What is cervical spondylosis
As the cervical intervertebral disc degenerates and ages, the intervertebral disc will bulge or protrude and be accompanied by pathological instability and loosening of the vertebral body, causing the vertebrae and small joints to proliferate and form bone spurs, the unstable intervertebral 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 in middle-aged and elderly people, and is a disease of old age, which generally increases with age. However, it is not uncommon for young people (as young as 16 years old) to develop cervical spondylosis clinically, which is mainly related to factors such as excessive head-down learning, fascination 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 a CT is done to see the exact condition of the bone spur.
Classification of cervical spondylosis and treatment options
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 paying attention to 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 clumsy and weak, it is necessary to see a specialist doctor for consultation and treatment at a spine specialist.
Nerve root type cervical spondylosis – mainly neck, shoulder, back and upper limb pain, 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 unstable walking like stepping on cotton, this type is the most severe 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 less severe 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 be out of 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, menopausal 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. A small number of patients with severe recurrent symptoms can be operated on, and 80-85% of patients are effective.
Effectiveness of surgery for cervical spondylosis
The data of a large number of surgical cases at home and abroad for more than 60 years show that the effective (surgery helps the patient substantially) rate of cervical spondylosis surgery 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%.
Systematic non-surgical treatment plan
Duration of treatment: 3-6 weeks.
Expected outcome: 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. Bed rest in severe cases, generally require low soft pillow for sleep, recommend trial of duck down pillow.
2
Wearing neck brace
Strictly wear neck brace for 1~2 weeks, and require continuous uninterrupted; remove it at night if you can’t tolerate it.
3
Drug therapy
1）Muscle relaxation and analgesia: Clozoxazone Tramadol hydrochloride Myna
2）Anti-inflammatory and analgesic: meloxicam, diclofenac sodium, celecoxib, protamine
3) short-acting hormone: dexamethasone prednisone
4) Nerve nutrition: methylcobalamin, vitamin B1
5) improve circulation: vitamin E prostaglandin
4
Cervical traction
Effective in most people. Continuous cervical traction is recommended, and 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 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 who need surgical treatment need to have clear changes of cervical spondylosis 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 for whom conservative treatment has not worked for 6 weeks to 3 months
3
Patients with progressive worsening of pain, numbness and weakness
Hospitalization time for surgery
About 7~10 days
Effectiveness of surgical treatment
Excellent rate of about 90%