Cervical spondylosis is a clinical manifestation caused by the deformation and narrowing of the cervical spinal canal or intervertebral foramen due to degenerative changes of the cervical spine, which irritates and compresses the cervical spinal cord, nerve roots, and sympathetic nerves causing their structural or functional damage. This disease is most often seen in patients over 40 years of age. Cervical spondylosis mostly occurs in middle-aged and elderly people, according to statistics, 70% of the patients in cervical 5 to hair 6 disease followed by cervical 6 cervical 4, 5 and cervical 7 thoracic 1.
Overview
Cervical spondylosis is a series of symptoms caused by degenerative degeneration of the cervical disc, cervical spine osteophytes and cervical injuries that cause imbalance in the internal and external balance of the cervical spine, stimulating or compressing the nerves and blood vessels in the neck. The main symptoms are neck and shoulder pain, dizziness and headache, numbness of the upper limbs, muscle atrophy, spasm of both lower limbs in severe cases, difficulty in walking, and even paralysis of the limbs, urinary and fecal disorders, and hemiplegia. This disease is also called cervical spine syndrome or neck and shoulder syndrome. It occurs mostly in middle-aged and elderly people, with a higher incidence in men than in women.
Cervical spondylosis, also known as cervical spine syndrome, is a general term for cervical spine osteoarthritis, proliferative cervicitis, cervical nerve root syndrome, and cervical disc prolapse, which is a disorder based on degenerative pathological changes. It is a clinical syndrome with a series of dysfunctions mainly due to long-term cervical spine strain, osteophytes, or disc prolapse and ligament thickening, resulting in compression of the cervical spinal cord, nerve roots or vertebral artery. It manifests as a series of pathological changes of cervical disc degeneration itself and its secondary effects, such as destabilization and loosening of vertebral joints, protrusion or prolapse of the nucleus pulposus, formation of bone spurs, ligamentous hypertrophy and secondary spinal stenosis, etc., which stimulate or compress the adjacent nerve roots, spinal cord, vertebral artery and cervical sympathetic nerve and other tissues, and cause various symptoms and signs of the syndrome.
Pathogenesis of cervical spondylosis
1, cervical degenerative changes: with the development of different stages of age, the cervical spine and intervertebral disc can undergo different changes, and while degenerative changes occur in the cervical vertebral body, the intervertebral disc also undergoes corresponding changes.
2, trauma factors: on the basis of intervertebral disc degeneration, strenuous activity or uncoordinated movement.
3, chronic strain: long-term poor labor posture, the intervertebral disc is subject to strain, extrusion or twisting from a variety of sources.
4, cold, moisture: especially on the basis of intervertebral disc degeneration, affected by cold, moisture factors, can cause local muscle tension increase, muscle spasm, increase the pressure on the intervertebral disc, causing damage to the fibrous ring
Cervical spondylosis – Classification
(1) Cervical type: i.e. localized type, caused by degenerative changes of the cervical disc causing local or reflex cervical spine pain in the occipital neck and shoulder and limited neck movement.
(2) Nerve root type: the stimulation of cervical degenerative disc changes, compression of spinal nerve roots, causing sensory and motor dysfunction, and is divided into two types of acute and chronic.
(3) Spinal cord type: cervical disc degenerative changes cause spinal cord compression and ischemia, causing spinal cord conduction dysfunction, which is divided into central type and peripheral type. The onset of the central type begins with the upper extremity and progresses to the lower extremity; the onset of the peripheral type begins with the lower extremity and progresses to the upper extremity. These two types can be further divided into mild, moderate and severe.
(4) Vertebral artery type: due to the stimulation of degenerative changes of the hook vertebral joint, compression of the vertebral artery, resulting in inadequate blood supply to the basilar artery.
(5) Sympathetic nerve type: stimulation of degenerative changes of the cervical intervertebral disc, compression of sympathetic nerve fibers in the neck, causing a series of reflex symptoms.
(6) Other types: refers to the esophageal compression type, etc.
Cervical spondylosis – clinical symptoms
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients start with mild symptoms and gradually worsen them later, while some have more severe symptoms.
This is related to the type of cervical spondylosis suffered, but there are often few simple types, mainly one type and one or several types mixed together, called mixed cervical spondylosis, so that the symptoms are very rich, diverse and complex.
The main symptoms are head, neck, shoulder, back and arm pain, neck stiffness and limited movement. The neck and shoulder pain can be radiated to the head and occipital region and upper limbs, some are accompanied by dizziness, house rotation, heavy cases with nausea and vomiting, bedridden, and a few can have vertigo and sudden collapse.
Some have fever on one side of the face and sometimes abnormal sweating. There is a feeling of heaviness in the back of the shoulder, weakness in the upper limbs, numbness in the fingers, loss of sensation in the skin of the limbs, weakness in holding objects in the hands, and sometimes unconscious gripping of objects to the ground.
Other patients have weakness in the lower limbs, unstable walking, numbness in the second foot, and a feeling like stepping on cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, swelling of the second eye, dryness, inability to open the second eye, tinnitus, ear blockage, loss of balance, tachycardia, panic, tight c feeling in the chest, some even have symptoms such as gastrointestinal distention.
A few people experience loss of control of bowel movements and urination, sexual dysfunction, and even tetraplegia. There are also symptoms such as dysphagia and dysphonia. These symptoms are related to the degree of onset, the duration of onset, and the individual’s physical condition.
