Treatment of cervical spondylosis
The treatment of cervical spondylosis is divided into surgical and non-surgical.
Most patients with cervical spondylosis have excellent results with non-surgical treatment, and only a small percentage of patients require surgery because non-surgical treatment is ineffective or the condition is severe.
Non-surgical treatment
It is currently reported that 90-95% of patients with cervical spondylosis are cured or in remission after non-surgical treatment. Non-surgical treatment is currently mainly a combination of Chinese medicine, Western medicine, Chinese and Western medicine, and rehabilitation therapy, etc. Chinese medicine treatment means combined with Western medicine anti-inflammatory and analgesic, vasodilator, diuretic and dehydrating, nerve-nourishing and other types of drugs. Zhang Qian, Department of Orthopedic Surgery, Liaocheng Second People’s Hospital
(A) Traditional Chinese medicine treatment
1.Chinese medicine evidence-based treatment.
Dialectical treatment of Chinese medicine: the basic method should be to use drugs in a typological and dialectical manner.
(1) Cervical cervical spondylosis: it is appropriate to dredge the wind and relieve the surface, disperse the cold and ventilate the ligaments, commonly used in Gui Zhi plus Ge Gen Tang (Gui Zhi, Paeonia, Licorice, Ginger, Jujube, Ge Gen) or Ge Gen Tang (Ge Gen, Ma Huang, Gui Zhi, Paeonia, Ginger, Jujube, Licorice), accompanied by throat inflammation, plus Yuan Shen, Pan Lan Gen, Jin Yin Hua, etc.
(2) Nerve root type cervical spondylosis: divided into.
Pain is the main cause of cervical spondylosis, and it is advisable to remove blood stasis and promote circulation, commonly used in the body pain and remove blood stasis soup (Angelica sinensis, Chuanxiong, Myrrh, Tao Ren, Qiang Wu, Hong Hua, Wu Ling Li, Gentiana, Radix Scutellariae Sinensis, Niubizi, Di Long, Roasted Grass); if it is damp-heat, it is advisable to clear heat and promote dampness, with Angelica sinensis and Qiang Wu (Angelica sinensis, Dang Shen, Bitter Ginseng, Cang X, Bai X, Sheng Ma, Fang Ji, Qiang Wu, Ge Gen, Zhi Mu, Pig’s ling, Yin Chen, Scutellariae, Ze Di Di, Gan Cao, Dao Zao). If accompanied by numbness, add Antispasmodic San (centipede, whole scorpion) to the above formula.
If numbness is predominant, accompanied by muscle atrophy, take the method of benefiting qi, resolving stasis and opening up the ligaments, commonly used to make up yang and return to five soup (astragalus, angelica, Chuanxiong, peony, peach kernel, safflower, di dragon) plus centipede, whole scorpion, etc.
(3) Vertebral artery type cervical spondylosis, divided into.
For dizziness with headache, in favor of blood stasis, it is appropriate to dispel blood stasis and open the ligaments, resolve dampness and pacify the liver, commonly used in Blood Mansions and Eliminating Blood Stasis Soup (Angelica sinensis, Chuanxiong, Radix Paeoniae, Radix et Rhizoma, Tao Ren, Safflower, Niubizi, Chai Hu, Citrus Aurantium, Radix Platycodon, Glycyrrhiza glabra); in favor of phlegm and dampness, it is appropriate to use Han Xia Bai Zhu Tian Ma Tang (Han Xia, Bai Zhu, Tian Ma, Fu Ling, Chen Pi, Glycyrrhiza, Dazao), etc.
Dizziness and head distension like wrapping, drowsiness, mouth pain, insomnia, is bile-stomach disharmony, phlegm-heat internal disturbance, it is advisable to regulate qi and resolve phlegm, clear bile and stomach, commonly used in warming bile soup (Radix et Rhizoma Polygoni, Poria, Chen Pi, Bamboo Roo, Citrus Aurantium, Glycyrrhiza glabra).
For dizziness, fatigue and weakness, and less colorful face, take Beneficial Qi and Ying to resolve dampness, commonly used in Beneficial Qi Smart Tang (Astragalus, Radix Codonopsis, Radix Paeoniae Alba, Phellodendron, Radix et Rhizoma, Radix et Rhizoma Glycyrrhizae).
