There are 14 cases of displacement of the cervical spine. It is the combination according to left and right rotation, front and back supination, and left and right lateral tilt.
Orthostatic position
1, spinous process: take a straight ruler, connect most of the spinous processes into a line, and a 3 mm offset from the midline is clinically significant. At this point is the direction of spine displacement is the direction of head rotation during reset. By the way, the direction of lumbar spine spine displacement is the direction on the top when the lateral position is reset. This point is very important.
2, the spinous processes of the pivotal vertebrae are mountainous in shape, and the tip should be referred to within the odontoid process, outside of which it makes sense. As for whether the first cervical vertebra or the second cervical vertebra is rotated, it depends on the position of most vertebrae.
3, Bilateral small joint gap is asymmetrical, one side has one side does not. It suggests rotation or lateral shift.
4, the annular pivot joint misalignment, you can see the annular gap asymmetry, the annular gap shows a wide side and a narrow side, then the vertebral body is rotated to the narrow side, the spinous process is rotated to the wide side, then the direction of rotation of the head should be to the wide side when reset.
5.The “eight” shadow of the cricoarticular joint is asymmetrical.
6.The same vertebral space is not rectangular, but is wide on one side and narrow on the other, suggesting lateral tilt.
Lateral position
1.Bilateral sign of vertebral body: (there are two edges on the upper and lower edges of vertebral body), suggesting rotation, if all of them have, it indicates the problem of body position.
2, small joint protrusion double protrusion sign: (joint protrusion appears two sides,) suggesting left and right rotation.
3, the posterior border of the vertebral body is interrupted somewhere, not in a continuous arc, suggesting anterior-posterior displacement. This is more consistent with the clinical symptoms of the patient and the site of pathology on the x-ray. Unlike some other x-ray signs, it may not necessarily be the site of the patient’s current pathogenesis.
4, intervertebral space narrowing: indicates disc degeneration at this site.
5, spinal canal sagittal diameter <11mm, consider spinal cord compression. <8mm can identify spinal cord type cervical spondylosis.
Note: The bilateral sign and the double protrusion sign have early diagnostic value for vertebral instability. Both signs result in vertebral body rotation due to instability. The bilateral sign appears in the lateral position because the posterior edge of the vertebral body cannot overlap, and the double protrusion sign appears because the small joints cannot overlap. A hyperflexion-hyperextension radiograph can show whether the cervical spine is stable.
Palpation
Position: The patient sits upright with the head and shoulder level vertical.
Manipulation: The thumb and middle finger are opened in the shape of a claw, and palpation is performed on both sides in pairs, and the fingers are pressed and slid as the main means.
1. Spinous process.
With or without skew (suggesting rotation); with or without the widening of the gap of the spinous process (suggesting a pitch of the vertebral body, with the possibility of herniated disc bulge, this point is also very useful in the judgment of the lumbar spine. Of course, the pressure pain should be added); whether there is a sense of step (slippage may be)
Since the spinous process has a bifurcation, after the bifurcation may appear a fork large and a fork small, can only be a reference.
2. Small articular eminence.
About three centimeters next to the spinous process
With or without convexity and concavity (suggesting rotation)
3, transverse process.
On both sides of the neck, the lateral process of the first cervical vertebra is directly under the mastoid process.
Use the thumb and middle finger to press together to determine whether there is rotation and displacement.
Cervical spondylosis
Clinically, we generally divide cervical spondylosis into three segments according to the location of the vertebrae causing the symptoms. The so-called upper cervical segment lesion, middle cervical segment lesion, and lower cervical segment lesion.
Upper cervical segment: 1 and 2 vertebrae. The symptoms are mainly dizziness and posterior occipital pain. Treatment: relaxation of the suboccipital muscles and chiropractic manipulation of 1 and 2 vertebrae. The acute phase emphasizes fixation. Middle cervical segment: 3 and 4 vertebrae. Symptoms are mainly shoulder pain and swelling, sympathetic symptoms. Good effect of tui na.
Lower cervical segment: 5, 6, 7 vertebrae. Symptoms are mainly radiating pain in the upper limbs.