Cervical spondylosis that is easily misdiagnosed and mistreated
The heart symptoms and ECG changes caused by cervical spondylosis are called cervical heart syndrome. Since cervical spondylosis and coronary artery disease are both common diseases in middle-aged and elderly people, they are easily misdiagnosed as coronary angina. The reason for this is that cervical spondylosis can cause compression of the medial branch of the anterior thoracic nerve and the lateral branch of the anterior thoracic nerve from C7 to Tl, which can cause pseudo-angina; or when the spasm of the anterior oblique muscle caused by the compression of the brachial plexus nerve or the spasm of the oblique muscle compresses the posterior branch of the spinal nerve, it can cause spasmodic pain of the left intercostal muscle and produce pseudo-angina. Compression of nerve roots by cervical spondylosis can directly cause spasm of the left thoracic major muscle, resulting in pseudo-angina. Compression of cervical spine joint osteophytes stimulates cervical sympathetic nerves, and the stimulating impulses spread downward through the subcardiac and cardiac sympathetic branches, producing visceral sensory reflexes and causing angina pectoris.
Clinical features: ① Needle-like pain or distension in the precordial region, lasting more than 15 minutes, sometimes up to several hours. (2) Nitrate preparations cannot terminate cervicogenic pseudo-angina, and there is no significant change in the electrocardiogram in cardiac stress test, and antiarrhythmic drugs also have difficulty in controlling cervicogenic arrhythmias. ③Cervical spine radiographs all showed obvious pathological changes. ④After treatment of cervical spondylosis, the abnormal cardiac performance can be improved with the improvement of cervical spondylosis. If you encounter a patient with arrhythmia of unclear etiology, accompanied by dizziness, sweating, neck and shoulder pain, soreness and numbness, or easily triggered by head and neck rotation, and the effect of regular antiarrhythmia is not satisfactory, you should think of the possibility of cervical spondylosis and promptly get X-ray or CT examination to clarify the diagnosis.
Cervical hypertension
Cervical spondylosis can cause an increase or decrease in blood pressure, and the increase in blood pressure is more common and is called cervical hypertension. It may be related to the dysfunction of the vertebrobasilar artery supply due to cervical spondylosis and the dysfunction of the sympathetic nerve due to stimulation.
Clinical features: ①There are typical symptoms and signs of cervical spondylosis, and the increase in blood pressure exceeds normal standards. (2) It is often accompanied by inadequate blood supply to the vertebrobasilar artery or cervical heart syndrome. ③The duration of cervical spondylosis is usually more than 1 year. ④Antihypertensive drugs are usually ineffective, and after treatment of cervical spondylosis, blood pressure often decreases to normal.
Cervical syncope
Sudden syncope can occur in cervical spondylosis, which is called cervical syncope and is easily misdiagnosed as cerebral arteriosclerosis or cerebellar disorders. The cause of syncope is due to hyperplastic changes in the cervical spine that compress the vertebral artery and cause insufficient blood supply to the basilar artery.
Clinical features: ①There is often a history of typical cervical spine disease. (2) Most of the time, the body loses support when the head is suddenly twisted during walking and suddenly falls to the ground. ③It is often accompanied by repeated episodes of vertigo, the occurrence of which is related to the change of neck position. ④There may be headache, nausea, vomiting, sweating and other symptoms of plant nerve dysfunction. Cervical spine photograph can show signs of hypertrophic cervical spondylosis, and vertebral arteriogram and TCD examination can show vertebrobasilar artery stenosis.
Cervical dysphagia
Dysphagia caused by cervical spondylosis is also called cervical dysphagia. The mechanism: (1) The posterior wall of the esophagus is directly compressed by the bones of the anterior edge of the cervical spine and causes stenosis spasm. ②Cervical spondylosis causes spasm or excessive relaxation of the esophagus due to plant nerve dysfunction. (③The bone spur formation is too long causing irritation response of the soft tissue around the esophagus. ④The bone spur is located at the level of the opening of the esophagus, and it is easy to obstruct the movement of the esophagus, even if the bone spur is also easy to produce symptoms.
Clinical features: ①The main manifestations are dysphagia and foreign body sensation in the esophagus. ②The dysphagia is sometimes mild, sometimes severe, non-progressive, and often accompanied by other manifestations such as neck and shoulder pain and numbness of the upper limbs of varying degrees.
③A few patients have symptoms such as swallowing pain, nausea, vomiting, hoarseness, dry cough and chest tightness. ④The lateral cervical spine film can see obvious changes such as bony flab protruding forward, barium meal examination of esophagus can observe the stenosis site, and CT can clearly show the hyperplasia of the anterior edge of cervical spine and the degree of esophageal compression. ⑤Hormone and anti-inflammatory drugs (such as anti-inflammatory pain) can be relieved after treatment, but it is easy to recur.
Cervicogenic headache
Cervicogenic headache is a syndrome caused by organic or functional lesions of the cervical-occipital region or (and) shoulder tissue, mainly ipsilateral headache. Pathological mechanism: ①The posterior branches of C1, C2 and C3 nerves and their branches from the cervico-occipital region are distributed in the corresponding ipsilateral head. (2) The C1, C2 and C3 nerves and their branches in the cervical region are associated with or converge with certain ganglia or nuclei that innervate the head and face. The headache starts from the abnormalities of single or multiple tissue structures in the cervical-occipital region or (and) the shoulder, resulting in organic or functional changes of local nerves.
Clinical features: Patients with cervicogenic headache often have symptoms in the cervical-occipital region or (and) shoulder, and the headache can be relieved or disappears after treatment of cervical spondylosis. Most of the headaches are simply treated during the consultation and treatment, but the cervico-occipital or (and) shoulder symptoms are ignored, resulting in a lingering headache.
Cervical visual impairment
Cervical spondylosis can cause loss of vision, eye swelling and pain, photophobia, tearing, unequal pupil size, and even reduced visual field and sharp loss of vision, and in a few patients, it can also cause blindness, which is called cervical visual impairment. The cause may be related to the plant nerve dysfunction caused by cervical spondylosis and ischemic lesions of the visual center of the occipital lobe of the brain secondary to insufficient blood supply to the vertebrobasilar artery.
Clinical features: ①Ocular symptoms and cervical spondylosis occur simultaneously or sequentially, and the two conditions are closely related to each other. (2) Intermittent blurred vision and painful swelling in one or both eyes in the early stage, followed by other ocular symptoms. ③Ophthalmic examination cannot find the cause, and treatment according to ophthalmology is ineffective. After treatment according to cervical spondylosis, vision can be significantly improved with the remission of cervical spondylosis.
Spinal cord type cervical spondylosis (CSM)
Spinal cord cervical spondylosis has an insidious onset, and the clinical symptoms are extremely atypical, which can easily lead to clinical misdiagnosis and mistreatment. CSM is insidious and has complex clinical manifestations, including tremor of one limb, twitching, burning sensation in one finger or palm, fear of cold, morning stiffness, weakness of lower limbs, hard of hearing in one ear, pain in both ears, and incomplete sensation of urination and defecation. The physical examination and history taking were not careful enough, and there was a lack of comprehensive analysis of the collected clinical data. Some pathogenic factors often do not show up on cervical spine X-ray films, so the diagnosis cannot be excluded implicitly based on X-ray plain films alone, and further myelography, CT or MRI should be done.