It is common to see patients in pain clinics who come in with neck and shoulder pain and the doctor asks, “What’s wrong there?” The patient replies, “I’m here for cervical spondylosis.” The doctor asks, “How do you know that you have cervical spondylosis?” The patient hands over the X-ray or CT film and says, “If you have cervical spine hyperplasia on the film, isn’t it cervical spine disease?” Is cervical spine hyperplasia necessarily cervical spondylosis? Let’s talk about this issue. The cervical and lumbar spine are the hubs of human spinal activity, and therefore, they are the parts of the entire spine with the highest incidence. The cervical spine, in particular, is the most vulnerable because it is the smallest, the weakest, the most mobile, and the most frequently active. As people age, especially after the age of 40, the bones of the cervical spine will undergo different degrees of hyperplasia, which is medically known as cervical degeneration. For example, a 60-year-old man, even if he has no symptoms, will definitely have cervical spine hyperplasia on his cervical spine X-ray, just like the wrinkles on the face, everyone will have at a certain age. Therefore, cervical spine hyperplasia itself is not a disease. However, the degree of hyperplasia can vary from person to person, even at the same age, due to differences in standard of living, living environment, labor intensity, physical exercise, physical fitness and genetic factors. Only when cervical spine hyperplasia or disc lesions stimulate and compress the adjacent spinal cord, nerve roots, blood vessels and sympathetic nerves, and thus produce a series of symptoms in the neck, shoulders and upper limbs, is it called cervical spondylosis. This means that cervical spine hyperplasia does not necessarily mean cervical spondylosis, and cervical spondylosis does not necessarily mean cervical spine hyperplasia. In the course of a person’s working life, the muscles, ligaments and fascia of the neck and shoulder will be damaged to different degrees. Some injuries are obvious, such as trauma, sprain, infection and surgery; some injuries are not obvious or chronic and accumulative, such as cold, moisture, strain and poor posture. Lesions in all these areas can lead to soreness, numbness and pain in the neck, back of the shoulder and upper limbs. Although the clinical manifestations are somewhat similar to those of cervical spondylosis, they are very different from cervical spondylosis in terms of treatment and prognosis, and are the most common cause of numbness and pain in the neck, shoulders and upper limbs. We found in the clinic that many patients diagnosed as “cervical spondylosis” by some hospitals are not cervical spondylosis at all through our further examination, but only some cervical muscle strain, neck and shoulder myofibrosis, frozen shoulder and other diseases. Let’s talk about cervical spondylosis again. Cervical spondylosis can be divided into five types: 1. Cervical cervical spondylosis. It is the most common in clinical practice and is caused by cervical disc lesions, unrelated to cervical spine hyperplasia. It is common in young adults and manifests as stiffness and pain in the neck, sometimes accompanied by headache. 2.Nerve root type cervical spondylosis. It can be caused by cervical disc herniation and compression or cervical spine spur proliferation, and is mostly seen in middle-aged and elderly people, manifesting as soreness, numbness and pain in one side of the neck, back of the shoulder and upper limbs. It is most likely to be misdiagnosed as such when the neck and shoulder pain is accompanied by cervical spine hyperplasia. 3.Spinal cord type cervical spondylosis. It is less common clinically and mainly manifests as general weakness and difficulty in walking. 4.Vertebral artery type cervical spondylosis. It is mainly due to the compression of vertebral artery caused by cervical spine hyperplasia and insufficient blood supply to the brain. Clinical manifestations are headache, dizziness, tinnitus, etc. 5.Sympathetic cervical spondylosis. It is caused by the sympathetic nerve next to the vertebrae stimulated by the bone spur of the hyperplasia type, which manifests as panic, dizziness, chest tightness, coldness of the upper limbs, false sweating, etc. Expert tip: When there is pain in the neck, shoulder and upper limbs, especially when there is cervical spine hyperplasia on X-ray, CT and other examinations, do not diagnose it as cervical spondylosis. It must be differentiated by detailed clinical examination and further imaging examination so as not to make the diagnosis and treatment go astray.