Overview of cervical spondylosis classification
Cervical spondylosis is a disease with diverse clinical symptoms and complex pathology. Clinically typed according to the symptoms of the cervical spine and the site of cervical spondylosis compression, there are currently six classifications of cervical spondylosis.
I. Cervical cervical spondylosis
1. Clinical manifestations: Early on, there may be head and neck and back pain, some of which are severe and dare not touch the neck and shoulder, while others are mild but treatment is always ineffective or recurrent; the head and neck dare not turn or tilt to one side, and often turn together with the torso when turning. The muscles in the neck and collar may be swollen or spasmodic, and there is obvious pressure pain. After the acute phase, the neck and shoulder area and upper back are often sore. Patients often complain that their neck is easily fatigued and they cannot read, write or watch TV for long; some feel headache, posterior occipital pain, chest pain and weakness of upper limbs; some patients complain of “neck tightness” and “stiffness” in the morning after waking up, and they have difficulty moving around or there is a ringing sound in the neck when moving. A few patients have reflex pain and numbness in the upper limbs, but the pain is not aggravated by neck activities.
2.The difference between cervical cervical spondylosis and other diseases
Neck sprain: Neck sprain is commonly known as a drop pillow, which is caused by muscle sprain of the neck. Because its onset is similar to that of cervical cervical spondylosis, it mostly develops in the morning. Therefore, the two are easily confused, and even individual physicians inappropriately regard the two as the same disease The cause of neck sprain is mostly due to poor neck position during sleep, resulting in local muscle sprain. It is completely different from cervical cervical spondylosis caused by intervertebral disc degeneration. Therefore, in the treatment of cervical cervical spondylosis patients, traction therapy is the main treatment, while for patients with neck sprain, traction is not only ineffective, but also can aggravate the condition.
Shoulder joint periarthritis: Shoulder joint periarthritis is also known as “frozen shoulder”, because it mostly develops around the age of 50, it is also called “fifty shoulder”, and its age of onset is similar to cervical spondylosis, and it is accompanied by neck traction symptoms. It is easy to confuse the two, but they should be differentiated because the treatment methods are obviously different.
Rheumatic myofibrositis: Rheumatic myofibrositis is a chronic disorder, mostly related to wind and cold, humidity, etc. It can occur in all parts of the body except the neck and shoulder. In addition to the neck and shoulder, it is also common in the lumbosacral region. Myofibrositis located in the neck and shoulder should be distinguished from cervical cervical spondylosis.
2. Nerve root type cervical spondylosis
1. Neck symptoms may vary in severity depending on the cause of radicular compression. If it is mainly caused by the herniated nucleus pulposus, there are obvious neck pain, paravertebral muscle pressure and formal cervical posture due to the direct stimulation of local sinus nerve. If it is caused by simple degeneration and osteophytes of the hook vertebral joint, the cervical symptoms are milder, and there may not even be any special findings.
2. Radicular pain is the most common, and its extent corresponds to the distribution area of the spinal nerve roots of the affected vertebral segment. In this case, it must be distinguished from dry pain (mainly radial nerve trunk, ulnar nerve trunk and median nerve trunk) and plexiform pain (mainly cervical plexus, brachial plexus and axillary plexus). Other sensory disorders in the distribution area of the nerve root accompany the radicular pain, among which numbness of the fingers, sensory allergy of the fingertips and loss of skin sensation are common.
3. Radicular dystonia is an obvious early increase in muscle tone in those with previous root compression, but it is soon weakened and muscle atrophy appears. The involvement is only limited to the muscle group innervated by the spinal nerve root. In the hand, the greater and lesser interosseous muscles and the interosseous muscles are the most obvious. It should be distinguished from dry and plexiform muscular atrophy and should be differentiated from muscle strength changes caused by spinal cord lesions. If necessary, electromyography or cortical evoked potentials can be performed to differentiate.
4, tendon reflex changes, that is, the involvement of spinal nerve roots involved in the reflex arc abnormal early appear active, but in the middle and later is reduced or disappeared, the examination should be compared with the contralateral. Pure radicular involvement should not have pathological reflexes, but if accompanied by pathological reflexes, it means that the spinal cord is involved at the same time.
5. Special tests Most of the pull tests that increase the tension of the spinal nerve roots are positive, especially in the acute phase and in those with mainly posterior root compression. The positive cervical compression test is mostly seen in cases with nucleus pulposus herniation, nucleus pulposus prolapse and vertebral joint instability; while most of them are weakly positive due to hooked vertebral hyperplasia; most of them are negative due to intra-vertebral canal occupational lesions.
