Cervical spondylosis is a degenerative change of the cervical disc tissue and its secondary pathological changes involving the surrounding tissue structures (nerve roots, spinal cord, vertebral artery, sympathetic nerve, etc.), and the corresponding clinical manifestations are cervical spondylosis.
1. The diagnosis is based on 1. It is mostly found in low-headed workers and is common in middle-aged and elderly people. There is a history of chronic strain or trauma.
2. Neck, shoulder and back pain, neck stagnation, upper limb numbness, or headache and dizziness. 3. Restriction of neck movement function, lesioned cervical vertebrae next to the spinous process, the affected side of the upper scapula often has pressure pain, can be felt as a hard nodule, upper limb muscle weakness or muscle atrophy, positive brachial plexus nerve pull test.
4. X-ray orthopantomographs may show hyperplasia of the hook vertebral joint, and lateral radiographs may show straightening of the cervical curvature, narrowing of the intervertebral space, osteophytes or calcification of the ligaments, and small intervertebral foramina on oblique radiographs.
5. CT or MRI is meaningful for qualitative localization and diagnosis.
1. External attack of wind and cold: pain and stiffness in the neck, involving the arms and fingers, heavy headache, fear of cold and bad wind, aggravated by cold weather. The tongue is pale, with thin white or thin greasy coating, and the pulse is floating and tight.
2. Qi stagnation and blood stasis: severe pain in the neck with fixed pain, radiating to the top of the occiput and the arms and fingers. The tongue is dark, or there are petechiae or petechiae, and the pulse is astringent.
3. Phlegm and blood stasis: pain in the neck, dizziness, head heavy as a wrap; numbness of the limbs, dullness; palpitation, nausea, tiredness and drowsiness; choking in the throat, coughing and wheezing with phlegm, chest tightness and distension, stomach and epigastric distension, and unpleasant complexion. Pale tongue with white and greasy coating.
4. Liver and kidney deficiency: sore neck, sore waist and knees, head and eyes sinking, deaf ears, insomnia and dreaminess, numbness of limbs. In the case of Yang deficiency, the face is white, the limbs are warm, the tongue is light and fat, with teeth marks on the side, and the pulse is sunken and sluggish; in the case of Yin deficiency, the face is flushed, the tongue is red with little moss and cracks, and the pulse is sunken and fine.
5, the governor of Yang does not pass: lower limbs impotence, tendons and veins detention, staggering gait, or even bedridden; waist and knees are sore and soft, two do a day monk hit a day bell difficult, or sexual dysfunction. The tongue is fat, with tooth marks on the side, and the pulse is sunken and weak.
Modern medical typing 1, cervical type: occipital neck pain, restricted neck movement, stiff neck muscles, with corresponding pressure pain points. x-ray film shows that the physiological arc of the cervical spine in the lesioned segment has changed.
2. Nerve root type: neck pain with upper extremity radiating pain, aggravated by posterior neck extension. The skin innervated by the compressed nerve root may show painful hypersensitivity in the acute stage, and in the later stage, it shows hyperalgesia, muscle weakness or muscle atrophy in the innervated muscles, abnormal tendon reflex, positive brachial plexus nerve pull test, percussion test and intervertebral foraminal squeeze test. The cervical spine X-ray shows that the vertebral body is hyperplastic, the intervertebral space becomes gap, and the intervertebral foramen becomes smaller. the posterior redundancy of the vertebral body and the narrowing of the nerve root canal can be seen in CT.
3, spinal cord type: early feeling of lower limb weakness, unstable walking, clumsy gait, complaining of the feeling of “stepping on cotton” under the feet. Then there is numbness and weakness in the upper limbs, and a feeling of banding in the chest and abdomen. This is often accompanied by bladder and rectal sphincter dysfunction. The spinal cord is often associated with bladder and rectal sphincter dysfunction, sensory impairment below the spinal cord segment, increased muscle tone in the lower extremities, decreased muscle strength, hyperactive knee and ankle reflexes, positive patellar clonus, and positive Hoffman’s sign (posterior extension examination is helpful for early diagnosis of spinal cord compression).
