Part I: Typology of cervical spondylosis
According to the different tissues and structures involved, cervical spondylosis is divided into: cervical type (also called soft tissue type), nerve root type, spinal cord type, sympathetic type, vertebral artery type, and other types (currently mainly referring to the esophageal compression type). If two or more types exist at the same time, it is called “mixed type”.
I. Cervical cervical spondylosis.
Cervical cervical spondylosis is caused by acute and chronic injury to the neck muscles, ligaments and joint capsule, degeneration of the intervertebral disc, instability of the vertebral body and misalignment of the small joints, etc. The body is attacked by wind and cold, cold, fatigue, improper sleep posture or inappropriate pillow height, which makes the cervical spine over-extend or over-flex, and certain muscles, ligaments and nerves in the neck are strained or compressed. It mostly develops at night or in the morning, and has the tendency of natural remission and recurrent attacks. 30 to 40 years old women are more common.
Nerve root type cervical spondylosis
Neurogenic cervical spondylosis is caused by irritation and compression of cervical nerve roots in the spinal canal or intervertebral foramen due to disc degeneration, herniation, segmental instability, osteophytes or bone redundancy formation. It has the highest incidence among all types, accounting for about 60-70%, and is the most common type in clinical practice. Mostly unilateral, single-root onset, but there are also bilateral, multi-root onset. It is usually seen in people between 30 and 50 years of age, and generally has a slow onset, but there are also cases of acute onset. There are more males than females by a factor of one.
C. Spinal cord cervical spondylosis
The incidence of spinal cord cervical spondylosis accounts for 12-20% of cervical spondylosis and has a high disability rate because it can cause limb paralysis. It usually starts slowly and is more common in middle-aged people aged 40 to 60. When combined with developmental cervical spinal stenosis, the average age of onset is younger than that of patients without spinal stenosis. Most patients have no history of cervical trauma.
Sympathetic cervical spondylosis
Sympathetic nerve dysfunction arises due to factors such as disc degeneration and segmental instability, which cause stimulation of sympathetic nerve endings around the cervical spine. Sympathetic cervical spondylosis has a wide range of symptoms, most of which are sympathetic excitation symptoms and a few are sympathetic inhibition symptoms. Since the surface of the vertebral artery is rich in sympathetic nerve fibers, when sympathetic nerve dysfunction occurs, the vertebral artery is often involved, resulting in abnormal diastolic function of the vertebral artery. Therefore, sympathetic cervical spondylosis is often associated with inadequate blood supply to the vertebrobasilar system along with symptoms of several systems in the body.
V. Vertebral artery type cervical spondylosis
In normal people, when the head is tilted or twisted to one side, the vertebral artery on the same side is squeezed and the blood flow to the vertebral artery is reduced, but the vertebral artery on the opposite side can compensate, thus ensuring that the blood flow to the vertebrobasilar artery is not greatly affected. When segmental instability and narrowing of the intervertebral space occur in the cervical spine, the vertebral artery can be twisted and compressed; the vertebral artery can be directly compressed by the vertebral margins and the bony bulge at the hook vertebral joint, or the sympathetic nerve fibers around the vertebral artery can be stimulated, causing spasm of the vertebral artery and instantaneous changes in the vertebral artery blood flow, resulting in inadequate blood supply to the vertebrobasilar system and symptoms, and therefore no symptoms outside the vertebral artery system.
Part II: Clinical diagnosis
I. Clinical diagnostic criteria
1, cervical type: with a typical history of drop pillow and the above-mentioned cervical symptoms and signs; imaging examination may be normal or only have physiological curvature changes or mild spinal space narrowing, with little bone formation.
2, nerve root type: symptoms (numbness, pain) and signs of radicular distribution; positive intervertebral foramen squeeze test or/and brachial plexus pull test; imaging findings are basically consistent with clinical manifestations; pain due to extra-cervical pathology (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps longus tendinitis, etc.) is excluded.
3, spinal cord type: clinical manifestations of cervical spinal cord damage; imaging shows cervical degenerative changes, cervical spinal stenosis, and confirms the presence of cervical spinal cord compression consistent with clinical manifestations; except for progressive amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, multiple peripheral neuritis, etc.