Vertebral artery type cervical spondylosis
1. Vertigo: It is the most common, and almost every patient has vertigo of varying severity, mostly accompanied by diplopia, nystagmus, tinnitus, deafness, nausea and vomiting. During the attack, the patient feels light-headed and unstable, as if he or she and the surrounding scenery are rotating in a certain direction; some patients also feel that they and the ground are moving, tilting and swaying. Vertigo or dizziness often occurs when the head is moved, such as when the head is tilted upward, when the head is suddenly turned or when the head is repeatedly turned from side to side, and in serious cases, fainting or coma may occur. Some patients can only turn their heads to one side, and turning their heads to the opposite side can easily lead to an attack, and turning to the opposite side again can reduce the symptoms; some patients also complain of an attack when they look at the blackboard while taking notes with their heads down. In short, the activity of the head and neck and the change of posture induce or aggravate the vertigo is an important feature of this disease.
2. Sudden collapse: It is a symptom unique to this type. Some of them occur when the vertigo is intense or when the neck is active. Patients may suddenly feel numbness and weakness of limbs and fall down, but they are clear-minded and can get up by themselves. This symptom is associated with sudden head movement or posture change. Some people think it is due to ischemia of the medulla oblongata, while others think it is due to sudden ischemia at the intersection of vertebral bodies.
3.Headache: It is a kind of vascular headache caused by vasodilatation of the collateral circulation due to insufficient blood supply of the solid vertebral basilar artery, which occurs in episodes and lasts for several minutes or hours, or even days. The pain is persistent and often appears or worsens in the morning, when the head is moving, or when the car is bumpy. The headache is usually located in the occipital region, top of the occipital region or temporal region, and is throbbing (pulsating pain), burning pain or swelling pain, which may radiate to the back of the ear, face, teeth, top of the occipital region, and even to the orbital region and the root of the nose. During the attack, there may be nausea, vomiting, sweating, salivation, panic, breath-holding, and blood pressure changes and other symptoms of autonomic dysfunction. In individual cases, there is pain, numbness, tingling or foreign body sensation in the face, hard palate, tongue and pharynx during the attack. Therefore, it is similar to the performance of migraine, and some people call it cervical migraine.
4.Ocular symptoms: such as visual fog, flash in front of the eyes, dark spots, transient dark haze, temporary visual field defects, vision loss, diplopia, hallucinations and blindness, etc. These ocular symptoms are mainly caused by ischemia of the posterior cerebral artery. Visual impairment is mainly caused by ischemia in the visual center of the occipital lobe of the brain, so it can be called cortical visual impairment. Ischemia of the 3rd, 4th, and 6th cerebral nuclei and medial longitudinal capsule can cause diplopia. In addition, because the vertebral artery is connected to the internal carotid artery system by the posterior communicating artery, it can reflexively cause retinal artery spasm and result in ocular pain and changes in the vascular tone of the fundus. Dilatation of the fundus venosus and thinning of the arteries are common during episodes, especially during neck hyperextension. Individual patients may develop vasospastic retinitis. Signs and symptoms such as blepharospasm, conjunctival congestion, corneal hypersensitivity leading to ulceration, lacrimal gland secretion disorder, retrobulbar optic neuritis, proptosis, glaucoma, and Horner’s sign have also been reported in some patients.
5, medullary paralysis and other cerebral nerve symptoms: such as slurred speech, swallowing disorder, loss of gag reflex, choking, soft palate paralysis, hoarseness, tongue extension disorder, oculofacial muscle twitching and facial nerve paralysis, etc.
6, sensory disorders: there may be facial, perioral, tongue, limbs or hemiplegia numbness, some accompanied by pins and needles, anthrax sensation, some may have deep sensory disorders.
From the above manifestations, it can be seen that the symptoms of this disease are many and mixed, but the diagnosis can still be made based on physical examination, x-ray and cerebral hemogram. Since the vertigo is severe during the attack, it is easy to fall down, so it is better to rest on the back during the attack, and the pillow should be lowered to reduce the cervical activity. In addition, it is especially important to prevent new injuries caused by sudden falls.
IV. Spinal cord type cervical spondylosis
1. Lower limb symptoms: Lower limb symptoms appear early and are heavy, mainly manifesting as slowly progressive numbness, coldness, pain, stiffness and trembling, unstable walking, clumsy gait and weakness of both lower limbs. Some patients have the feeling of walking on cotton, head heavy and stumbling; in severe cases, lower limb spasms, difficulty in walking, bedridden and unable to take care of themselves.
2, upper limb symptoms: appear later, some lighter or earlier patients may not have upper limb symptoms, or symptoms are ignored by patients. The symptoms are mostly sensory-motor disorders of the upper limbs bilaterally, such as numbness, soreness, burning sensation, painful shivering, weakness and inflexibility of activities, etc.; even the fine movements of both hands such as holding a pen, holding chopsticks, serving a bowl and tying a button cannot be performed with the hands. Since spinal cord cervical spondylosis is often combined with nerve root damage, that is, some of the symptoms of nerve root cervical spondylosis, the patient may experience pain and numbness in the upper limbs, which may occur in one or more fingers, several fingers on the radial side (thumb side) or ulnar side (pinky side) of the hand, and also in the shoulder, upper arm and forearm, and may also be radiated in the direction of nerve travel.
