Cervical spondylosis
Because of the frequent daily activities of the neck, strain injury often occurs in the neck after middle age, including cervical spine osteophytes, cervical ligament calcification, cervical intervertebral disc degeneration and so on. When such strain changes affect the cervical nerve roots, spinal cord or major blood vessels in the neck, symptoms such as numbness, pain, dizziness and tinnitus can occur, which are collectively referred to as cervical spondylosis. This disease is mostly seen in patients over 40 years old.
[Diagnosis basis]
I. Medical history
A history of chronic strain or trauma, or congenital malformation of the cervical spine or degenerative changes of the cervical spine, mostly occurring in middle-aged people over 40 years of age.
II. Symptoms and signs
(A) Chronic onset, most patients gradually feel pain in one shoulder, arm and hand, numbness, headache and dizziness, stiff neck, or even weakened grip strength, muscle atrophy, or lower limb weakness or dysfunction.
(b) The functional activities of the neck and shoulder or upper limbs are limited, and there is often pressure pain in the spine of the lesion and the affected intra-superior scapular angle, and hard nodules in the form of cords can be found.
(c) Some of them may have headache and dizziness at the same time or alternate episodes of dizziness when the neck is extended backward or bent sideways, and may have nausea, tinnitus, deafness and blurred vision. The gait may be unstable and even sudden collapse, and the patient may wake up immediately after the sudden collapse due to the change of neck position.
Special examination
Positive pull test, positive pressure top test, positive Hoh’s sign.
Auxiliary examination
X-ray frontal, lateral and oblique films of the cervical spine can understand the pathological changes, and CT and MRI can make qualitative diagnosis.
V. Differential diagnosis
(a) Localized type should be differentiated from drop pillow and frozen shoulder
1, the pressure point of drop pillow is located in the muscle (such as sternocleidomastoid muscle, rhomboid muscle, etc.), and the pressure pain is more obvious, while the pressure pain point of cervical spondylosis is mostly located in the spinous process and joint capsule, the drop pillow can be palpated in the back of the neck with striated muscle elevation, and the pressure pain is obvious, while cervical spondylosis only has mild muscle tension. When cervical spine traction is performed, the pain of the fallen pillow does not decrease, and some even increase, and the fallen pillow is more sensitive to closed treatment.
2.Frozen shoulder has obvious shoulder joint activity disorder, pain point is located around the shoulder joint, for pain point closed effective; and X-ray film without cervical spondylosis patient-like physiological anterior curvature straightening, hyperplasia and other changes.
(2) Neurogenic cervical spondylosis should be differentiated from cervical rib syndrome, cervical dorsal myofasciitis and frozen shoulder.
1, cervical rib syndrome The transverse process of the 7th cervical vertebra is too long or there is mechanical compression of the cervical ribs, and the anterior oblique muscle spasm compresses the brachial plexus nerve and subclavian artery and produces neurovascular symptoms. There are the following characteristics: vascular symptoms, cold, purple or pale fingers, reduced symptoms when the affected limb is raised; sinking of the affected shoulder, weakened or absent radial artery pulsation on the affected side. Adelson’s test is positive; X-ray shows that the transverse process of the 7th cervical vertebra is too long or there are free small ribs at the outer end of the transverse process.
2, cervical dorsal myofasciitis There is widespread pain in the neck, but no obvious radiating pain, no abnormal tendon reflexes, most of the X-rays do not show abnormalities, and anti-inflammatory drugs are effective.
The pain is mostly located in the shoulder joint, the radiating pain in the upper limbs is not obvious, and the pressure points are mostly in the short head of the biceps tendon, the rostral process attachment, and the tendon sheath of the long head of the biceps.
(C) Spinal cord type cervical spondylosis should be differentiated from primary lateral sclerosis and posterior longitudinal ligament calcification of the cervical spine
1.Primary lateral sclerosis Progressive spastic paraplegia or quadriplegia without sensory impairment, with a clear lumbar puncture test.
2, cervical posterior longitudinal ligament calcification calcification of the posterior longitudinal ligament narrowing the anterior and posterior diameter of the spinal canal only when serious spinal cord symptoms, X-ray film can clearly show the affected vertebrae posteriorly with increased density of cords or nodular shadow.
(d) Vertebral artery type cervical spondylosis should be distinguished from Meniere’s disease, cerebral arteriosclerosis and ophthalmogenic vertigo
1.Meniere’s disease Sudden onset, illusion of shaking surrounding scenery or oneself, vertigo is aggravated by easy stimulation such as light and mood swings; vertigo attacks are regular, accompanied by horizontal nystagmus, and can be asymptomatic after relief, no abnormal findings in neurological examination, vestibular function test is not normal.
2.Cerebral arteriosclerosis The symptoms of cerebral cortical hypofunction such as dizziness and memory loss are not related to the activity of cervical spine, and are mostly accompanied by abnormal blood pressure and blood lipid.
3. Ophthalmogenic vertigo May have obvious refractive error, which can be relieved when the eyes are closed.
(E) Sympathetic cervical spondylosis should be differentiated from Raynaud’s disease and neurosis
1. Raynaud’s disease Most often occurs in young women, with paroxysmal, symmetrical, intermittent whitening and cyanosis of the fingertips, which can be triggered by mood swings and cold and relieved in summer, with normal peripheral pulses.
2, neurosis is more common in women, symptom changes are closely related to mood swings, more complaints but less objective signs, cervical spine X-rays are mostly abnormal.