Cervical spondylopathy refers to degenerative degeneration of cervical discs and osteophytes of cervical vertebrae, which stimulate or compress the adjacent spinal cord, nerve roots, blood vessels and sympathetic nerves, resulting in a series of manifestations in the neck, shoulders and upper extremities, which is called cervical spondylolisthesis or cervical spondylopathy for short. As the human spine, the cervical spine has the smallest volume, the worst strength, large mobility, high activity frequency, and large unit area load; with the growth of age and the cumulative effect of various acute and chronic strains, it gradually leads to cervical disc nucleus pulposus dehydration, degeneration, fiber ring bulge, rupture, cervical space narrowing, intervertebral ligament injury, relaxation, resulting in vertebral instability, periosteum strain and extrusion, and local microvascular rupture and bleeding and hematoma. With the mechanization of the hematoma and the deposition of calcium salts, a bone superfluity is finally formed. The clinical symptoms of cervical spondylosis occur when the protruding disc and the hyperplastic bone flab stimulate or compress the adjacent spinal nerve root, vertebral artery or spinal cord, resulting in injury, sterile inflammation and post-repair reaction. The latest view is that cervical spondylosis occurs as a result of degeneration or injury leading to imbalance in the dynamic and static balance of the cervical spine, which is caused by ectopic compression or chemical stimulation or immune response. The classification of cervical spondylosis is not very uniform at present, and a more comprehensive classification can be seven types, namely cervical, radicular, spinal, vertebral artery, sympathetic, mixed and other types.
Chinese medicine calls this disease cervical palsy, and believes that feeling external evil, fall injury, and movement disorder can make the collar meridians and qi and blood run poorly, so the neck pain, stiffness, soreness and swelling; liver and kidney deficiency, qi and blood loss, the supervisory vein is empty, tendons and bones are not nourished, qi and blood cannot nourish the brain, and headache, dizziness, tinnitus, deafness; meridians are blocked, qi and blood do not run smoothly, resulting in pain and numbness in the upper limbs and other symptoms. Cervical spondylosis is mainly closely related to the Directing Vessel and the Hand and Foot Sun Meridians.
Diagnostic criteria
1. There is a history of chronic strain or trauma. Or there is congenital malformation of the cervical spine or degenerative lesion of the cervical spine.
2, mostly in middle-aged people over 40 years old, long-term low head workers or those who are used to watching TV and video for a long time, often present chronic onset.
3, neck, shoulder and back pain, headache and dizziness, stiff neck, numbness of the upper limbs.
4.Limited function of neck movement, pressure pain in the spinous process of the cervical vertebrae and the internal superior angle of the scapula on the affected side, hard nodules in the form of strips can be felt, there may be muscle weakness and muscle atrophy in the upper limbs, and the brachial plexus pulling test is positive. The head press test is positive.
5, X-ray orthopantomograph shows that the hook vertebral joint is hyperplastic, and the chisel-like protrusion may be skewed in the open position. The lateral radiograph shows straightening of the cervical curvature, narrowing of the intervertebral space, osteophytes or ligamentous calcification, and small intervertebral foramen in oblique radiographs.
6.Pathological typing
(1) Cervical type: occipital neck pain, restricted cervical movement, stiffness of the cervical muscles, and corresponding pressure pain points.
(2) Nerve root type: neck pain with upper limb radiating pain, aggravated by posterior cervical extension, decreased sensation in the distribution area of the skin segment of the compressed nerve root, abnormal tendon reflex, muscle atrophy, decreased muscle strength, restricted cervical movement, positive pull test and head press test. Cervical spine X-ray shows: vertebral body hyperplasia, hook joint hyperplasia is obvious, the vertebral space is narrowed, and the intervertebral foramen is small. CT shows posterior vertebral redundancy and narrowing of the nerve root canal.
(3) Spinal cord type: early tightness of the lower limbs, unstable walking, like walking on a beach, late paralysis of one lower limb or all four limbs, diaphoresis or urinary retention. The spinal cord is affected by sensory disturbance below the spinal cord segment, increased muscle tone, hyperreflexia, and positive vertebral body bundle sign. x-ray shows: narrowing of the intervertebral space, serious hyperplasia of the posterior edge of the vertebral body and protrusion into the spinal canal. ct and mri examinations show: narrowing of the spinal canal, hyperplasia of the posterior edge of the vertebral body or disc bulge compressing the spinal cord.
(4) vertebral artery type: headache, vertigo, tinnitus, deafness, blurred vision, postural sudden collapse, symptoms are aggravated when the cervical vertebrae are laterally bent and posteriorly extended. x-ray shows: the transverse process distance becomes smaller, the hook vertebral joint is enlarged. ct examination may show the size of the left and right transverse process hole is asymmetrical, one side is relatively narrow. Vertebral artery angiography shows tortuous, thinning or complete obstruction of the vertebral artery.
(5) Sympathetic nerve type: eyelid weakness, blurred vision, pupil dilation, eye soreness, tearing, headache, migraine, dizziness, occipital and neck pain, tachycardia or bradycardia, precordial pain, increased blood pressure, cold extremities or red and hot fingers, excessive or little sweating on one extremity, etc. X-rays show hyperplasia of the hook vertebrae, narrowing of the intervertebral foramen, change in the physiological curvature of the cervical spine or different degrees of misalignment. There is compression on vertebral arteriogram.
Identification criteria
1.Chinese medicine identification
(1) Wind-cold-damp type: numbness in the neck, shoulder and upper limbs, mainly pain, heavy head, stiff neck, unfavorable movement, cold and wind, light red tongue, thin white fur, tight pulse.
(2) Qi stagnation and blood stasis type: tingling pain in the neck, shoulder and upper limbs, with fixed pain, accompanied by numbness of the limbs, dark tongue, tight pulse.
(3) Phlegm-dampness blocking type: dizziness, dizziness, heavy head like a wrap, numbness of the limbs, dullness, dark red tongue, thick and greasy coating, smooth pulse.
(4) Liver and kidney deficiency: dizziness and headache, tinnitus and deafness, insomnia and dreaminess, numbness of the limbs, redness of the face and eyes, red tongue with little fluid, and a stringent pulse.
(5) Qi and blood deficiency: dizziness, pale face, palpitation, shortness of breath, numbness in the limbs, tiredness and fatigue, pale tongue with little coating and weak pulse.
2. Meridian identification
(1) Governor’s meridian evidence: pain and numbness in the neck, shoulder and upper limbs, weakness in the lower back and a feeling of heaviness in the lower limbs, gradually developing into weakness in the lower limbs, inability to move and difficulty in walking (as a manifestation of spinal cervical spondylosis).
(2) Foot sun meridian evidence: pain in the neck and posterior occipital region, stiffness and tightness in the neck (a manifestation of lesions above the C3 to 4 vertebral space).
(3) Hand Sun meridian evidence: significant local pressure pain, neck discomfort, pain radiating to the ulnar side of the forearm and 4 to 5 fingers (manifestation of lesions in the C7 to T1 intervertebral space damage C8 nerve root damage).
(4) Hand Yangming meridian evidence: radiating pain on the lateral side of the neck, shoulder, arm and upper arm and on the radial side of the forearm (manifestation of a lesion in the C4-5 intervertebral space damaging the C5 nerve root); or pain radiating along the radial side of the affected limb to the thumb (manifestation of a lesion in the C5-6 intervertebral space damaging the C6 nerve root); or pain spreading to the index finger and middle finger (manifestation of a lesion in the C6-7 intervertebral space damaging the C7 nerve root).