3, trunk symptoms: numbness, pain in the chest and abdomen, and a feeling of being bound by tight straps (the technical term is “bandage feeling”), resulting in chest tightness and breathlessness.
4. Bladder and rectal sphincter disorders are also common, manifesting as urinary urgency and impatience when there is a feeling of wanting to urinate, and sometimes poor control of urination and even urination of pants. Weakness in urination, incomplete urination and constipation, etc. In severe cases, urinary retention or urinary incontinence. Some male patients can also have sexual dysfunction.
V. Sympathetic cervical spondylosis
I. Five sensory symptoms.
1, eye: there are symptoms of sympathetic nerve stimulation (eye distension disease, photophobia, tearing, blurred vision, vision loss, pupil enlargement, eye danger weakness, gold stars in front of the eyes, flying mosquitoes, etc.) and sympathetic nerve paralysis symptoms (eye sunken, eye danger drooping, dry eyes, pupil narrowing.
2.Nose: nasopharyngeal discomfort, pain, nasal congestion or odor, etc.
3.Ear: tinnitus, hearing loss, and even deafness.
4. Throat: there may be throat discomfort, dryness, foreign body sensation, warmth, and toothache, etc.
II. Head and facial symptoms.
Headache, migraine, head sinking and dizziness, pain in the comb or the back of the neck, as well as facial fever, congestion, numbness and other symptoms.
Third, vasomotor disorders.
1, vasospastic symptoms: coldness, cyanosis, woodiness, pain, edema, and decreased skin temperature in the limbs.
2, vasodilatation symptoms: redness, burning, pain and swelling of finger ends.
IV. Neurotrophic and sweat gland dysfunction.
Cyanosis, coolness, dryness, thinning, excessive or little sweating, excessive hair, or hair in withering, shedding, dry and lusterless nails, as well as nutritional skin ulcers, etc.
V. Cardiovascular symptoms.
Panic, heartbeat, arrhythmia, pain in the precordial region, paroxysmal tachycardia, high and low blood pressure.
VI. Other symptoms.
There may be nausea, warmth, stomach discomfort, pain, loose stools or constipation, frequent urination, urinary urgency, dribbling, and amenorrhea. Many patients also have mood symptoms such as insomnia, dreaminess, irritability and impulsiveness. Sympathetic cervical spondylosis alone is rare and difficult to diagnose. The initial diagnosis is usually made based on the above-mentioned manifestations of phytonadic dysfunction, the effect of cervical spine activity and posture on symptoms, degenerative changes in the cervical spine, such as narrowing of the pushing space, asymmetry and hyperplasia of the hook spine joints, misalignment of small joints, narrowing of the intercervical foramen and bone spurs, and other similar diseases are excluded. If necessary, planetary ganglion or supracervical sympathetic ganglion and high-best epidural closure can help in the diagnosis. The diagnosis is easier for those with radicular or medullary cervical spondylosis and signs.
VI. Esophageal compression type cervical spondylosis
Esophageal type cervical spondylosis is characterized by pharyngeal and esophageal symptoms such as dryness of the throat, pain in the throat, obvious foreign body, difficulty in swallowing and mute voice. The diagnosis of cervical spondylosis is based on pathological changes such as straightening of the physiological curvature of the cervical spine, reversion, increase of the anterior curvature, displacement of the vertebral body, hyperplasia of the anterior edge of the vertebral body, and inflammatory exudation of the mucous membrane of the posterior wall of the esophagus, ulceration of different degrees, and diverticulum formation on X-ray lateral film.
The severity of symptoms is directly related to the size of the change in curvature, the degree of formation of bony redundancy, the form and location of vertebral body displacement, the patient’s age of onset, and the duration of the disease.
The degree and location of pain and dryness in the throat of esophageal cervical spondylosis is different from that of chronic pharyngitis. The symptoms of chronic pharyngitis, such as pain and dryness, are mostly confined to the pharynx and cheeks, and are sometimes mild and severe, and can be aggravated by other diseases such as upper respiratory tract infections. The pain and dryness of esophageal cervical spondylosis are located downward, and most patients have pain in the upper part of the laryngeal node, which may gradually decrease with the strengthening of the cervical activities. The dryness and pain in the throat are more severe, and the foreign body sensation is not obvious. Moreover, the foreign body sensation occurs mostly when swallowing, unlike the foreign body sensation of pruritus, which is significantly affected by emotions. The use of medication for pharyngeal and pruritus is mostly ineffective for esophageal cervical spondylosis . The symptoms of cervical spondylosis may be reduced to some extent and then return to the original level. In contrast, symptom reduction is obvious when using cervical spine treatment methods , especially after correcting vertebral body displacement has an immediate effect. In individual patients, severe hyperplasia at the anterior edge of the vertebral body leads to slow symptom reduction and prolonged treatment time, but still has some efficacy.