Diagnostic criteria and treatment principles of cervical spondylosis
I. Definition of cervical spondylosis
Degenerative changes of cervical disc tissue and its secondary pathological changes involving the surrounding tissue structures (nerve heel, spinal cord, vertebral artery sympathetic nerve, etc.) and the corresponding clinical manifestations are cervical spondylosis.
Second, general principles
1.The diagnosis can be confirmed if the clinical manifestations are consistent with what is seen in imaging.
2, with typical clinical manifestations of cervical spondylosis and normal imaging, attention should be paid to the diagnosis of cervical spondylosis only after excluding other disorders
3.If there is only abnormal imaging performance without clinical symptoms of cervical spondylosis, it should not be diagnosed as cervical spondylosis.
Diagnostic principles for each type of cervical spondylosis: In addition to the above principles, the diagnostic bases for each type of cervical spondylosis are as follows
1.Cervical type.
(1) Complaint of abnormal sensations such as head, neck and shoulder pain with corresponding pressure pain points.
(2) The cervical spine shows curve changes, or intervertebral joint instability and other manifestations on the X-ray film.
(3) Other disorders of the neck should be excluded (drop pillow, frozen shoulder, rheumatic myofibrositis, neurasthenia and other pain in the neck and shoulder not caused by degenerative disc degeneration.
2.Nerve root type.
(1) With typical radicular symptoms (numbness and pain) and the scope is consistent with the area innervated by the cervical spinal nerve.
(3) The imaging findings are consistent with the clinical presentation.
(4) No significant effect of painful point closure (this test may not be performed if the diagnosis is clear).
(5) Excluding the pain of the upper extremity caused by extra-cervical lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps tenosynovitis, etc.).
3.Spinal cord type.
(1) Clinical manifestations of cervical spinal cord damage.
(2) X-rays show osteophytes and spinal stenosis at the posterior edge of the vertebral body. Imaging confirms the presence of spinal cord compression.
(3) Excluding amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
4.Vertebral artery type: the diagnosis of vertebral artery type cervical spondylosis is a problem to be studied.
(1) There was a sudden collapse attack and cervical vertigo.
(2) Positive rotational neck test.
(3) X-rays show segmental instability or osteophytes of the hook vertebral joint.
(4) Most of them are accompanied by sympathetic symptoms.
(5) Exclude ophthalmogenic and otogenic vertigo.
(6) Exclude insufficiency of the basilar artery supply caused by compression of the carotid artery segment I (the segment of the vertebral artery before entering the cervical and transverse foramen).
(7) Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) should be performed before surgery.
5, sympathetic type: clinical manifestations are dizziness, dizziness, tinnitus, hand numbness, tachycardia, precordial pain and a series of other symptoms, with instability or degeneration on X-ray and negative vertebral arteriography.
6, other types: cervical vertebrae with anterior bird’s mouth-like hyperplasia compressing the esophagus causing dysphagia (confirmed by barium esophageal examination), etc.
Indications for surgery for cervical spondylosis (modified plan)
I. General principles.
01. In general, the indications for surgery for cervical spondylosis are relative. Surgery for cervical spondylosis is complicated and involves certain risks, so the indications for surgery should be strictly controlled.
02. It is currently believed that: surgical treatment for cervical spondylosis mainly achieves the purpose of decompression and reconstruction of stability, and has no therapeutic significance for irreversible lesions of the spinal cord itself. The patient’s occupation, age, tolerance of the patient’s organism condition to surgery, and the patient’s attitude to surgery should be considered when choosing surgical treatment.
4. The pathological mechanism and clinical manifestations of cervical spondylosis are complex, and the appropriate surgical modality should be selected according to different conditions.
II. Indications for surgery for each type
1.Cervical type: In principle, surgery is not required. Only in rare cases where long-term non-surgical treatment is ineffective and seriously affects normal life or workers, surgery can be considered.
2. Nerve root type: In principle, non-surgical treatment is required.
(1) Regular and systematic non-surgical treatment is ineffective for more than 3-6 months, or non-surgical treatment is effective but recurrent, and the symptoms are more serious and affect normal life or workers.
(2) Those with progressive atrophy of the innervated muscles due to nerve root lesions.
(3) There are obvious symptoms of nerve root irritation, acute severe pain, affecting sleep and normal life.
03.Spinal cord type: In principle, once the spinal cord type cervical spondylosis is diagnosed and there is no contraindication to surgery, it should be treated surgically. For those with a wide spinal canal and mild symptoms, appropriate non-surgical treatment can be taken and followed up regularly, but if it is ineffective or aggravated, surgery should be performed.
4.Vertebral artery type: Surgery can be considered for those with the following conditions.
(1) Cervical vertigo with a history of sudden collapse, which is not treated by non-surgical treatment.
(2) Those with cervical selective vertebral arteriogram or DSA confirmed.
5.Sympathetic type: Surgery can be considered if the symptoms seriously affect the patient’s life, and the non-surgical treatment is ineffective and confirmed as segmental instability or disc bulge.
6.Other types (at present, it mainly refers to those with esophageal compression): if swallowing difficulty is caused by compression and irritation of the esophagus by the bone superfluous, and the non-surgical treatment is ineffective, the bone superfluous should be removed.