Neurogenic cervical spondylosis is a general term for pain and numbness in the corresponding nerve distribution area caused by nerve root compression due to degenerative changes in the cervical disc and its secondary pathological changes. The main clinical symptom is neck pain + radiating numbness in the upper limbs. It has the highest incidence among all types of cervical spondylosis, accounting for about 60%.
The aseptic inflammation and edema produced by neurogenic cervical spondylosis can be absorbed and the pain and numbness can be relieved by drugs and physical therapy. However, the nerve roots of neurogenic cervical spondylosis want to release the compression can only be solved by cervical traction after the acute period (wearing a collar). Functional exercise is an important measure to prevent the disease and prevent its recurrence. Therefore, in the treatment of neurogenic cervical spondylosis, drugs, physical therapy, collar, cervical traction and functional exercise are equally important. The prevention of the disease before it occurs is of the utmost importance.
I. Prevention of disease before it happens.
To improve the bad habits in life and work. Many young people like to lie on the sofa and read books, long hours of low head, sleeping with their heads down when sitting in public transport are bad habits. When working, get up every half hour, turn your head and neck, and move around for a while. Air conditioning can not blow against the neck, you can prepare a jacket with a collar in the office, pay attention to the warmth of the neck and shoulders. In addition, pay attention to the sleeping position, the best to lie flat.
Lying on your side or sleeping on your stomach and pressing your arms under your head will increase the burden on your cervical spine. The pillow should be narrower, can rest under the neck, to a fist height is better. Sleeping with the head slightly tilted back can ensure a slight curvature of the cervical spine. The bed should be wide enough to lay a mattress on a hard bed. To adjust the height of the table and chairs and workbench to adapt to the days and days of intense work.
II. Functional exercise.
This is a lasting but extremely effective hope project, if you can adhere to, the long-term effect is often surprising. The purpose and role of functional exercises for cervical muscles in neurogenic cervical spondylosis are mainly twofold.
① to strengthen the neck muscles, enhance their ability to tolerate fatigue and improve the stability of the cervical spine, thus consolidating the treatment effect and preventing recurrent attacks ;
② Through relaxation exercises in all directions of the neck, the blood circulation in the cervical spine area is activated, stasis and edema are eliminated, and the ligaments of the neck are stretched to relax the spastic muscles and regulate the stress of the cervical spine, thus reducing the symptoms.
During the acute attack of neurogenic cervical spondylosis, it is advisable to rest locally and it is not advisable to increase exercise stimulation; in the remission of symptoms, exercises based on cervical muscle isometric exercises can be performed; when the symptoms basically disappear or are in a chronic state, you can start
(1) cervical spine mobility training, (2) cervical spine function training
(2) functional exercise of cervical spine
(3) strengthening cervical muscle exercise to promote the further elimination of symptoms and consolidate the therapeutic effect. When cervical spine mobility training, functional exercise and cervical muscle strengthening exercise must be noted: if there are more obvious or progressive symptoms of nerve root and spinal cord compression, they should be stopped at any time. And promptly conduct further examination.
Functional exercise should be done at any time, at the right time and at the right time. For detailed treatment, please refer to the scientific article “Treatment of cervical cervical spondylosis” and “Cervicogenic vertigo” on this website.
Cervical collar.
During the acute attack period, the neck can be fixed appropriately, which can limit cervical spine activities and protect the cervical spine, reduce nerve root wear, reduce the traumatic reaction of intervertebral joints, facilitate the decreasing of tissue edema, consolidate the therapeutic effect and prevent recurrence. However, too long fixation of the collar can easily lead to joint stiffness and muscle atrophy. Therefore, after the condition is stabilized, the collar should be removed as soon as possible and functional exercises should be carried out. In addition to neurogenic cervical spondylosis, this collar is also suitable for cervicogenic vertigo, cervical cervical spondylosis, fixation after cervical spine trauma, fixation after cervical spine surgery and spinal cord cervical spondylosis who do not want to operate.
IV. Drugs.
The aseptic inflammation and edema produced by neurogenic cervical spondylosis can be absorbed by methods such as drugs and pain relief.
V. This article focuses on traction for neurogenic cervical spondylosis
(i) Role of traction therapy.
It is widely popular and effective at home and abroad. It can increase the intervertebral foramen and intervertebral space, open the ligaments with folds or ossification, relieve the compressed nerve roots and spinal cord, improve their blood supply, and help restore the function of nerve tissue. The general effects of cervical traction are now considered to be.
(1) Widening the vertebral space, restoring the stability of the cervical thrust and its normal physiological function.
(2) Relieving muscle spasm, stripping and loosening adhesions, eliminating inflammation and edema.
(3) To distract the embedded joint capsule in order to promote the rectification of vertebral body slippage and hook vertebral joint misalignment.
(4) Enlarging the intervertebral foramen and intervertebral space and distracting the folded or ossified ligaments to relieve the compressed nerve roots and spinal cord, improve their blood supply, and help the recovery of nerve tissue function. x-ray study proves that the intervertebral space can be widened by 2.5-5 mm and the longitudinal diameter of the cervical spinal canal extended by more than 10 mm after traction.
(5) Traction opens the tortuous vertebral artery, restores the proportional relationship between the length of the cervical spine and the vertebral artery, keeps the vertebral artery open, maintains normal cerebral blood supply, and restores normal brain tissue function.
In short, traction can adjust and restore the internal and external balance of the cervical spine, and then restore the normal physiological function of the cervical spine. It has been studied that after cervical flexion of 15° and 6 kg of traction, the pressure of cervical intervertebral disc decreased by 50% and the overall displacement of cervical spine increased by 50% on average. Therefore, traction can make pain symptoms significantly relieved or gradually disappear. In the state of traction, the pressure of weight on the disc can be removed; the compression of the disc and its surroundings caused by the muscle contraction and the tension of the ligaments can be reduced.
