prayer. After all, prayer in illness (any prayer is not a simple set of words) is an amazing, centuries-old rhythm of words, which has a very beneficial effect on the activity of brain structures and subcortical structures; This prayer has helped so many people if it is repeated several times a day:

Prayer in illness:
Lord God, Master of my life, in Your goodness You said: I do not want the sinner to die, but for him to turn and live. I know that this disease from which I suffer is Your punishment for my sins and iniquities; I know that for my deeds I have deserved the heaviest punishment, but, O Lover of Mankind, deal with me not according to my malice, but according to Your boundless mercy. Do not wish my death, but give me strength so that I patiently endure the disease, as a well-deserved test for me, and after healing from it I turn with all my heart, with all my soul and with all my feelings to You, the Lord God, my Creator, and live to fulfill Your holy commandments, for the peace of my family and for my well-being. Amen.

Now you know what will help alleviate your condition. I wish you health, Evgeniy Nikolaevich, and many years of life!