I. What is cervical spondylosis?
Cervical spondylosis refers to degenerative changes in the intervertebral disc tissues of the cervical spine and its secondary pathological changes involving the surrounding tissue structures (nerve roots, spinal cord, vertebral artery, sympathetic nerve and anterior central spinal artery, etc.), with clinical manifestations corresponding to the imaging changes.
How many types of cervical spondylosis are there?
1.Cervical cervical spondylosis: the patient presents with abnormal sensations such as pain in the occipital, temporal, auricular and other lower head, neck and shoulder, and is accompanied by corresponding pressure points.
2.Neurogenic cervical spondylosis: The patient presents with more typical radicular symptoms, the scope of which is consistent with the area innervated by the cervical spinal nerve.
3.Spinal cord type cervical spondylosis: the patient shows manifestations of spinal cord damage, with motor, sensory and reflex disorders of the extremities as the main features.
4.Vertebral artery type cervical spondylosis: Patients have had sudden collapse attacks and cervical vertigo, and mostly have cranial symptoms, including blurred vision, tinnitus and hearing impairment.
5.Sympathetic cervical spondylosis: The diagnostic criteria for this type of spondylosis are still controversial and need to be further discussed.
6.Other types of cervical spondylosis: such as esophageal compression cervical spondylosis, cervical instability cervical spondylosis, anterior central spinal artery compression cervical spondylosis, etc.
7.Mixed cervical spondylosis: those with two or more types of cervical spondylosis as mentioned above, mostly seen in patients with long disease duration and relatively high age.
C. Treatment of cervical spondylosis
1.Non-surgical treatment.
(1) Good living and working habits are the basic premise of prevention and treatment of cervical spondylosis. Including: avoid high pillows, low head, hard brakes and strenuous exercise.
(2) Continuous, light-weight head and neck traction should be regarded as safe and effective therapy, and cervical and back muscle exercises should be performed under traction.
(3) Acupuncture, physiotherapy, massage and drugs can be used as appropriate, but pushing, pushing and neck gymnastics are not advocated to prevent aggravating the degeneration, instability and injury of the cervical spine.
(4) Swimming is beneficial to the rehabilitation of the cervical spine, and high-intensity sports that make the cervical spine overactive are not advocated.
(5) Manipulation treatment of cervical spondylosis has the risk of causing acute spinal cord injury, and the indications should be strictly controlled.
2.Surgical treatment
The basic principles of surgical treatment are
(1) Strict indications for surgery.
(2) Surgery for cervical spondylosis is aimed at decompression and reconstruction of stability, and has no therapeutic significance for irreversible lesions of the spinal cord itself.
(3) Strict evaluation of the patient is required before surgery.
(4) Select the appropriate surgical approach according to the specific condition.
(5) Preserve the mobility of the vertebral body as appropriate according to the specific conditions of the patient.
Indications for surgery for various types of cervical spondylosis
1.Cervical cervical spondylosis: in principle, surgery is not required, except for individual cases where long-term conservative treatment is ineffective and seriously affects normal work or life. Intervertebral fusion or artificial disc implantation or other surgical methods can be used.
2.Neurogenic cervical spondylosis: in principle, non-surgical treatment is adopted. Surgical treatment can be adopted if one of the following conditions is present.
(1) Patients whose regular and systematic non-surgical treatment has been ineffective for more than 3 months, or whose non-surgical treatment is effective but recurrent and severe symptoms affect the quality of life or normal work.
(2) Progressive atrophy of the innervated muscles due to nerve root compression lesions.
(3) Patients who have obvious symptoms of nerve root compression and persistent severe pain, which seriously affect sleep and normal life.
3.Spinal cord type cervical spondylosis: If there is no contraindication to surgery for patients with diagnosed spinal cord type cervical spondylosis, in principle, surgery should be performed as early as possible.
4.Vertebral artery type cervical spondylosis: those who meet the following conditions can be treated surgically.
(1) Cervical vertigo with symptoms of sudden collapse, which is ineffective by non-surgical treatment.
(2) Those who are confirmed by MRA or DSA.
5. Mixed cervical spondylosis: These patients have complicated symptoms and are mostly of advanced age, so they should be treated with caution. For patients whose normal work and life have been affected and whose non-surgical treatment has been ineffective for 2-3 months, surgical treatment should be considered.
6.Other types of cervical spondylosis: if conservative treatment is not effective after 2-3 months, surgery can be considered if there are no contraindications to surgery.