I. Definition of cervical spondylosis
Degenerative changes of cervical disc tissue and its secondary pathological changes involving the surrounding tissue structures (nerve roots, spinal cord, vertebral artery sympathetic nerve, etc.), with corresponding clinical manifestations as cervical spondylosis.
Second, general principles
1.The diagnosis can be confirmed if the clinical manifestations are consistent with the imaging findings.
2.With typical clinical manifestations of cervical spondylosis and normal imaging, attention should be paid to the diagnosis of cervical spondylosis only after excluding other disorders.
3.If there is only abnormal imaging performance without clinical symptoms of cervical spondylosis, it should not be diagnosed as cervical spondylosis.
Diagnostic principles for each type of cervical spondylosis: In addition to the above principles, the diagnostic bases for each type of cervical spondylosis are as follows
1.Cervical type.
(1) Complaint of abnormal sensations such as head, neck and shoulder pain with corresponding pressure pain points.
(2) The cervical spine shows curve changes, or intervertebral joint instability and other manifestations on the X-ray film.
(3) Other disorders of the neck should be excluded (drop pillow, frozen shoulder, rheumatic myofibrositis, neurasthenia and other pain in the neck and shoulder not caused by degenerative disc degeneration.
2.Nerve root type.
(1) With typical radicular symptoms (numbness and pain) and the scope is consistent with the area innervated by the cervical spinal nerve.
(2) The imaging findings are consistent with the clinical manifestations.
(3) No significant effect of painful point closure (this test may not be performed if the diagnosis is clear).
(4) Excluding the pain of the upper extremity caused by extra-cervical lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps tenosynovitis, etc.).
3.Spinal cord type.
(1) Clinical manifestations of cervical spinal cord damage.
(2) X-rays show osteophytes and spinal stenosis at the posterior edge of the vertebral body. Imaging confirms the presence of spinal cord compression.
(3) Excluding amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
4.Vertebral artery type: the diagnosis of vertebral artery type cervical spondylosis is a problem to be studied.
(1) There was a sudden collapse attack and cervical vertigo.
(2) Positive rotational neck test.
(3) X-rays show segmental instability or osteophytes of the hook vertebral joint.
(4) Most of them are accompanied by sympathetic symptoms.
(5) Exclude ophthalmogenic and otogenic vertigo.
(6) Exclude insufficiency of the basilar artery supply caused by compression of the carotid artery segment I (the segment of the vertebral artery before entering the cervical and transverse foramen).
(7) Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) should be performed before surgery.
5, sympathetic type: clinical manifestations are dizziness, blurred vision, tinnitus, hand numbness, tachycardia, precordial pain and a series of other symptoms, instability or degeneration on X-ray, negative vertebral arteriogram.
6, other types: cervical vertebrae anterior bird’s beak-like hyperplasia compressing the esophagus causing dysphagia (confirmed by barium esophagogram), etc.