What is cervical spondylosis?
As the cervical disc degenerates and ages, the disc will bulge or protrude, and accompanied by pathological instability and loosening of the vertebral body, causing the vertebrae and small joints to proliferate and form bone spurs, the unstable disc and bone spurs compress and damage the surrounding spinal cord, nerves, blood vessels, some people have neck, shoulder and arm pain, some people have numbness and walking instability, some people have headaches, dizziness, panic and nausea and other different symptoms, this condition is called cervical spondylosis This condition is called cervical spondylosis.
It starts slowly and insidiously, mostly occurs in middle-aged and elderly people, and is an old age disease, which generally increases with age. However, it is not uncommon for young people (as young as 16 years old) to develop cervical spondylosis, which is mainly related to factors such as excessive head-down learning, obsession with cell phones and computers, and long-term desk work.
What tests are needed for diagnosis?
Without an accurate and comprehensive diagnosis, there is no treatment, and the most important thing to diagnose cervical spondylosis is expert consultation and physical examination. Auxiliary examinations are also necessary, usually X-rays and MRI, X-rays to observe the location and size of the bone spur and MRI (magnetic resonance imaging) to observe the degree and location of deformation and degeneration of the spinal cord under pressure. Sometimes CT is also done to see the exact condition of the bone spur.
Classification and treatment options for cervical spondylosis There are generally six types of cervical spondylosis in China: cervical, radicular, spinal, vertebral artery, sympathetic, and mixed. Cervical cervical spondylosis can be an independent type or an early stage of other types of cervical spondylosis.
It mostly manifests as painful stiffness in the head, neck, collar and back, and dull pain around the shoulder joint and/or the inner or upper side of the scapula. Generally, oral anti-inflammatory and pain-relieving medications, wearing a neck brace and taking care of rest are sufficient, and most people will be relieved in about three weeks. If this state develops, or if neck, shoulder and arm pain (upper limbs) or numbness in the hands and feet (extremities) occurs at the beginning, especially if the movement of the hands and feet is awkward and weak, it is necessary to seek professional consultation and treatment at a spinal disease specialist.
Neurogenic cervical spondylosis – mainly pain in the neck, shoulder, back and upper limbs. 80-90% of conservative treatment works well, but symptoms can recur. If the symptoms recur for more than 2~3 months, or a few patients with severe pain that cannot be tolerated, or arm weakness and muscle atrophy, surgery is required, including plasma interventional minimally invasive surgery and artificial disc replacement that preserves the motor function of the cervical spine. Spinal cord type cervical spondylosis – characterized by symptoms such as weakness and numbness of the limbs, inflexibility of the hands, and walking unsteadily like stepping on cotton, this type is the most serious and is often misdiagnosed as cerebral infarction and lumbar synostosis. Most patients (60-80%) with spinal cord type cervical spondylosis will develop slowly, with the end result being a wheelchair.
Therefore, surgery is the main treatment for this type of cervical spondylosis as soon as it is diagnosed; the lighter the condition the earlier the surgery, the better the results. Generally, the anterior cervical surgery is chosen for 1~2-segment compression, and the posterior cervical surgery is chosen for 3~4-segment compression, and most patients can leave bed for 1-2 days after surgery. Sympathetic nerve type (more) and vertebral artery type cervical spondylosis (very rare) – symptoms such as neck, shoulder and back pain, dizziness and headache, panic and chest tightness, nausea and vomiting, blurred vision, etc. are most common. This type of cervical spondylosis is difficult to diagnose or treat because it is characterized by vegetative nerve disorder, so it is often misdiagnosed as: neurosis, menopause It is often misdiagnosed as neurosis, menopause syndrome, depression, heart disease and so on, and patients suffer a lot as they wander around in neurology, gastroenterology, ear, nose and throat, cardiovascular medicine and other departments without proper diagnosis and treatment.
For sympathetic cervical spondylosis, we generally focus on conservative treatment and minimally invasive interventional treatment (low-temperature plasma myeloplasty), and such patients have a variety of subjective symptoms and are prone to recurrent attacks, so both patients and doctors need to treat them with great care and endurance. A small number of patients with severe recurrent symptoms can be operated, and 80-85% of patients are effective.
Effectiveness of cervical spine surgery A large number of surgical cases at home and abroad for more than 60 years show that the effective rate of cervical spine surgery (surgery helps the patient substantially) is about 80-90%, the complication rate is about 5-8%, and the incidence of permanent nerve loss is less than 0.2-0.5%. I have performed more than 1000 open cervical spine surgeries since 1997, with an excellent surgical rate of 85% and complications of 6.67% (27/405, 2013 statistics), with no direct surgical deaths or paralysis. More than 300 cases of minimally invasive cervical plasma surgery with 2.1% complications (all cured), postoperative follow-up efficiency: 95% on the day of surgery, 81% two months after surgery, 76% six months after surgery, 73% three years after surgery.
Systematic non-surgical treatment plan
Duration of treatment: 3 to 6 weeks.
Expected efficacy: 1/3 complete remission; 1/3 partial remission; 1/3 persistent pain – switch to surgical treatment
1.Activity restriction
Full rest for 2~3 weeks. Restrict neck activities, avoid stretching the neck and lifting and carrying heavy objects. In severe cases, bed rest, generally require low soft pillow to sleep, recommended to try duck down pillow.
2.Wear a neck brace
Strictly wear the neck circumference for 1~2 weeks, requiring continuous and uninterrupted; remove it at night if it cannot be tolerated.
3.Drug therapy
1) Muscle relaxation and analgesia: chlorzoxazone, tramadol hydrochloride, Myna.
2) Anti-inflammatory and analgesic: meloxicam, diclofenac sodium, celecoxib, pautazone.
3) Short-acting hormone: dexamethasone prednisone.
4) Nerve nutrition: methylcobalamin, vitamin B1.
5) Improve circulation: vitamin E, prostaglandin.
4. Cervical traction
Most people are effective. Recommended continuous cervical traction, intermittent traction once (half an hour) or twice a day. The course of treatment is about 2 weeks.
5.Physical therapy
Heat therapy.
Physiotherapy: divine light,, ultrasound, ultrashort wave.
Massage.
6.Sports therapy
Muscle isometric contraction cervical spine exercise.
7.Auxiliary Chinese medicine
1)Cervical pain granules.
2)Cervical rejuvenation.
Indications for surgical treatment.
Patients with one of the following conditions need surgical treatment.
Patients treated surgically need to have clear cervical spondylosis changes on X-ray, CT and MRI.
1.Patients with persistent or recurrent shoulder and arm pain, especially those with upper limb or hand weakness.
2.Patients whose conservative treatment has been ineffective for 6 weeks to 3 months.
3.Patients with progressive aggravation of pain, numbness and weakness.