Most of the symptoms are mild at the onset and are not taken seriously, most of them can recover on their own, sometimes light and sometimes heavy. If the disease is left untreated for a long time, it can cause psychological damage and produce symptoms such as insomnia, irritability, anger, anxiety and depression. Clinical symptoms of cervical spondylosis appear, but they should also be distinguished from symptoms not caused by cervical spondylosis. If the same symptoms of vertigo are present, otogenic vertigo, Meniere’s disease, vestibular dysfunction, and auditory neuroma should be excluded first. There are also vertigo of cerebral origin and vertigo of ocular origin. Also the same neck and shoulder upper extremity pain should be associated with such as drop pillow, frozen shoulder, thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome. Rheumatic muscle and arthritis, spondylitis tumor, etc. should be differentiated.
Cervical spondylosis – clinical examination
General examination
(1) pressure point paravertebral or spinous process pressure pain, the location of pressure pain is generally consistent with the affected segment.
(2) The range of motion of the cervical spine, i.e., the examination of forward flexion, back extension, lateral flexion and rotation activities. The limitation of cervical movement is more obvious in neurogenic cervical spondylosis, while vertigo may occur in a certain direction of movement in vertebral artery type cervical spondylosis.
(3) Intervertebral compression test. The patient’s head is tilted to the affected side, the examiner’s left palm is placed flat on the top of the patient’s head, the right hand holds the palm and taps the dorsal side of the left arm, and the test is positive if there is radicular pain or numbness. In the case of heavy nerve root symptoms, the pain and numbness can appear or increase with light pressure on the head with both hands.
(4) Intervertebral tie separation test is positive for suspected radicular symptoms if the patient is seated and the head is held with both hands and traction is applied upward, and if the pain and numbness in the upper extremity is reduced.
(5) Nerve root traction test. Also known as brachial plexus pull test, the patient sits, the head is turned to the healthy side, the examiner holds one hand against the back of the ear, the other hand holds the wrist and pulls in the opposite direction, if there is numbness or radiating pain in the limb is positive.
(6) Hoffman’s sign examination right hand lightly hold the patient’s forearm, one hand index finger to hold its middle finger, with the thumb tapping the middle finger nail, if there is a positive that is four finger flexion reflex, it means the pre part of the spinal cord, nerve injury.
(7) Rotation neck test, also known as vertebral artery twist test, the patient sits, do active rotation of the neck activities, repeated several times. If vomiting or sudden fall occurs, the test is positive, suggesting vertebral artery type cervical spondylosis.
(8) Sensory impairment examination of cervical spine patients can help to understand the degree of lesion by doing skin sensory examination. The sensory disorder in different parts can determine the segment of the diseased cervical spine; pain usually appears in the early stage, numbness appears when it has already entered the middle stage, and the complete disappearance of sensation is already in the late stage of the lesion.
(9) examination of muscle strength in cervical spondylosis with injury to nerve roots or spinal cord, muscle strength is reduced, and if innervation is lost, muscle strength can be zero. The site and segment of nerve injury can be judged according to the different nerves innervated by each muscle.
Special examination
The diagnosis of cervical spondylosis mainly relies on clinical manifestations and imaging examination, but when conditions permit, some auxiliary methods can be used to help determine the nature and location of lesions and differential diagnosis.
For example, Quiggan’s test, myelography, vertebral arteriogram, selective spinal arteriogram, cervical venogram and so on. The Quiggan’s test determines the presence or absence of obstruction by measuring the pressure of cerebrospinal fluid through lumbar 4-5 puncture to the subvertebral space in the spinal canal.
The degree of obstruction can also be inferred from the biochemical examination of the cerebrospinal fluid based on the elevated amount of protein, which can help in the diagnosis and differential diagnosis of cervical spondylosis by understanding the compression of the spinal cord. Myelography, which is performed by injecting iodine preparation or air into the spinal canal. It helps in the diagnosis and differential diagnosis of various disorders in the spinal canal and spinal canal, such as spinal cord disease itself, tumor, spinal cord compression due to cervical spondylosis and spinal canal measurement; it can also clarify the site and extent of spinal cord compression.
However, since vertebral puncture itself can cause a series of side effects and various reactions can occur with the use of contrast agents, it has a certain degree of risk and should be strictly controlled clinically. Vertebral arteriography is performed through the vertebral artery and subclavian artery, or the brachial artery or femoral artery can be cut for cannulation. It is mainly used for the diagnosis and differential diagnosis of vertebral artery-type cervical spondylosis. It is also a routine examination before decompression surgery to determine the site and extent of the procedure. Selective spinal arteriogram is performed by injecting an appropriate amount of contrast agent into the artery supplying blood directly to the cervical medulla according to the condition of the disease, and according to its imaging results, the site of the tumor can be determined and the diagnosis of spinal cord vascular malformation, spinal cord ischemia, and posterior edge of the vertebral body compressor can be made.
Cervical venography is the direct injection of contrast into the vertebral body from the inner edge of the sternocleidomastoid muscle, which shows the changes in the morphology and flow rate of the extra-vertebral and intra-vertebral veins through venous reflux, so as to infer the lesions inside and outside the spinal canal, which is especially suitable for cervical spondylosis combined with spinal cord symptoms.