Cervical spondylosis is a syndrome of a series of symptoms and signs resulting from changes such as cervical spine osteophytes, cervical collateral ligament calcification, and cervical disc atrophy and degeneration, which stimulate or compress the cervical nerves, spinal cord, and blood vessels. Cervical spondylosis is a common disease, and although there is no mention of cervical spondylosis in Chinese medicine, its related symptoms are scattered in discussions on paralysis, impotence, strong collar, and vertigo.
The disease is most often seen in middle-aged and elderly patients over 40 years old, and is mostly caused by chronic strain or acute trauma. The neck is prone to strain injury after middle age because of the frequent daily activities of the neck and the large degree of activity, which makes it vulnerable to trauma. For example, those who are engaged in long-term head-down work such as accounting, transcription, sewing, embroidery or long-term computer users; or those who have suffered trauma to the neck; or due to the lack of liver and kidney in old age, tendons and bones slack, causing intervertebral disc atrophy and degeneration, reduced elasticity, expansion to the surrounding area, narrowing of the vertebral space, followed by hyperplasia of the anterior and posterior edges of the vertebral body and the hook vertebral joint, small joint relationship changes, vertebral body subluxation, narrowing of the intervertebral foramen, hypertrophy of the ligamentum flavum A series of changes, such as the thickening of the ligamentum flavum, degeneration and calcification of the collateral ligament, etc. The vertebral hyperplasia can cause reactive congestion, swelling, fibrosis, and calcification of the surrounding bulging disc, posterior longitudinal ligament, and joint capsule, which together form a mixed protrusion. When such strain changes affect the cervical nerve roots, the cervical spinal cord or the major blood vessels in the neck, a series of related symptoms and signs can occur. The common basic types of cervical spondylosis are neurogenic, spinal cord, vertebral artery, and sympathetic.
Neurogenic cervical spondylosis, also known as paralytic cervical spondylosis, has the highest incidence among all types and is the most common clinically. Its main manifestations are sensory and motor deficits and reflex changes consistent with the distribution area of the spinal nerve roots. Nerve root symptoms are caused by lesions such as hypertrophy and calcification of cervical ligaments, degeneration of cervical discs and osteophytes, which affect the narrowing of the intervertebral foramen and compression or stimulation of the spinal nerve roots, resulting in the gradual appearance of various symptoms. The joint between the 5th-6th cervical vertebrae and the 6th-7th cervical vertebrae is more mobile, so the incidence is higher than that of the rest of the cervical joints.
Chiropractic cervical spondylosis, also known as paralytic cervical spondylosis, is more common and has serious symptoms, characterized by chronic progressive tetraplegia. Once the diagnosis and treatment is delayed, it often develops into irreversible nerve damage. Since the spinal cord is mainly damaged, and the course of the disease is mostly chronic and worsens when triggered, the clinical manifestation is hypesthesia and upper motor neuron damage symptoms below the damage plane. The symptoms below the damage plane are mostly numbness, decreased muscle strength and increased tone. Patients with spinal cord-type cervical spondylosis mostly have spinal stenosis, which develops with the addition of anterior and posterior compression factors. Protruding intervertebral discs, bone redundancy, calcification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum can cause secondary stenosis of the spinal canal, and if combined with vertebral joint instability, it increases the stimulation or compression of the spinal cord.
Vertebral artery cervical spondylosis is also called vertigo cervical spondylosis. The second segment of the vertebral artery passes through the transverse foramen of the cervical spine and travels alongside the vertebral body. When the hook vertebral joint is enlarged, it can cause compression and irritation to the vertebral artery, causing insufficient blood supply to the brain and producing symptoms such as dizziness and headache. When the cervical spine is degenerated and the vertebral joints are unstable, the relative displacement between the transverse foramina increases and the vertebral artery that travels between them has more chances to be stimulated, and the vertebral artery itself can be twisted to cause different degrees of impairment of cerebral blood supply.
Sympathetic cervical spondylosis The cervical disc degeneration itself and its secondary changes that stimulate sympathetic nerves and cause related syndromes are called sympathetic cervical spondylosis.
Key points for diagnosis and investigation
Neurogenic cervical spondylosis Most patients have no obvious history of trauma. Most patients gradually feel unilateral limited pain in the neck, with electric shock-like radiation from the cervical root to the shoulder, upper arm, forearm and even the fingers, and a numbness, either predominantly painful or predominantly numb. The pain is sore, burning or electric shock-like, and can be aggravated by posterior neck extension, coughing, or even increasing abdominal pressure. The upper extremities are heavy, sore and weak, and hold objects that fall easily. Some patients may have dizziness, tinnitus, ear pain, reduced grip strength and muscle atrophy, and the neck is often painless in such patients.
Clinical examination: restricted neck movement, stiffness, radiating pressure pain on the anterior side of the cervical transverse process, pressure pain points on the upper part of the affected scapula, some patients may feel striated nodules, decreased sensation in the area of the skin segment distribution of the compressed nerve root, abnormal tendon reflexes, and decreased muscle strength. In cervical 5-6 intervertebral lesions, stimulation of the cervical 6 nerve root causes hyperalgesia in the affected thumb or thumb and index finger; in cervical 6-7 intervertebral lesions, stimulation of the cervical 7 nerve root causes hyperalgesia in the index and middle fingers. Positive brachial plexus nerve pull test and positive cervical intervertebral foramen squeeze test.
X-ray examination: X-ray of cervical spine in front and side, oblique or lateral hyperextension and hyperflexion can show changes such as vertebral body hyperplasia, crooked vertebral joint hyperplasia, narrowing of the vertebral space, reduction, disappearance or anteversion of the physiological curvature of the cervical spine, mild slippage, calcification of the collateral ligament and small intervertebral foramen.