4, sympathetic type: diagnosis is more difficult, and there is a lack of objective diagnostic indicators. Clinical manifestations of sympathetic nerve dysfunction and imaging show segmental instability of the cervical spine are present. In some patients with atypical symptoms, if the symptoms are reduced after planetary ganglion closure or high cervical epidural closure, it will help the diagnosis. Vertigo due to other causes besides.
(1) Otogenic vertigo: vertigo is caused by vestibular dysfunction in the inner ear. For example, Meniere’s syndrome and embolism of the auditory artery in the ear.
(2) Ophthalmogenic vertigo: refractive error, glaucoma and other ophthalmic disorders. (3) Vertigo of cerebral origin: insufficiency of blood supply in vertebrobasilar artery due to atherosclerosis, lacunar cerebral infarction; brain tumor; sequelae of traumatic brain injury, etc.
(4) Vasculogenic vertigo: Vertebrobasilar insufficiency due to stenosis of V1 and V3 segments of vertebral artery.
Part III: Treatment
1.Acupuncture therapy
It includes acupuncture and moxibustion. Acupuncture is to use refined metal needles to pierce certain parts of the body and stimulate them with appropriate techniques to unblock the meridians, improve the qi and blood, and eliminate clinical symptoms, while moxibustion is to use moxa strips or cones ignited and smoked to stimulate the acupuncture points to achieve the purpose of adjusting the function of qi and blood in the meridians and organs of the human body and preventing and controlling diseases through stimulation.
2.Physical factor therapy
The main function of physical factor therapy is to dilate blood vessels, improve local blood circulation, release the spasm of muscles and blood vessels, eliminate inflammation and edema of nerve roots, spinal cord and surrounding soft tissues, reduce adhesions, regulate the function of plant nerves, and promote the recovery of nerve and muscle functions. Commonly used treatment methods.
(1) Direct current ion introduction therapy
Commonly used with various western drugs (glacial acetic acid, VitB1, VitB12, potassium iodide, nufocaine, etc.) or traditional Chinese medicine (wu tou, wei ling xian, safflower, etc.) placed on the back of the neck, connected to the anode or cathode according to the performance of the drug, opposed or diagonally opposed to another electrode, each time electrified for 20 minutes, applicable to all types of cervical spondylosis.
(2) Low-frequency modulated medium-frequency electrotherapy
Generally, 2000Hz-8000Hz medium frequency electricity is used as the carrier frequency, and low frequency electricity of different waveforms (square wave, sine wave, triangle wave, etc.) from 1 to 500Hz is used as the modulating waveform, which is modulated in different ways and compiled into different prescriptions. The prescriptions are selected according to different conditions, and the electrode placement method is the same as that of DC. Each treatment generally lasts 20-30 minutes and is suitable for all types of cervical spondylosis.
(3) High potential therapy
Using high-potential therapy instrument, the patient sits on the plate electrode or treatment seat, with the foot on the insulating pad, and each treatment lasts 30 to 50 minutes. At the same time, rolling electrodes can be used for 5 to 8 minutes in the posterior neck collar area or the affected area, once a day, every 12 to 15 days as a course of treatment, which can be used for all types of cervical spondylosis, among which sympathetic cervical spondylosis has the best effect.
(4) Other therapies
Such as magnetic therapy, electric excitation therapy, audio electrotherapy, interference electrotherapy, wax therapy, laser irradiation and other treatments are also frequently used in the physical therapy of cervical spondylosis, and the proper choice can achieve certain effects.
3.Traction therapy
Cervical spine traction is a common and effective method for treating cervical spondylosis. Cervical traction helps to release the muscle spasm of the neck, relax the muscles and relieve the pain; release the soft tissue adhesions, stretch the contracted joint capsule and ligaments; improve or restore the normal physiological curvature of the cervical spine; increase the intervertebral foramen, release the stimulation and compression of the nerve roots; enlarge the vertebral space and reduce the pressure in the intervertebral disc. Adjust the microscopic abnormal changes of the small joints, so that the synovial membrane of the joint embedment or the misalignment of the synovial joint can be reset; the three major elements of the direction (angle) of traction force, weight and traction time must be mastered when cervical spine traction treatment is carried out in order to obtain the best therapeutic effect of traction.