(4) Spinal cord type cervical spondylosis: increased muscle tone, chest and abdomen with a feeling of girdling take the method of dispelling blood stasis and clearing the internal organs, with Fuyuan and invigorating blood soup (rhubarb, Chai Hu, red flowers, peach kernel, angelica, smallpox powder, piercing sorrel, roasted licorice). If the lower limbs are weak and the muscles are atrophied, take the method of tonifying the middle and benefiting the qi and nourishing the spleen and kidneys, Dihuang Drink (Radix et Rhizoma Pseudostellariae, Gui Zhi, Cistanches, Cornu Cervi Pantotrichum, Shu Di, Bacopa Monnieri, Acorus Calamus, Yuan Zhi, Dendrobium, Poria, Mai Dong, Wu Wei Zi) combined with Sheng He Tang (Astragalus, Radix Codonopsis, Angelicae Sinensis, Radix Paeoniae, Chuan Xiong, Shu Di, Chai Hu).
Sympathetic cervical spondylosis has more symptoms, so it is appropriate to treat the symptoms according to the condition.
2. External treatment of Chinese medicine: Chinese medicine with different effects such as promoting qi and dispersing stasis, warming the meridians and dispersing cold, relaxing the tendons and activating the collaterals or clearing heat and detoxifying the toxins is made into different dosage forms and applied to the relevant parts of patients with cervical spondylosis. The common methods of external treatment of cervical spondylosis include teng medicine, compress medicine, spray medicine, etc.
3. Tui Na and orthopedic manipulation: they have the functions of adjusting the internal organs, balancing yin and yang, promoting qi and blood generation, activating blood circulation and eliminating blood stasis, promoting tissue metabolism, releasing muscle tension, and managing tendon reset. The basic techniques include massage, kneading, pointing, pressing and wrenching.
Special emphasis is placed on the fact that massage must be carried out by a medical professional. Cervical spondylosis treatment should be gentle, avoid violence. The vertebral artery type and spinal cord type patients should not apply posterior joint manipulation. It is difficult to exclude lesions such as tumors in the vertebral canal, developmental stenosis of the vertebral canal, spinal cord compression symptoms, bony destruction of the vertebral body and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occiput, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is prohibited.
4. Acupuncture therapy: including acupuncture and moxibustion. Acupuncture is the use of refined metal needles into certain parts of the body, with appropriate techniques to stimulate, while moxibustion is the use of moxa or moxa cones ignited and smoked acupuncture points for stimulation, through stimulation to achieve the adjustment of the human meridian organs qi and blood function, prevention and treatment of disease.
(II). Rehabilitation treatment
1. Physiotherapy
The main function of physical factor therapy is to dilate blood vessels, improve local blood circulation, release the spasm of muscles and blood vessels, eliminate inflammation and edema of nerve roots, spinal cord and surrounding soft tissues, reduce adhesions, regulate the function of vegetative nerves, and promote the recovery of nerve and muscle functions. Commonly used treatment methods.
(1) Direct current ion introduction therapy
Commonly used with a variety of western drugs (glacial acetic acid, VitB1, VitB12, potassium iodide, nufocaine, etc.) or Chinese medicine (Wu Tou, Wei Ling Xian, safflower, etc.) placed on the back of the neck, according to the performance of drugs connected to the anode or cathode, with another electrode opposed or oblique opposed, each time the electricity for 20 minutes, applicable to all types of cervical spondylosis.
(2) Low-frequency modulated medium-frequency electrotherapy
Generally, IF electricity of 2000Hz-8000Hz is used as the carrier frequency, and low frequency electricity of different waveforms (square wave, sine wave, triangle wave, etc.) of 1-500Hz is used as the modulating waveform, which is modulated in different ways and compiled into different prescriptions. The prescriptions are selected according to different conditions, and the electrodes are placed in the same way as DC. Each treatment generally lasts 20-30 minutes and is suitable for all types of cervical spondylosis.
(3) Ultrashort wave therapy
The treatment is carried out with ultrashort wave of wavelength about 7m. Generally, two medium-sized electrode plates are used, which are placed behind the neck and the extensor side of the forearm of the affected limb, or monopolar placed behind the neck. In the acute stage, no heat is applied once a day for 12 to 15 minutes, and in the chronic stage, micro heat is applied for 15-20 minutes each time. 10-15 times is a course of treatment. Applicable to nerve root type (acute phase) and spinal cord type (spinal edema phase).