Neurogenic cervical spondylosis should be differentiated from ulnar neuritis, thoracic outlet syndrome, carpal tunnel syndrome and other diseases.
Chiropractic cervical spondylosis Slowly progressive numbness, coldness and pain in both lower extremities, poor walking, weakness, weak legs, easy to stumble and fall, and inability to cross obstacles. The symptoms are relieved when resting, aggravated by stress and exertion, and progressively aggravated when slowed down. In the late stage, lower limbs or quadriplegia, urinary incontinence or retention.
Clinical examination: limited cervical movement is not obvious, upper limb movement is inflexible, sensory and motor impairment of bilateral spinal cord conduction tracts, i.e. sensory impairment below the compressed spinal cord segments, increased muscle tone, hyperreflexia, positive cone bundle sign.
The cervical spinal cord is a very important part of the spinal cord.
Spinal cord cervical spondylosis should be differentiated from spinal cord tumors and spinal cord cavernous disease.
Vertebral artery cervical spondylosis The main symptoms are unilateral cervical-occipital or occipital top episodes of headache, vision loss, tinnitus, hearing loss, dizziness, and sudden collapse episodes. It is often triggered or aggravated by head movement to a certain position, and vertigo attacks caused by head and neck rotation are the most characteristic of this disease. Vertebral artery flow test and vertebral arteriogram can assist in the diagnosis and identify whether the vertebral artery is normal, has compression, tortuosity, thinning or blockage.
X-ray examination: it can show vertebral segment instability and lateral hyperplasia of the hook vertebral joint.
Vertebral artery type cervical spondylosis should exclude diseases such as ophthalmogenic and otogenic vertigo and brain tumor.
Sympathetic cervical spondylosis The main symptoms are headache or migraine, sometimes accompanied by nausea and vomiting, soreness and pain in the neck and shoulder, cold and cyanosis in the upper limbs, blurred vision in the eyes, swelling and pain in the eye sockets, weakness of the eyelids, dilated or narrow pupils, often tinnitus, hearing loss or loss. Persistent pressure pain or drilling pain in the precordial region, arrhythmia, and tachycardia. Symptoms may be significantly aggravated by head and neck rotation, and compression of the spinous processes of unstable vertebrae may induce or aggravate sympathetic symptoms.
The diagnosis of sympathetic cervical spondylosis alone is difficult, and care should be taken to differentiate it from diseases such as coronary artery insufficiency and neurosis.
Treatment
The main treatment is manual therapy, together with medicine, traction and gong practice.
Tendon manipulation Tendon manipulation is the main method for treating cervical spondylosis, which can relieve the symptoms of some patients more quickly. Firstly, the cervical collar is relaxed by using point pressure, pinching, flicking, rolling, massage and other techniques to relax the tense and spastic muscles; then the cervical collar is rotated, the patient takes a slightly lower sitting position, the operator stands behind the patient’s side, holds the patient’s jaw with the same side elbow bend, the other hand holds its back occiput, the patient is told to relax the neck, the operator pulls the patient’s head toward the top of the head, and then rotates to the home side, when it is close to the limit. When it is close to the limit, the patient will continue to rotate 5-10 degrees with appropriate force, and a slight joint popping sound will be heard, and then the other side will be rotated. This technique must be fully relaxed in the neck muscles, always maintain the head lifting force under the rotation trigger, do not use violence, the rotation trigger technique if improperly used there is a certain risk, so it should be used with caution, spinal cord type cervical spondylosis is prohibited to avoid danger; Finally, the relaxation technique to relieve the pain and discomfort caused by the treatment techniques (Figure 8-3).
Medication For treatment, it is advisable to nourish the liver and kidney, dispel wind and cold, activate and relieve pain, and take Chinese medicine such as tonifying kidney and strong tendon soup, tonifying kidney and strong tendon pill, or neck pain spirit, neck rejuvenation, and root pain flat punch; for obvious numbness, take whole scorpion powder, 1.5g each in the morning and evening, and mix with boiling water; for obvious vertigo, take Guaifeng Ningxin tablets, and also take Danshen injection intravenously; for acute attack and heavy neck and arm pain, it is advisable to activate blood and relieve tendon, and take Shujian Tang internally.
Traction treatment Usually the occipital jaw belt traction method is used. Patients can be traction in sitting or supine position, traction posture to slightly tilt the head forward is appropriate, traction weight can be gradually increased to 6-8kg, every other day or once a day, each time 30 minutes. Occipital traction can relieve muscle spasm, expand the vertebral space, smooth the flow of Qi and blood, and reduce the symptoms of compression and irritation.
Practice activities Do activities such as cervical forward flexion and backward extension, left and right lateral flexion, left and right rotation and forward extension and backward contraction. In addition, you can also do gymnastics, taijiquan, aerobics and other sports exercises.
[Prevention and care]
Reasonable use of pillows, choose the right height and hardness, maintain a good sleep position. Long-term ambulatory workers should pay attention to the functional activities of the neck to avoid chronic strain injury due to the long time in a low posture. During the acute attack period, attention should be paid to rest, mainly static, supplemented by movement, also can be used to fix the neck circumference or neck brace for 1-2 weeks. In the chronic period, activity and exercise should be the main focus. The course of cervical spondylosis is long, and the symptoms of non-surgical treatment are prone to recurrence, and patients often have pessimistic psychology and impatient mood. Therefore, we should pay attention to psychological care, make propaganda and explanation to patients with a scientific attitude, help patients to establish confidence, cooperate with treatment and recover as soon as possible.