I. Concept
Cervical spondylosis, also known as cervical spine syndrome, is a general term for cervical osteoarthritis, proliferative cervicitis, cervical nerve root syndrome and cervical disc prolapse, which is a disorder based on degenerative pathological changes. It is a clinical syndrome with a series of dysfunctions mainly due to long-term cervical spine strain, osteophytes, or disc prolapse and ligament thickening, resulting in compression of the cervical spinal cord, nerve roots or vertebral artery.
The cervical disc degeneration itself and its secondary series of pathological changes, such as vertebral joint instability, loosening; nucleus pulposus protrusion or prolapse; bone spur formation; ligamentous hypertrophy and secondary spinal stenosis, etc., stimulate or compress the adjacent nerve roots, spinal cord, vertebral artery and cervical sympathetic nerve and other tissues, and cause a variety of symptoms and signs of the syndrome.
II. Pathological changes
The basic pathological changes of cervical spondylosis are degenerative changes of the intervertebral disc. The cervical spine is located between the skull and the thorax, and the cervical intervertebral disc has to do frequent activities under the weight-bearing situation, and is susceptible to excessive subtle trauma and strain and development.
The main pathological changes are: early degeneration of the cervical disc, reduction of the water content of the nucleus pulposus and swelling and thickening of the fibers of the annulus fibrosus, followed by vitreous degeneration and even rupture. After the degeneration of the cervical disc, the resistance to compression and tension is reduced. When subjected to the gravitational force of the skull and the pulling force of the cephalothoracic muscles, the degenerated disc can undergo limited or extensive bulging in all directions, resulting in narrowing of the intervertebral disc space, overlapping and misalignment of the articular processes, and reduction of the longitudinal diameter of the intervertebral foramen.
Due to the weakening of the intervertebral disc’s resistance to strain, intervertebral instability occurs when the cervical spine moves and the stability between adjacent vertebrae decreases, increasing intervertebral mobility and causing mild slippage of the vertebral body, followed by changes such as osteophytes in the posterior tuberosity, hook joint and vertebral plate, degeneration of the ligamentum flavum and collar ligament, chondrosis and ossification.
As the cervical intervertebral disc bulges around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum are lifted, and a gap is formed between the vertebral body and the protruding disc and the lifted ligamentous tissue, called the “ligamentous intervertebral disc gap”, in which tissue fluid accumulates, together with the bleeding caused by microscopic injury, so that this bloody fluid becomes mechanized and then calcified and ossified, thus forming a bone superfluity. The laxity of the anterior and posterior ligaments of the vertebral body makes the cervical vertebrae unstable and increases the chance of trauma, so that the bone superfluous gradually increases.
Together with the bulging fibrous ring, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, the bone superfluous forms a mixture of protrusions into the spinal canal at the equivalent of the intervertebral disc, which may have a compressive effect on the spinal nerve or spinal cord. The bony flab of the hook vertebral joint may protrude from anterior to posterior into the intervertebral foramen to compress the nerve roots and vertebral artery. Osteochondritis at the anterior border of the vertebral body does not usually cause symptoms, but there are reports in the literature of such anterior osteochondritis affecting swallowing or causing hoarseness.
Compression of the spinal cord and nerve roots starts with functional changes only and gradually produces irreversible changes if the pressure is not relieved in time. Therefore, if non-surgical treatment is ineffective, surgical treatment should be promptly performed.
III. Classification and clinical manifestations of cervical spondylosis
According to the different damaged tissues and structures, cervical spondylosis is divided into six types as follows. If two or more types exist at the same time, it is called “mixed type”.
(1) Cervical cervical spondylosis.
(1) Abnormal sensations such as head, neck and shoulder pain with corresponding pressure pain points.
②The cervical spine shows curvature change or intervertebral joint instability on X-ray, with “bilateral”, “double protrusion”, “cut concave”, “hyperplasia “hyperplasia” and other manifestations.
(3) Excluding cervical sprain (commonly known as “drop pillow”), frozen shoulder, rheumatic myofibrosis, neurasthenia and other shoulder and neck pain not caused by cervical disc degeneration.
(2) Neurogenic cervical spondylosis.
① With more typical radicular symptoms (numbness and pain), and its scope is consistent with the area innervated by the involved nerve roots.
②X-ray film shows changes in cervical curvature, instability or osteophytes.
③The pressure neck test or upper limb pull test is positive.
④The effect of painful point closure treatment is not obvious.
⑤ The clinical manifestations are consistent with the abnormalities seen on the radiographs at the segmental level.
(6) Exclude cervical spine bone substantial lesions (such as tuberculosis, tumor, etc.), thoracic outlet syndrome, periarthritis, tennis, gum biceps cholecystitis and other disorders with upper limb pain as the main cause.
(3) Spinal cord type cervical spondylosis.
① Clinical manifestations of spinal cord compression are divided into two types: central and peripheral. The symptoms of the central type start from the upper limbs, while those of the peripheral type start from the lower limbs, and are divided into three degrees of mild, moderate and severe.
②X-ray film shows that the posterior edge of the vertebral body has more osteophytes, and the anterior and posterior diameter of the canal appears narrow.
③Excluding amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
④If individual differential diagnosis is difficult, myelography can be performed.
⑤ If available, CT and MRI can be done and scanned for exclusion.
(4) Vertebral artery type cervical spondylosis.
①There has been a fall attack with cervical vertigo.
② Positive rotational neck test.
(③X-ray shows intervertebral joint instability or hook-and-push joint osteophytes.
④Except otogenic and oculogenic vertigo.
⑤Excluding insufficient blood supply to the basilar artery caused by compression of one segment of the vertebral artery (i.e., the segment of the vertebral artery before entering the transverse foramen of cervical 6) and three segments of the cervical vertebral artery (i.e., the segment of the vertebral artery before exiting the cervical spine into the skull).
(6) Excluding neurosis and intracranial tumors.
(7) To confirm the diagnosis of the disease, especially the pre-surgical localization, should be based on vertebral arteriography.
(8) Push the pulse flow map and EEG only for reference value.
(5) Sympathetic cervical spondylosis: clinical manifestations include a series of sympathetic symptoms such as dizziness, blurred vision, tinnitus, hand numbness, tachycardia, pain in the precordial region, etc., instability or degeneration on X-ray, and negative vertebral arteriography
(6) Other types such as esophageal cervical spondylosis: cervical vertebrae with anterior bird’s beak-like hyperplasia compressing the esophagus causing dysphagia, etc. This can be confirmed by barium esophagogram.
Fourth, the latest diagnostic criteria of cervical spondylosis are.
(1) The diagnosis can be confirmed if the clinical manifestations are consistent with what is seen in the imaging.
(2) For those with typical clinical manifestations of cervical spondylosis and normal imaging findings, attention should be paid to the exclusion of other patients before diagnosing cervical spondylosis.
(3) If there is only abnormal imaging performance without clinical symptoms of cervical spondylosis, cervical spondylosis should not be diagnosed.