4, vertebral artery type: dizziness, nausea, emesis, often associated with head and neck rotation, aggravated by cervical lateral bending and back extension; history of sudden collapse, which can be recurrent, but no impairment of consciousness; or tinnitus and deafness, blurred vision and sympathetic symptoms. X-ray shows small transverse process spacing, segmental instability or osteophytes in the crooked vertebral joint; CT shows asymmetric size of the left and right transverse process foramina and relative narrowing on one side. The results of vertebral artery ultrasound or and color ultrasound (TCD) measurements are of particular diagnostic significance. Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) helps to confirm the diagnosis.
5. Sympathetic type: headache, occipital pain, head swelling, headache is often persistent, mainly in the frontal region, especially in the eye sockets and brow ridge bones. Due to the involvement of different segments, there will be eyelid weakness, blurred god objects, astringency or tearing, bilateral pupils or lid fissures of different sizes, tinnitus, deafness, pain in the precordial region, tachycardia or bradycardia, increased blood pressure; cold extremities or red and hot fingers, little or excessive sweating on one extremity, etc. It may be accompanied by nerve root irritation signs such as neck and shoulder pain. Cervical spine X-ray shows that the hook joint is hyperplastic, the vertebral space is narrowed, the intervertebral foramen is small, and the physiological curvature of the cervical spine is changed or there are different degrees of misalignment.
Fourth, the treatment plan 1, cervical type: roll method, press and knead method of operation on the back of the neck and shoulders, focusing on the operation of the spastic soft tissue; cervical application of gentle shaking method and extraction and extension method. For those with cervical spine dislocation, cervical spine adjustment techniques can be reasonably applied.
2.Nerve root type: operate on the back of the neck, shoulder and upper limb of the affected cervical spine by rolling, one-finger pushing or kneading, and apply cervical spine adjustment techniques reasonably to those with cervical spine misalignment signs, such as small-amplitude rotation of the cervical spine in the state of cervical spine extraction and extension, and rotation and positioning wrenching under extraction and extension.
3, spinal cord type: roll, one-finger pushing or kneading on the back of the neck and shoulders to promote blood circulation in the cervical spinal canal and reduce spinal cord compression; then operate the lower limbs with manipulation to gradually improve the spasticity of the lower limb muscles. For those with cervical spine slippage signs, cervical spine short lever fine-tuning manipulation can be reasonably applied to improve functional cervical spine spinal stenosis and reduce spinal cord compression, and cervical spine trigger method should be used with caution.
4.Vertebral artery type: operate on the back of the neck and shoulders by rolling and pressing, then gently operate on the patient’s two temporal and forehead by pushing with one finger and rubbing with fish interval, and then operate on the occipital, temporal, forehead, orbital, back, chest and other parts depending on the characteristics of the patient’s clinical symptoms.
5.Other therapies a. Traction: Applicable to those with spinal space stenosis. The patient’s reaction should be observed during the initial traction, and traction should be discontinued immediately if there is any aggravation of symptoms.
b. Acupuncture: Fengchi, Tianzhu, and cervical spine points can be used.
c. Drugs: Chinese herbal medicines for internal or external application can be used to invigorate blood circulation and remove blood stasis, and antipyretic and analgesic drugs, mannitol or sodium heptaerythroside for static dehydration, which are suitable for the acute stage.
d. Closure: cervical nerve root closure or sacral canal drip, applicable to the acute stage.
V. Complication management After the appearance of severe spinal cord compression symptoms, patients should be promptly recommended for surgical treatment.
Precautions 1.Tui na is applicable to all types of cervical spondylosis, but attention should be paid to the choice of force and type of manipulation and the safety of manipulation, and the trigger method should avoid roughness.
2.Based on prevention. Pay attention to the position and duration of work and study, the reasonableness of the pillow and the warmth of the back of the neck and shoulder.
3.Rest should be the main focus during the attack period and reduce the neck activities. During the remission period, insist on the functional exercise of the neck muscles.
Evaluation of efficacy 1.Cure: The original symptoms of each type disappear, the neck and limb functions return to normal, and the ability to work and live before the onset of the disease is restored.
2.Improved: the original symptoms of each type are reduced, and the function of neck and limbs are improved.
3.Not cured: no improvement of symptoms.