(4) Ultrasonic therapy
Frequency 800kHz or 1000kHz ultrasonic therapy machine, sound head and the skin of the neck in close contact, along the vertebral space and paravertebral movement, intensity with 08 ~ 1W/cm2, available hydrocortisone cream as a contact agent, once a day, 8min each time, 15-20 times a course of treatment. For the treatment of spinal cord type cervical spondylosis.
Ultrasound frequency as above, sound head moving along both sides of the neck with two supraganglial fossa, intensity 08 ~ 1.5W/cm2, 8-12min each time, the rest as above, used for the treatment of neurogenic cervical spondylosis.
(5) Ultrasonic conductivity targeted transdermal drug delivery treatment
Ultrasonic conductivity instrument and ultrasonic conductivity gel patch were used, and 2% lidocaine injection was selected as the transdermal drug. The patch was first fixed in the treatment transmitter head of the instrument, and 1 ml of prepared lidocaine injection was added to the two coupling gel patches respectively, and then the patch was fixed to the front of the patient’s neck together with the treatment transmitter head. The treatment parameters were selected as conductivity 6, ultrasound intensity 4, frequency 3, treatment time 30 minutes, once a day, 10 days as a course of treatment. It is used to treat vertebral artery type and sympathetic nerve type cervical spondylosis.
(6) High potential therapy
Using high-potential therapy instrument, the patient sits on the plate electrode or treatment seat with the foot on the insulating pad, and each treatment lasts 30-50 minutes. It can be used for all types of cervical spondylosis, among which sympathetic cervical spondylosis has the best effect.
(7) Light therapy
Ultraviolet therapy: the back of the neck on the flat hairline down to the second thoracic vertebra, the amount of erythema (3-4 biological amount), once every other day, 3 times a course of treatment, together with ultra-short wave treatment of nerve root type acute stage.
Infrared therapy: various infrared instruments are available, behind the neck irradiation. 20 ~ 30min / time. Used for soft tissue type cervical spondylosis, or with cervical traction therapy (infrared therapy before cervical traction).
(8) Other therapies.
Such as magnetic therapy, electrical excitation therapy, audio electrotherapy, interference electrotherapy, wax therapy, laser irradiation and other treatments are also frequently used in the physical therapy of cervical spondylosis, and properly selected can achieve certain results.
2. Traction therapy
Cervical spine traction is a common and effective method for treating cervical spondylosis. Cervical traction helps to release the muscle spasm of the neck, relax the muscles and relieve the pain; release the soft tissue adhesions, stretch the contracted joint capsule and ligaments; improve or restore the normal physiological curvature of the cervical spine; increase the intervertebral foramen and release the nerve root stimulation and compression; enlarge the vertebral space and reduce the pressure in the intervertebral disc. The microscopic abnormal changes of small joints are adjusted so that the misalignment of synovial or synaptic joints can be reset;
Cervical spine traction treatment must master the direction of traction force (angle), weight and traction time three elements, in order to obtain the best therapeutic effect of traction.
(1) traction mode: commonly used occipito-mandibular band traction method, usually using sitting traction, but the condition is heavy or can not sit traction horizontal traction. Continuous traction, intermittent traction or a combination of both can be used.
(2) traction angle: generally according to the lesion site, such as lesions mainly in the upper cervical segment, traction angle should be 0-10 °, such as lesions mainly in the lower cervical segment (neck 5-7), traction angle should be slightly forward, can be between 15-30 °, while pay attention to the combination of patient comfort to adjust the angle.
(3) Traction weight: the weight of intermittent traction can be determined by 10%-20% of its own body weight, and continuous traction should be reduced appropriately. Generally, the initial weight is light, such as 6 kg to start, and then gradually increase.
(4) traction time: traction time to continuous traction 20 minutes, intermittent traction is 20-30 minutes is appropriate, once a day, 10-15 days for a course of treatment.
(5) precautions: individual differences should be fully considered, the elderly and frail people should traction weight lighter, traction time shorter, young and strong can hold heavier and longer; traction process should pay attention to observe and ask the patient’s reaction, such as discomfort or aggravation of symptoms should immediately stop traction, find the cause and adjust, change the treatment plan.
