I. What is cervical spondylosis?
Cervical spondylosis is a syndrome of a series of clinical symptoms caused by degenerative degeneration of the cervical disc and osteophytes of the cervical spine. Cervical spondylosis can be divided into cervical, neurogenic, spinal cord, vertebral artery, sympathetic and other types. Cervical spondylosis often manifests clinically as pain in the neck, shoulder and arm, upper back of the scapula and anterior thoracic region, arm and hand numbness, muscle atrophy, and even tetraplegia. It can occur at any age, with middle-aged and elderly people above 40 years old being the most common. Cervical spondylosis is characterized by high incidence, long treatment course and easy recurrence.
Second, the cause and mechanism of cervical spondylosis
Cervical spondylosis is mainly caused by degenerative changes of the cervical intervertebral disc and cervical spine and its accessory structures.
1.Intervertebral disc Degenerative changes of the cervical intervertebral disc usually start after the age of 30. The nucleus pulposus becomes thin and the intervertebral space becomes narrow, so that the fibrous ring and surrounding ligaments become relaxed and the stability of the cervical spine is weakened, which makes it easier to further strain and degenerative changes. Degeneration of the fibrous ring and narrowing of the intervertebral space make it easy for the disc to protrude posteriorly and laterally. Cervical 4, 5, cervical 5, 6 intervertebral mobility is the largest, stress is also the most concentrated, the most vulnerable to injury.
2, the vertebral body and its accessory structures when the disc thinning causes cervical instability, the surrounding ligaments are often strained by abnormal stress, resulting in damage to its attachment point and causing osteophytes. The narrowing of the vertebral space also increases the stress on the posterior joint and the hook joint, causing damage and hyperplasia. The segments prone to hyperplasia are cervical 5, cervical 6, cervical 4 and cervical 7 in that order.
3, disc herniation, vertebral body posterior margin hyperplasia, yellow ligament hypertrophy, etc. can cause spinal canal stenosis, resulting in spinal cord type cervical spondylosis. Hook vertebral joint, posterior joint hyperplasia, and disc protrusion to the lateral posterior can compress or stimulate the nerve root, vertebral artery and sympathetic nerve, causing corresponding symptoms.
4.Vascular factors and chemical factors
The pathogenesis of cervical spondylosis, like lumbar disc herniation, cannot be explained by mechanical compression factors alone, but also by vascular and chemical factors at work, thus causing edema and inflammation that trigger or aggravate neurological symptoms.
Third, the treatment methods of cervical spondylosis
(A) Tui Na treatment
1, the role and indications massage for the treatment of cervical spondylosis preferred therapy, Chinese medicine believes that cervical spondylosis is due to long-term strain on the neck, loss of harmony between qi and blood, coupled with external wind and cold, blocking the meridians, massage treatment can harmonize qi and blood, Gui Feng disperses cold, dredge tendons and channels, so as to achieve the effect of relieving spasm and pain. Tui Na is applicable to all types of cervical spondylosis except for the spinal cord type with severe cervical spinal cord compression.
For spinal cord cervical spondylosis, it is not traditionally advocated to carry out massage treatment, because it may aggravate the damage to the spinal cord, but there are reports of safe and effective traction and massage treatment in China, therefore, light spinal cord cervical spondylosis is not necessarily contraindicated to massage treatment, but the technique should be gentle and exempt from the spinning technique.
2.Methods The massage technique should be a combination of rigid and soft, do not be rough, commonly used procedures such as:
(1) in the back of the neck repeatedly for the kneading method, rolling method and one finger Zen pushing method, and then in the neck and shoulder of the Governor, the hand three Yang meridian part of the Yu points such as Fengchi, Fengfu, shoulder within the Yu, shoulder well, Tianzong, lack of pots and other points for point, pressure or take method, and then in the oblique muscles and scapular muscle at the line of flick method. In case of nerve root type, the main points of shoulder, elbow and hand should be included in the treatment; in case of vertebral artery type, the head and face points such as Baihui and Sun should be included. Then use the rotating trigger technique. Finally, wipe, tap and clap are used to finish.
(2) the implementation of the rotating trigger technique, first asked the patient to rotate the neck to one side, the surgeon two hands were placed on the patient’s lower occipital and occipital posterior slightly forceful rotation of the head and neck at the same time. At this point, attention must be paid to 1) the rotation angle should not be too large, 2) the possible “click” sound when rotating the neck should not be pursued unilaterally, and 3) the spinal cord type and vertebral artery type cervical spondylolisthesis should not be rotated.
(II) Traction therapy
1. Indications Cervical traction is commonly used as therapy for neurogenic, cervical and sympathetic cervical spondylosis. However, spinal cord type cervical spondylosis with more obvious spinal cord compression and obvious cervical segmental instability should not be used.
2, the method of cervical traction Generally use the cervical pillow traction belt for cervical traction.