The disc and its surroundings are not loaded, which is conducive to the supply of nutrients to the disc and its surroundings, so that the damaged annulus fibrosus and its surroundings can be repaired; it is conducive to the venous return of the disc and its surroundings, eliminating edema and promoting the remission of inflammation.
(B) Specific operation of traction.
Cervical spine traction is the main treatment for neurogenic cervical spondylosis. The modern scholars mostly study the angle, weight and time of cervical traction, and although there are certain achievements, there are still shortcomings. For example, it is difficult to form a standardized clinical treatment plan because of the interference of many factors such as the angle, weight and time of traction.
1, traction angle: traction in the cervical flexion position can make the intervertebral space and intervertebral foramen increase and the soft tissue behind the neck stretch, which is suitable for patients with cervical spondylosis intervertebral space stenosis and intervertebral foramen deformation. Flexion of 15 degrees is the maximum angle to keep the physiological curvature of the cervical vertebrae straight and not to have anti-arch, so forward flexion of not more than 15 degrees is appropriate. Posterior extension traction is suitable for patients with altered physiological curvature of the cervical spine, with the aim of restoring normal physiological curvature. Neutral traction can be used for various types, but it is less targeted.
2, traction force: traction force to achieve cervical spine gap increase without causing muscle and joint injury as the purpose. Generally 2~4kg in sitting position and about 10kg in lying position. According to the traction weight classification can be divided into light weight, body weight and large weight traction.
(1) The weight of light weight traction is generally 1.5kg～2.0kg, which is mostly used for longer traction.
(2) Body weight traction is a method of short traction with a weight close to the body weight.
(3) Large weight traction is between the two, the weight is generally between 1/13 to 1/10 of the body weight, and the time is 15 to 30 minutes.
3, traction time: generally in 15 to 20 minutes. Too long is easy to cause muscle and ligament static injury. A course of treatment for about 20-30 days.
4, traction position: according to the classification of traction position can be divided into sitting, lying and oblique traction.
(1) sitting traction is generally suitable for mild and moderate patients, the use of more simple, more hospitals use, family can also be carried out. Sitting traction position is not easy to stabilize, angle change is also small, but has the advantage of traction without friction. Sitting traction method is: after the occipital jaw belt pockets the patient’s head, the patient sits on a stool, traction rope around the carriage above the head, and then through another carriage down traction certain weight for traction.
(2) The prone traction method is as follows: the patient is lying in bed with the pulley mounted on the bed frame above the head. After the occipito-mandibular band is wrapped around the patient’s posterior occiput and lower jaw, the traction rope is pulled down by a certain weight via the top of the head pulley. The advantage of supine traction is that the posterior widening of the C4-C7 intervertebral space is more obvious in the supine position, and the neck muscles do not have to support the weight of the head, so that it is comfortable.
The angle is also easy to adjust, and the patient can be fully rested and traction can be applied during sleep, which is generally suitable for severe patients with 24-hour continuous traction.
(3) The oblique traction method is between the first two positions and is suitable for patients with cardiac insufficiency.
(4) Portable traction method, that is, the use of some simple equipment and inflatable neck circumference, brace against traction, etc. for traction.
5, traction mode: can be divided into continuous traction and intermittent traction. Continuous traction in the whole process always maintain traction; intermittent traction in the traction process there are several intervals of traction. The latter is mostly chosen by those who are old and in heavy condition.
According to the traction time classification can be divided into short time and long time traction. Short traction is generally 15-30 minutes each time. Long traction is suitable for inpatients. The length of traction time is related to the traction weight, such as body weight traction. It generally lasts 15-30 seconds each time, 3 times in a row, with an interval of 1 to 2 minutes each time. From the combination of the above factors, there can be many methods of neck traction, and each hospital also tends to select them according to their own conditions and different treatment experiences.
However, in general, the method of sitting, small weight, short time or continuous, occipito-mandibular band is mostly used in China. The weight starts at 4 kg and is gradually increased to 10 kg with the course of treatment. Once a day, each time for 15 to 30 minutes, each course of treatment in about 20 times.
6, traction indications: traction is mainly adapted to age 18 years or older (too young bones are not yet fully developed) without serious osteoporosis: neurogenic cervical spondylosis, cervical cervical spondylosis, cervical spine physiological curvature changes.
7, family self-traction: in the use of traction frame for family self-traction of the neck, it should be stressed that this traction must be directed by a doctor and informed of precautions before proceeding. Inappropriate repeated traction can lead to relaxation of the ligaments attached to the cervical spine, accelerate degeneration and reduce the stability of the cervical spine.
8.Traction does not adapt to stop.
1, cervical spine muscle and ligament static injury, clinical manifestation is similar to drop pillow.
2, nerve root injury, numbness and pain in the upper limbs.
3, vertebral small joint dysfunction, manifested as limited neck movement.
4.Vertebral artery distortion, reduced blood supply, manifested as vertigo.
5.Dislodged vertebral artery plaque, easily causing lacunar cerebral embolism.
6, occipital nerve injury, manifested as headache
9, traction contraindications: traction, although safe, simple and effective. But all contraindications should be ruled out, especially for the elderly should be more cautious. Should be applied only when the nuclear magnetic examination is determined feasible. Such as cervical disc herniation, cervical spinal stenosis, cervical fracture, cervical tuberculosis, cervical tumor, spinal cord cervical spondylosis, serious osteoporosis, serious degeneration, serious cardiovascular disease, etc. should be excluded.