(6) Contraindications to traction: obvious discomfort or aggravation of symptoms after traction, no improvement after adjustment of traction parameters; obvious spinal cord compression, serious segmental instability; serious degenerative degeneration of aged vertebral joints, obvious narrowing of the spinal canal, serious calcification and ossification of ligaments and joint capsule.
3. Manipulation treatment
It is based on the anatomical and biomechanical principles of cervical vertebrae and joints, and is a passive activity treatment of the spine and small joints of the spine by pushing, pulling, rotating, etc. to adjust the anatomical and biomechanical relationship of the spine, and at the same time to loosen and rationalize the muscles and soft tissues related to the spine, so as to improve the function of the joints, relieve spasm and reduce pain. The purpose is to improve joint function, relieve spasm and reduce pain.
Commonly used methods are Chinese and Western techniques. Chinese techniques refer to the traditional Chinese massage and tui-na techniques, which generally include bone and joint repositioning techniques and soft tissue massage techniques. Western-style techniques commonly used in China are McKenzie (Mckenzie) method, joint loosening techniques (Maitland technique), chiropractic (chiropractic) and so on.
Special emphasis should be placed on the fact that manipulative treatment of cervical spondylosis must be performed by trained medical professionals. It is advisable to control the strength of the manipulation according to the individual situation and to be as gentle as possible, avoiding violence. It is difficult to exclude lesions such as tumors in the spinal canal, developmental stenosis of the spinal canal, spinal cord compression symptoms, bony destruction of vertebrae and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occipital area, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is cautious or prohibited.
4. Exercise therapy
Exercise therapy for cervical spine refers to the exercise of the neck and other related parts as well as the whole body by using appropriate exercise methods. Exercise therapy can enhance the muscle strength of the neck, shoulder and back muscles, stabilize the cervical spine, improve the function of the joints between the vertebrae, increase the range of motion of the cervical spine, reduce nerve irritation, reduce muscle spasm, eliminate pain and other discomfort, correct abnormalities or deformities in the alignment of the cervical spine, and correct poor posture. Long-term adherence to exercise therapy can promote the body’s adaptation to the compensatory process, thereby achieving the purpose of consolidating the therapeutic effect and reducing recurrence.
Cervical spine exercise therapy is commonly used in the form of freehand exercises, stick exercises, dumbbell exercises, etc. Mechanical training is also available when available. Types usually include cervical spine flexibility exercises, cervical muscle strength training, cervical spine correction training, etc. In addition, there are whole-body exercises such as running, swimming, ball games, etc. are also common therapeutic exercises for cervical spine disorders. Patients with cervical spondylosis can be instructed to adopt the “Neck and shoulder disease exercise prescription”.
Exercise therapy is applicable to patients with all types of cervical spondylosis in remission and post-operative recovery. The specific methods and approaches vary according to different types of cervical spondylosis and different individual physiques, and should be carried out under the guidance of a specialist.
5. Application of orthopedic brace
Orthopedic braces for cervical spine are mainly used to fix and protect the cervical spine, correct the abnormal mechanical relationship of the cervical spine, reduce neck pain, prevent over-extension, over-flexion and over-rotation of the cervical spine, avoid further damage to the spinal cord and nerves, reduce spinal edema, reduce the traumatic reaction of the intervertebral joints, help repair the tissues and relieve the symptoms, and cooperate with other treatment methods at the same time to consolidate the curative effect and prevent recurrence.
The most commonly used ones are neck circumference and neck brace, which can be applied to patients in the acute stage of all types of cervical spondylosis or those with severe symptoms. Neck brace is also mostly used for patients with cervical spine fracture or dislocation, who still have intervertebral instability or subluxation after early treatment. Wearing a neck brace for protection is necessary when riding in high-speed cars and other means of transportation, whether with or without cervical spondylosis. However, unreasonable long-term use should be avoided as it may lead to cervical muscle weakness and poor cervical mobility.
Regardless of that type of cervical spondylosis, the basic principle of its treatment is to follow the basic principle of non-surgical treatment first and then surgery after it is ineffective. This is not only because of the pain and injury and complications associated with surgery itself, but more importantly because the vast majority of cervical spondylosis itself can be stopped, improved or even cured through non-surgical treatment. Unless there are a few cases with clear indications for surgery, regular non-surgical treatment should be started and continued for 3 to 4 weeks, which is generally effective. For individual cases with progressive development (mostly spinal cervical spondylosis), early surgery is required as a matter of urgency.