(1) posture: position can be taken sitting or lying, for convenience, more stable sitting position, so that the neck from the longitudinal axis of the trunk forward about 20 ° – 3O °, avoid over-extension. The patient is required to fully relax the neck, shoulder and the whole torso muscles. The traction position should be comfortable for the patient, and should be adjusted as appropriate if there is discomfort. In patients with vertebral artery type, the anterior tilt angle should be small, and in patients with spinal cord type cervical spondylosis, the posture should be nearly vertical, avoiding forward flexion traction.
(2) traction weight and duration: commonly used traction weight varies greatly, traction force to super head weight is better, can be from 1/10 to 1/5 of the patient’s own body weight, most with 6-7kg, the beginning with a smaller weight to facilitate patient adaptation. At the end of each traction, the patient should have an obvious feeling of neck stretching, but no special discomfort, if this feeling is not obvious, the weight should be increased as appropriate. The duration of each traction is usually 20-30 minutes. The traction weight and duration can be made in different combinations, generally the duration is shorter when the traction weight is larger and longer when the traction weight is smaller.
(3) Traction frequency and duration: generally traction 1-2 times a day, there are also 3 times a day, 10-20 days for a course of treatment, can continue for several courses until the basic elimination of symptoms.
(4) If traction in sitting position is not effective, or if the patient has heavy symptoms or is too weak to sit, traction in supine position can be used. Use pillow cushion to maintain proper posture, traction weight is generally 2-3kg. rest 15 minutes after 2 hours of continuous traction, then traction again, the total time of traction can reach 1O-14 hours per day.
(5) Intermittent traction can be performed using electric traction apparatus, which is considered to be beneficial for relaxing muscles and improving local blood circulation. Generally, traction for 2 minutes, relax or reduce the traction weight for 1 minute, repeatedly for about half an hour.
(iii) Physiotherapy
Physiotherapy can improve local blood circulation, relax spastic muscles and relieve symptoms. High frequency (microwave, ultra-short wave), low and medium frequency electrotherapy (such as TENS, intermittent electrotherapy, computerized medium frequency), ultrasound, magnetic therapy, etc. can be used.
(D) Exercise therapy
1, the role of exercise therapy exercise therapy for cervical spondylosis is mainly to do medical gymnastics exercises, the purpose and role of cervical spondylosis medical gymnastics are mainly two aspects: (1) through the relaxation of the neck in all directions of movement, active cervical spine regional blood circulation, eliminate bruising edema, while stretching the neck ligaments, relaxing spastic muscles, thereby reducing symptoms; (2) strengthen the neck muscles, enhance their ability to tolerate fatigue, improve (2) strengthen the cervical muscles, enhance their tolerance to fatigue and improve the stability of the cervical spine, so as to consolidate the treatment effect and prevent recurrent attacks.
2.Indications and contraindications When the symptoms of each type of cervical spondylosis are basically relieved or in a chronic state, medical gymnastics can be started to promote the further elimination of symptoms and consolidate the therapeutic effect. Local rest is recommended during the acute attack of symptoms, and it is not advisable to increase the stimulation of movement. Exercise is contraindicated when there are more obvious or progressive spinal cord compression symptoms, especially cervical backward movement should be contraindicated. In the case of vertebral artery cervical spondylosis, gentle and slow rotation of the neck is recommended, and the amplitude should be controlled appropriately.
(E) Nerve block therapy
Intervertebral foraminal block (epidural block) and paravertebral sympathetic nerve block are effective treatment methods, and repeated single blocks or continuous drug injection with a tube can receive good results. Single blocks are performed twice a week for 5 sessions. For epidural placement, the drug can be injected once a day, every 5 times for a course of treatment.
Stellate ganglion block is effective in the treatment of sympathetic cervical spondylosis (usually combined with intervertebral foramen and cervical pain point block). The immediate effect is often received after the first block treatment, but the long-term effect cannot be maintained, so it must be repeatedly administered to consolidate the effect, and at least 2 to 4 consecutive courses of treatment are required.
IV. Psychotherapy
V. Guidance of daily life activities
1, pillow and sleep: the center of the pillow should be slightly concave, the height of 12 ~ 16cm, the neck should be pillowed on the pillow, can not be suspended, so that the head to keep slightly back. Those who are accustomed to side lying position, should make the pillow with shoulder height. When sleeping, do not lie down and read, and do not put your hands above your head for a long time.
2.Avoid over-extension and over-flexion of the neck: Patients with spinal cord cervical spondylosis should avoid over-extension and over-flexion of the neck when washing the face, brushing teeth, drinking water and writing.
3.Some daily activities should be stopped: During the disease, certain activities that over-activate the cervical spine should be stopped, such as rubbing the glass at high places
Sixth, drug treatment
1, the acute stage can be used anti-inflammatory and pain-relieving western medicine or topical medicine.
2, each phase can be used to activate blood circulation and remove blood stasis. The Chinese herbal medicine that relaxes the tendons and reduces swelling is used for treatment.