Clinically, I often see 40 to 50 patients each morning in the spine surgery specialist clinic, and there are many patients complaining of “cervical spondylosis”, but which are the real patients with cervical spondylosis and which need surgical treatment? First of all, we have to start with the clinical classification of cervical spondylosis, which is generally divided into six types: spinal, radicular, vertebral artery, sympathetic, cervical and mixed. Of these, the spinal, radicular and mixed types are the most common types that require surgery. Most of the other three types do not require surgery. So what are the characteristics of each type? 1, spinal cord type cervical spondylosis: mainly due to cervical disc herniation or prolapse, or combined with the formation of bone superfluous, ligament ossification and other factors causing pressure on the spinal cord in the cervical spinal canal, resulting in different clinical symptoms, typical symptoms include: weakness and numbness of the limbs, no strength to hold things in the hands, can’t do fine movements, no strength in the lower limbs when walking, unstable walking, the feeling of stepping on cotton or uneven feeling on the soles of the feet, a feeling of something binding in the chest, and a feeling of a severe spinal cord. In severe cases, the patient may not be able to walk at all, the muscles may be atrophied, and the bowels may even become dysfunctional. Of course, in the early stage, there may be only a part of the symptoms, or even only numbness and mild weakness, and then it is time to see a specialized spine surgeon to avoid a significant increase in symptoms, although surgery can reduce the symptoms, but complete recovery is no longer possible. This type of cervical spondylosis should be promptly treated with surgery to release the spinal cord compression, and good postoperative neurological recovery can be obtained. 2.Nerve root type cervical spondylosis: It is mainly caused by the herniated or prolapsed cervical intervertebral disc causing pressure on the nerve roots of the cervical spine, thus causing different clinical symptoms. Typical symptoms are mainly manifested as: unilateral (occasionally bilateral) pain in the shoulder or upper limb, often with radiating pain, but no pressure sensation when pressing the painful area, which can be distinguished from local upper limb diseases such as frozen shoulder and tennis elbow. The results of surgery for this type of cervical spondylosis are excellent, and the pain in the shoulder or upper extremity disappears in all patients immediately after the surgery when they are awake after the release of the cervical nerve root compression. Only very few patients, after the painful symptoms of cervical nerve root compression by the protruding cervical disc, do not seek medical consultation in time, or the acute prolapse of the cervical disc, there is a significant weakening of the strength of one shoulder or upper limb, then the pain can disappear completely after surgery, and the weakness of the limb will not continue to increase, but some strength cannot be fully restored. 3.Vertebral artery type: It is mainly caused by the compression of the vertebral arteries on both sides of the cervical spine due to the instability of the cervical spine, and is often diagnosed as “cervical vertigo” by doctors, mainly manifesting as episodes of dizziness or vertigo, sometimes accompanied by tinnitus and other symptoms, often related to changes in head position (such as rotation, flexion and extension), and generally not combined with symptoms of the limbs. This type of cervical spondylosis generally has poor surgical efficacy, so the general clinical consensus among spine surgeons is that unless there is an obvious combination of segmental instability of the cervical spine, symptomatic treatment is generally used to improve the symptoms of dizziness. 4, sympathetic type: mainly caused by cervical sympathetic nerve involvement, imaging will generally have a certain cervical disc slightly protruding, but the spinal cord or nerve compression is not obvious, the main symptoms are dizziness, headache, panic, tinnitus, nausea and other sympathetic symptoms, this type of cervical spondylosis surgical efficacy is not exact, some have good results, some are not effective, so only those who repeatedly long-term treatment is not effective will consider receiving surgical treatment, surgery needs to be Surgery needs to be done with caution. 5. Cervical type: This type is the most common type clinically, with only local symptoms in the neck, such as neck discomfort, neck pain, neck soreness, stiffness, etc., often for symptoms repeatedly for a long time, patients go around to see doctors, but there is no way to cure them, surgeons say it is fine, no need to operate, internal medicine doctors use some medicine, acupuncture, physiotherapy, etc., but also can not be completely cured, symptoms are sometimes good and sometimes bad. In fact, the cause of the onset of many of these patients is caused by not paying attention to the usual work, study or lifestyle habits. For example, the head is often lowered, or the neck continues in one position for too long without moving the neck, resulting in long-term overload of the neck muscles or ligaments, small joints and other structures, and the accumulation of strain becomes a disease. This type mainly needs to change the habits, which is the most important, not only rely on the doctor’s medication can be cured, low head or head does not move for a period of time need to move the neck, give the cervical spine a little vacation, will receive a better effect over time. The doctor’s medication is only an auxiliary treatment when the acute neck pain and discomfort. 6.Mixed type: This type is also more common clinically, and symptoms often exist from the combination of the above two or more types, such as neurogenic type combined with spinal cord type, etc. Generally, as long as there are clinical symptoms of spinal cord type or neurogenic type, and conservative medical treatment is ineffective, it is necessary to consider surgery. Sometimes the combined hypertension or dizziness symptoms can be cured after surgery for unclear reasons. To sum up, as long as the spinal cord type, neurogenic type or combined spinal cord type or neurogenic type of mixed cervical spondylosis is not effective by regular medical conservative treatment, it should receive surgery in a timely manner, so as not to avoid delaying the disease and leaving lifelong regrets if the symptoms are serious and cannot be fully recovered even after surgery. Formal internal conservative treatment is suitable for early-onset cervical spondylosis, such as caused by not serious disc herniation compressing the spinal cord or cervical nerve root, can be used occipital jaw belt traction, the use of dehydration drugs, analgesic anti-inflammatory drugs, short-term application of hormones, generally can obtain good therapeutic effect. The best exercise is to insist on swimming, especially breaststroke is the most suitable. The constant backward extension movement under the horizontal non-weight-bearing state of the neck is conducive to the retraction of mildly herniated cervical discs, thus curing the nerve compression caused by mild cervical disc herniation. The second beneficial exercise is playing badminton, which is also a posterior extension movement of the neck, and swimming, but it is not suitable for elderly patients. If regular conservative treatment is carried out and beneficial functional exercises are adhered to, avoiding bad habits of long-term head bowing or continuous neck inactivity, many people’s cervical spondylosis can be cured for life without surgery, or even completely.