Cervical spondylosis is a complex syndrome of symptoms due to changes in the physiological curvature of the cervical spine and degenerative changes in the intervertebral discs, joints and other tissues that stimulate or compress the cervical nerve roots, spinal cord, vertebral artery and sympathetic nerves in the neck. The lesions mainly involve the cervical spine, intervertebral discs, surrounding ligaments and fibrous structures; the main clinical manifestations of patients are pain in the head, neck, arms, hands and forehead, etc., and there may be progressive limb sensory and motor dysfunction, which may lead to tetraplegia in severe cases. It is more common in adults aged 40 to 60 years old, with more men than women.
Most patients with cervical spondylosis can be relieved by conservative treatment, and over-treatment of patients causing injury and economic burden should be avoided.
Clinical manifestations
Neurogenic cervical spondylosis is the most common type of cervical spondylosis, and the main clinical manifestations are as follows.1. It mostly develops over the age of 40, with a slow onset and a long course.2. Pain and numbness in the neck, shoulder, arm and hand are the main symptoms. Pain and numbness are reflected by nerve root distribution and have localization value. The symptoms can occur unilaterally or bilaterally.3. The affected limbs may show muscle weakness, muscle atrophy, loss of grip strength, and may have the phenomenon of falling objects.4. Some patients have stiff neck and limited movement. There may be significant pressure pain in the spinous process, paraspinal process, supraspinal and infraspinal muscles, and scapular spine margin. The nerve root pull test and cervical compression test may be positive.5. The biceps and triceps tendons and radial periosteal reflexes of the affected limbs may be active in the acute stage. The reflexes are weakened in those with long duration of disease.
Clinically, this type of cervical spondylosis needs to be differentiated from frozen shoulder, cervical tuberculosis, cervical spine tumor, cervical disc herniation and thoracic outlet syndrome. It is also more common.
Clinical symptoms and signs
I. Symptoms
Pain and sensory abnormalities in patients with neurogenic cervical spondylosis are mainly manifested in the neck, shoulders, arms and fingers. Because the lower cervical vertebrae are relatively fixed and have a large weight-bearing capacity, the lower cervical vertebrae are more likely to be involved, and the cervical vertebrae at the C5-6 and C6-7 levels are the most common in clinical practice.
The onset of neurogenic cervical spondylosis is slow, with occasional acute onset due to trauma. In the early stage, it is mostly discomfort, soreness and dull pain in the arm and shoulder after waking up, which can be aggravated by changing the head and neck position or exerting force, and sometimes there can be severe nerve root pain or numbness, which can be improved after rest. Acute onset patients often have typical nerve root pain, manifesting as slash-like or pinprick-like radiating pain, often aggravated by increased abdominal pressure such as coughing, sneezing, breath-holding and exertion, and may be accompanied by sensory hypersensitivity. Patients with long duration of disease often have abnormal sensation, and the nature of pain is mainly dull pain.
Second, physical signs
Physical examination may reveal limitation of neck movement, stiffness of cervical muscles, and pressure pain in the oblique muscles, supraspinatus, infraspinatus, rhomboid, pectoralis major, and cervical nerve root outlet. The tendon reflexes are weakened, and the muscles innervated by the damaged spinal nerve roots have reduced strength and muscle atrophy.
Treatment
I. General treatment
1.Change the poor working and living posture
Such as the use of moderately sized health pillow, not to choose a large pillow, hard pillow, flat pillow, not to take the prone position when sleeping; in the cold season to pay attention to the warmth of the neck; in between work and study to carry out multi-directional activities of the neck. All these can help prevent the occurrence and development of cervical spondylosis.
2.Add a neck brace
The neck brace can restrict head and neck activities, and can achieve the effect of pain relief for patients with acute attacks of neurogenic cervical spondylosis.
3.Head traction
The use of 4-6kg weights for head traction can relax the neck muscles, widen the vertebral space and open the intervertebral foramen, which is conducive to the return of early bulging discs.
4.Massage and physical exercise of head and neck
It helps to relax the neck muscles, promote the blood circulation in the neck, and enhance the muscle strength of the neck muscles and the stability of the head and neck.
Second, drug treatment
1.Neurotrophic drugs
For the damage of inflammatory changes of the nerve can play a nutritional, repair role. The commonly used drugs include B vitamins, which can be applied for a long time, such as vitamin B1 20mg/time, 3 times/d; vitamin B12 preparations such as Micropo or adenosine coenzyme B12, 0,5mg/time, 3 times/d. Neurontin is a newer neurotrophic drug, which can have both nutritional and analgesic effects on injured nerves, and is suitable for those with chronic neuronal injuries and abnormal sensations. Neurontopin can be both orally and intravenously injected, orally 8U/time, 2 times/d, at least 4 weeks of continuous application; intravenous drip 3, 75U/time, 2 times/d, at least 2 weeks of continuous application.
2.Analgesic drugs
They are the most commonly used drugs in clinical practice, mainly including anti-inflammatory analgesics and central analgesics. Anti-inflammatory and analgesic drugs mainly inhibit prostaglandin synthesis to achieve analgesic effect. For example, indomethacin 20mg/d, 2-3 times/d. Central analgesic drugs such as tramadol 50-100 mg/d, 1 time/12h.
3.Vasodilator and blood-activating drugs
By promoting systemic blood circulation to achieve nerve nutrition, reduce or eliminate edema of spinal nerve root and repair effect. Such as salvia, niacin, cervical rejuvenation, etc.
Third, nerve block therapy
Nerve block is currently the most effective method in the conservative treatment of nerve root cervical spondylosis. Its mechanism of action is: through eliminating inflammation and edema of nerve or local pain points, relieving muscle spasm, blocking pain malignant circulation mechanism, increasing local blood circulation, and achieving the purpose of analgesia. The commonly used formulations of blocking drugs are: 1% lidocaine, vitamin B12 0,5-1mg, hydrocortisone acetate 12,5-25mg (or compound betamethasone 4-7mg). The ultrasound-guided selective cervical nerve root block carried out in our hospital achieves targeted drug delivery, avoiding the systemic side effects of oral medication, and dynamic visual monitoring of the whole process, avoiding the risk of drug delivery by experience and sensation. Only one or two treatments are needed to reduce inflammation and pain and relieve symptoms caused by nerve root edema.
The commonly used nerve block methods are.
i. cervical epidural space block, which is mostly no longer used
Second, cervical nerve root block, especially ultrasound-guided intrathecal injection, can achieve target drug delivery, the whole ultrasound dynamic monitoring, to avoid injury and other complications
C. Stellate ganglion block
It is suitable for patients with various types of cervical spondylosis, cervicogenic headache, cervical radiculitis, hook spine arthritis, neck and shoulder pain, frozen shoulder, thoracic outlet syndrome, anterior oblique angle muscle syndrome, phrenic neuralgia, etc.
Prevention of cervical spondylosis
Prevention of cervical spondylosis is better than treatment, and careful prevention in daily life can help reduce the occurrence of cervical spondylosis, and the following points are worth noting.
1, do not take the prone position when sleeping, the pillow should not be too high, too hard or too flat.
2, avoid and reduce acute injuries, such as avoid lifting heavy objects, do not tighten the emergency brake, etc.
3, to prevent wind and cold, humidity, avoid midnight, early morning bath or wind and cold blowing. Wind and cold make the local blood vessels contract, blood flow is reduced, which hinders the metabolism and waste removal of tissues, and humidity hinders the evaporation of skin.
4.Actively treat local infection and other diseases.
5.Correct bad posture, reduce strain, every 1~2h of head lowering or head tilting, appropriate neck activities should be carried out to reduce muscle tension.