I. Awareness of cervical spondylosis and treatment methods
The development of society, economy and technology has changed the living habits of many people, and the incidence of cervical spondylosis is increasing drastically due to long hours of work, playing with cell phones and computers with heads down and driving frequently, etc. In the past, middle-aged people were the majority, but there is a trend of rejuvenation. Usually, most patients consider whether they have cervical spondylosis when they feel symptoms such as neck pain, numbness of hands, dizziness and stuffiness, and go to the hospital for examination and diagnosis as soon as possible.
There are many treatment methods for cervical spondylosis, which can be divided into two categories: non-surgical treatment and surgical treatment according to the severity of the disease. Most people who suspect cervical spondylosis will go directly to the local clinic for traditional Chinese medicine treatment such as massage, massage, acupuncture and plastering, and a significant portion of them can be relieved or stabilized for a long time.
Some patients’ symptoms do not improve after the above treatments, and even worsen, resulting in weakness of limbs, unstable walking or paraplegia. These patients should go to the hospital in time for early diagnosis, early determination of the severity of the disease, and early formal treatment to avoid aggravation or delay of the disease due to improper treatment.
Non-surgical treatment for cervical spondylosis includes manipulation, Chinese and Western medicine, cervical collar, cervical pillow, cervical traction, local closure, physiotherapy, acupuncture and functional exercise, etc.; surgical treatment includes posterior cervical single-opening spinal canal decompression angioplasty, anterior cervical intervertebral disc removal, cervical vertebral body subtotal cut and graft fusion, artificial cervical disc replacement and many other non-fusion techniques as well as minimally invasive treatment, such as radiofrequency ablation, plasma ablation and ozone injection, etc. When treating, the appropriate method should be selected according to the patient’s condition.
Determination of the severity of cervical spondylosis
Cervical spondylosis is a broad diagnosis, and cervical disc herniation, cervical spinal stenosis, cervical longitudinal ligament ossification, cervical spondylolisthesis, cervical spinal cord cavity and cervical spinal deformity can be called cervical spondylosis. In fact, what most people recognize as cervical spondylosis mainly includes cervical disc herniation and cervical spinal stenosis. Due to differences in age, gender, geography, occupation and individual differences, the degree of cervical spondylosis varies, and so do the principles and treatment plans.
The advantages of MRI are: it can see whether the entire cervical spinal canal is normal or narrowed, whether the cervical medulla is compressed and degenerated, the degree of cervical disc (C2-C7) protrusion, the curvature of the cervical spine, and whether there is inflammation, tuberculosis, tumor, occupancy, and abnormal lesions in the cervical spine; the advantages of CT are: it can accurately determine the degree and location of cervical disc protrusion in a segment and the degree of stenosis of the bony spinal canal in the corresponding plane; it can clearly The advantages of CT are: it can accurately determine the degree of cervical disc herniation, location and narrowing of the bony spinal canal in the corresponding plane; it can clearly see the osteophytes and ligamentous ossification in a segment of the cervical spine;
Therefore, the severity of cervical spondylosis can only be accurately determined by cervical MRI combined with cervical CT. Of course, the severity of symptoms of cervical spondylosis is not exactly proportional to the degree of cervical medullary compression, and the necessary physical examination and description of the patient’s self-perception can also help to determine the severity of cervical spondylosis.
C. What are the indications for cervical spondylosis surgery?
1.Spinal cord cervical spondylosis, cervical spine MRI or CT can clearly see cervical disc herniation compressing the spinal cord and leading to spinal cord degeneration.
2.People with long-term pain and numbness in both upper limbs or one limb, muscle atrophy and weakness in both hands.
3, long-term vertigo, numbness and weakness, cervical spine instability can be seen on X-ray in cervical hyperextension and hyperflexion position.
4.Increased muscle tone of the limbs, unstable walking, and pathological signs of both hands (+).
5, cervical spine CT or MRI can be seen cervical disc prolapse, and the symptoms have not improved for more than 3 months after traction, massage, physical therapy, drugs, etc.
6.Cervical MRI or cervical CT shows ossification of the posterior longitudinal ligament of the cervical spine and severe narrowing of the cervical spinal canal.
7.Occupying lesions, metastases and tuberculosis in the cervical spinal canal.
Will cervical spondylosis surgery lead to paralysis?
Many patients with cervical spondylosis are often reluctant to undergo surgery after learning that they have cervical spondylosis because they do not care or for economic reasons, or they are reluctant to undergo surgery because they are overly worried about the risks of surgery and the paralysis that may result from surgery, thus delaying the timing of surgical treatment and affecting the effect. Once trauma can lead to catastrophic consequences such as paraplegia.
Surgery for cervical spondylosis is indeed risky, but in recent years, with the progress of medicine and the rapid development of spinal surgery technology, surgery for cervical spondylosis has become very mature in large hospitals, and the trauma is small, the post-operative recovery is fast, and you can get out of bed the next day of surgery, resulting in a very low chance of paraplegia, which of course also depends on the skill and experience of the surgeon.
V. Who is suitable for minimally invasive treatment?
In recent years, minimally invasive surgery has developed rapidly due to the development of scopic technology. Minimally invasive treatment of the spine is considered to be an effective method for the treatment of initial cervical spondylosis with little trauma and quick recovery, and is easily accepted by most people, but minimally invasive treatment is not suitable for cervical posterior longitudinal ligament ossification, cervical spinal stenosis, cervical instability free cervical disc prolapse, and cervical spondylosis caused by tuberculosis, tumor, and many lesions.
We believe that minimally invasive treatment is suitable for mild to moderate herniated or bulging cervical discs in one or more stages, where the outer fibrous ring is not ruptured and the spinal cord is mildly compressed with the aid of cervical MRI or cervical CT. In addition, it must also meet the condition that the patient has undergone conservative treatment such as traction, exercise, physiotherapy, and medication for more than 3 months before doing minimally invasive treatment, and the effect is not good. cervical spondylosis is not suitable for most patients.
VI. Am I suitable for conservative treatment? How to treat?
Patients with cervical spondylosis who are treated conservatively usually have a mild condition, which may even be accompanied by cervical muscle strain (such as drop pillow), frozen shoulder, arthritis, etc. It is easy to describe the condition as heavy, but imaging examination does not reveal obvious cervical disc protrusion or cervical spinal stenosis, therefore, we suggest that a scientific treatment plan be adopted after the condition is clearly defined, which will help the early treatment and recovery of cervical spondylosis.
The conservative treatment method often taken for cervical spondylosis is mainly based on traction and functional exercise of the posterior cervical muscles, which can also be combined with symptomatic treatment such as Chinese medicine massage, acupuncture, massage and plastering.