Most headaches in middle-aged and elderly people over 40 years old are related to cervical spondylosis, except for brain problems. Since the symptoms of cervical spondylosis are related to its type, although it is the same cervical spondylosis, the symptoms occur differently due to different types; even the same person’s cervical spondylosis has different symptoms at different stages due to changes in the “parts” of the cervical spine involved in the lesion, which makes it easy to be misdiagnosed. Therefore, in order to avoid misdiagnosis, it is beneficial to “target” the treatment. The type of cervical spondylosis and its main characteristics should be identified.
Types of cervical spondylosis and its main characteristics
Cervical spondylosis is divided into neurogenic, vertebral artery, sympathetic (nerve) and spinal cord types according to the pathology and clinical manifestations, with the neurogenic type being the most common (accounting for about 50% to 60% of patients with the disease), followed by the vertebral artery type, and more often the mixed type, in which patients have symptoms of the neurogenic type such as headache, occipital and shoulder pain, numbness of fingers, etc., and symptoms of insufficient blood supply to the vertebrobasilar artery such as vertigo and transient cerebral ischemia. The patient may also have symptoms of sympathetic type, such as panic, tightness in the precordial area, numbness and coldness of the hands, and no sweating or excessive sweating on one side of the face.
(1) Key points for identification of neurogenic cervical spondylosis.
(1) Most of them are over 40 years old, with slow onset, sometimes mild and sometimes severe, and a long course of disease.
(2) Headache and neck-shoulder-arm pain, headache is prominent in the occipital region and may radiate to the forehead and temples. Numbness in the fingers, mostly unilateral, but also bilateral (mostly in the little finger, ring finger and small interphalangeal muscle). Some patients have a combination of symptoms of vertebral artery type such as dizziness, vertigo, ear shutdown or tinnitus.
③Cervical stiffness and restricted movement, especially head tilting back can aggravate headache and dizziness.
④There is obvious limited pressure pain in the spinous process, paraspinal process and occipital nerve distribution area of the cervical vertebrae (equivalent to the “Fengchi point”). However, we should be alert to the fact that this kind of cervical stiffness and obvious limited pressure pain must exclude multiple causes of increased intracranial pressure and cervical spine trauma, etc.
(5) A frontal and lateral X-ray of the cervical spine shows degenerative and proliferative changes such as straightening of the cervical spine, narrowing of the intervertebral space, acromegaly, and hyperplasia of the anterior and posterior edges of the vertebral body.
(2) Key points for identification of vertebral artery type cervical spondylosis.
(1) Recurrent episodes of vertigo (spinning or ground tilting, sense of self instability) in middle-aged and elderly people, nausea and heavy vomiting. It occurs for the first time in the morning and at night when the head position changes. Usually there may be dizziness and heaviness, lack of mental clarity, foggy vision, tinnitus, and hearing loss. Head and neck activities, especially when the head is tilted back and extended, can trigger or aggravate the symptoms. Some patients have neck and shoulder pain, finger numbness and other nerve root irritation symptoms.
(2) Headache is caused by insufficient blood supply to the vertebrobasilar artery, and the expansion of its collateral circulation vessels causes distending pain or throbbing pain in the head and occipital area and parieto-occipital area; some patients also have neck and shoulder pain and upper limb string pain and other partial manifestations of neurogenic cervical spondylosis.
(③) Restricted pressure points, especially the tendon attachment points in the cervical area, such as the posterior inferior border of the mastoid process and the base of the occiput, are obvious.
(④) X-ray of cervical spine shows general degenerative changes in addition to transverse hyperplasia of the osteochondral spine and cervical intervertebral instability are often more obvious.
(3) Key points for identifying sympathetic cervical spondylosis.
(1) headache (or migraine), head heaviness) with nausea and vomiting; neck pain and weakness, patients often have the feeling that their necks cannot support the weight of their heads.
② Eye symptoms are more prominent: orbital pain, sore and swollen eyes, dryness, foggy vision and decreased visual acuity, etc.
③Tinnitus, hearing loss or even hearing loss.
④Cardiovascular symptoms such as vague pain in the precordial region, arrhythmia, tachycardia, and increased blood pressure. In addition, due to sympathetic nerve excitation causing vasospasm in the limbs, the ends of the limbs become cold; the head, neck, face or limbs may have a numbing sensation. In short, patients with sympathetic cervical spondylosis have a wide range of symptoms and can show abnormal changes in multiple organs and systems (it has been observed that one patient has as many as 36 kinds of symptoms).
(4) Key points for identification of spinal cord type cervical spondylosis.
(1) Neck and shoulder pain with numbness and weakness of the limbs, awkward walking or even inability to stand. Some patients have a feeling of thoracic or abdominal girdling, fecal incontinence, difficulty urinating or frequent and urgent urination.
②Sensory impairment, with diminished or absent pain sensation in the extremities being the most common; hand muscle atrophy, increased muscle tone in the extremities, hyperactive tendon reflexes, etc.
③Lumbar penetration cerebrospinal fluid dynamics test Most of them show incomplete obstruction. The cervical spine X-ray is the same as that of neurogenic cervical spondylosis.
Warm reminder.
1.Cervical stiffness and obvious limited pressure pain in the spinous process of cervical spine or its paracentral and occipital nerve distribution areas are not absolute positive signs of cervical spondylosis, and multiple causes of increased intracranial pressure, meningeal irritation and cervical spine trauma must be excluded.
2. Based on the typical symptoms of cervical spondylosis combined with clinical medical and neurological examinations, the diagnosis can generally be made without taking cervical spine films or CT or MR. There is no correlation between the cervical spine film and the patient’s symptom performance because the cervical spine may change to different degrees after people reach the age of 35~40, but most of them do not have cervical spondylosis symptoms. The author, who is nearly 80 years old, has significant cervical spine proliferative degeneration, but no symptoms of cervical spondylosis. If cervical disc herniation or spinal cord type cervical spondylosis is suspected, cervical magnetic resonance imaging (MRI) should be done to further confirm the diagnosis and treatment.
3, the symptoms of cervical spondylosis are more complicated because of its different types or the combination of two or three types, plus the lack of specificity of the symptoms of this disease and the lack of characteristic signs, inexperienced clinicians often misdiagnose it as “neurosis”, “neuropsychological disorder “It is not uncommon to see this disease. Please pay more attention to both doctors and patients.