Diagnosis and treatment of cervical spondylosis

  Cervical spondylosis is a syndrome with a series of clinical symptoms caused by degenerative changes in the cervical discs. It is clinically subdivided into five types, including cervical, radicular, spinal, vertebral artery and sympathetic, and two or more compound types.  I. The treatment methods are different for different types of patients. The diagnosis of different types of cervical spondylosis is as follows: 1. Cervical cervical spondylosis: the patient complains of abnormal sensations such as pain in the head and occipital area, neck and neck and shoulder and back, accompanied by corresponding pressure points. cervical spine on X-ray shows such manifestations as curvature change or intervertebral joint instability. CT and MRI show mild bulging of cervical intervertebral disc.  2. Nerve root type: The patient complains of radiating pain and numbness in one or both upper limbs, and even the upper limbs cannot be abducted, and its scope is in the area innervated by the cervical spinal nerve. The cervical disc herniation is visible on CT and MRI, and its segments are consistent with the cervical spinal nerve segments associated with upper limb radiating pain and numbness. And the painful point closure in the affected upper shoulder limb was not effective.  3.Spinal cord type: The patient complains of tightness of the trunk, the feeling of stepping on a cotton blanket, etc. The X-ray film shows osteophytes at the posterior edge of the vertebral body and spinal stenosis, and the CT and MRI show a herniated cervical disc with severe compression of the cervical spinal cord.  4.Vertebral artery type and sympathetic nerve type are more complicated and will not be introduced this time.  Second, modern medicine uses the following treatment methods in the treatment of cervical spondylosis: 1. Oral medication: including anti-inflammatory and analgesic drugs, muscle relaxants, and also plant-based drugs and proprietary Chinese medicines. It is important to emphasize that the use of drugs to relieve symptoms when the pain is more pronounced in patients with initial onset is not only beneficial to life at that time, but also slows down the further development of cervical spondylosis. Because the muscle tension spasm caused by the pain can further contribute to the aggravation of the lesion.  2. Cervical spine traction method and physiotherapy of neck and shoulder, as well as exercise therapy.  3. Surgical treatment is mainly a method for patients with severe disease caused by cervical disc herniation and vertebral instability. Surgical treatment is mainly to reduce or eliminate the compression and irritation, strengthen the stability of the diseased cervical spine, and prevent the nerve root and cervical medullary damage from progressively aggravating and becoming irreversible changes. Since the pathological changes are clearly targeted and the method is powerful, the effect is mostly rapid and obvious.  4. Minimally invasive surgery treatment represented by collagenase nucleolysis, laser disc decompression and radiofrequency discoplasty. It has the function of surgical operation to reduce or eliminate the compression and irritation and prevent the progressive aggravation of nerve root and cervical medullary damage, and also has the characteristics of small trauma and quick recovery. It is suitable for patients with mild symptoms but poor results of conservative treatment, as well as for patients with severe symptoms but old and frail bodies. And it is more effective for general patients with moderate to severe symptoms.  Modern medical research believes that the early stage of cervical spondylosis is degeneration of the cervical intervertebral disc, the water content of the nucleus pulposus decreases and the fibers of the annulus fibrosus swell and thicken, followed by glass-like degeneration and even rupture. After the degeneration of the cervical intervertebral disc, the resistance to compression and tension is reduced. When subjected to the gravitational force of the head and the pulling force of the cephalothoracic muscles, the degenerated disc can undergo limited or extensive bulging in all directions, resulting in narrowing of the intervertebral disc space, misalignment of the articular processes, and reduction of the longitudinal diameter of the intervertebral foramen.  Due to the weakening of the intervertebral disc’s resistance to strain, intervertebral instability occurs when the cervical spine moves and the stability between adjacent vertebrae decreases, and intervertebral mobility increases and mild slippage or displacement occurs. Narrowing of the intervertebral disc space and misalignment of the articular eminence may induce osteophytes in the posterior tuberosity, the hook joint and the vertebral plate, and degeneration and relaxation of the ligamentum flavum to squeeze the dural sac forward.  As the cervical intervertebral disc bulges around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum are lifted, and a ligamentous intervertebral disc gap is formed between the vertebral body and the protruding disc and the lifted ligamentous tissue, in which tissue fluid accumulates, together with the bleeding caused by microscopic injury, so that this bloody fluid becomes mechanized and then calcified and ossified, thus forming an osteophyte. The laxity of the anterior and posterior ligaments of the vertebral body makes the cervical vertebrae unstable and increases the chance of trauma, so that the bone superfluous gradually increases.  Together with the bulging fibrous ring, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, the bone superfluous forms a mixture of protrusions into the spinal canal at the equivalent of the intervertebral disc, which may have a compressive effect on the spinal nerve or spinal cord. The bony flab of the hook vertebral joint may protrude from anterior to posterior into the intervertebral foramen to compress the nerve roots and vertebral artery. The anterior border of the vertebral body does not usually cause symptoms, but it has been seen clinically to affect swallowing and even cause hoarseness. Compression of the spinal cord and cervical spinal nerve roots starts with functional changes only and gradually produces irreversible changes if the pressure is not reduced in time.  Therefore, if conservative treatment is ineffective, surgery should be performed promptly. The application of minimally invasive surgery is an effective means of early resolution of cervical disc bulging and protrusion in all directions and preventing the subsequent series of pathological changes.