(1) Traction mode: commonly used occipito-mandibular band traction method, usually using sitting traction, but the condition is heavy or can not sit traction horizontal traction. Continuous traction, intermittent traction or a combination of both can be used. (2) traction angle: generally according to the lesion site, such as the lesion is mainly in the upper cervical segment, traction angle should be 0-10 °, such as the lesion is mainly in the lower cervical segment (cervical 5 ~ 7), traction angle should be slightly forward, can be between 15 ° ~ 30 °, while pay attention to the patient’s comfort to adjust the angle. (3) Traction weight: the weight of intermittent traction can be determined by 10% to 20% of its own body weight, while continuous traction should be reduced appropriately. Generally, the initial weight is light, such as 6 kg to begin with, and then gradually increase.
(4) traction time: traction time to continuous traction 20 minutes, intermittent traction is 20 to 30 minutes is appropriate, once a day, 10 to 15 days for a course of treatment.
(5) precautions: individual differences should be fully considered, the old and frail should be traction weight lighter, traction time shorter, young and strong can hold heavier and longer; traction process should pay attention to observe and ask the patient’s reaction, such as discomfort or symptom aggravation should immediately stop traction, find the cause and adjust, change the treatment plan.
(6) Contraindications to traction: obvious discomfort or aggravation of symptoms after traction, no improvement after adjustment of traction parameters; obvious spinal cord compression and serious segmental instability; serious degenerative degeneration of aged vertebrae and joints, obvious narrowing of the spinal canal, serious calcification and ossification of ligaments and joint capsule.
4.Manipulation treatment
It is based on the anatomical and biomechanical principles of cervical vertebrae and joints, and for its pathological changes, passive activities such as pushing, pulling and rotating the spine and small joints of the spine are performed to adjust the anatomical and biomechanical relationship of the spine, and at the same time, the muscles and soft tissues related to the spine are loosened and straightened to improve joint function, relieve spasm and reduce pain. The purpose is to improve joint function, relieve spasm and reduce pain.
Part IV Prevention of cervical spondylosis
Degenerative changes in the cervical discs are almost inevitable with age. However, if attention is paid to avoiding some factors that promote degenerative changes in the intervertebral discs in life and work, it will help prevent the occurrence and development of cervical degenerative changes.
First, the correct understanding of cervical spondylosis, establish confidence to overcome the disease
The course of cervical spondylosis is relatively long, the degeneration of the intervertebral disc, the growth of bone spurs, ligament calcification, etc. is related to ageing and aging of the body. The disease is often recurrent, and the symptoms may be heavy during the attack, affecting daily life and rest. Therefore, on the one hand, it is necessary to eliminate the fear of pessimism, and on the other hand, it is necessary to prevent the mentality of getting by and giving up active treatment.
II. About rest
Patients with acute attacks or first attacks of cervical spondylosis should pay proper attention to rest, and those with serious conditions should rest in bed for 2-3 weeks. From the perspective of cervical spondylosis prevention, it is better to choose a bed that is conducive to the stability of the disease and to maintain the balance of the spine. The position, shape and material of the pillow should be selected, and a good sleeping position is also needed to maintain the physiological curvature of the entire spine and make the patient feel comfortable, so as to relax the muscles of the whole body and adjust the physiological state of the joints.
Third, about health care
1, medical sports health exercises without any symptoms of cervical spondylosis, can be carried out several times a day in the morning and in the evening for slow flexion, extension, left and right lateral flexion
and rotation of the neck. Strengthen the cervical back muscle isometric resistance contraction exercise. It is significant for cervical spine patients to quit smoking or reduce smoking to relieve their symptoms and gradually recover. Avoid overexertion that leads to recurrent inflammation of the throat, avoid excessive weight bearing and human vibration and thus reduce the impact on the intervertebral disc.
2, avoid long-term low posture
To avoid prolonged head-down work, banking and accounting professionals, office desk work, computer operations and other personnel, this position so that the neck muscles, ligaments are strained for a long time and strain, prompting cervical disc degeneration. Change the position after about 1 hour of work. Change the bad work and life habits, such as lying in bed reading, watching TV, etc.
3, the neck is placed in the physiological state of rest
Generally, the adult neck padding is about 10 cm high, high pillow so that the neck is in a state of flexion, the result is the same as the low head posture. When lying on the side, the pillow should be raised to the height of the head does not appear lateral flexion.
4.Avoid trauma to the neck
When you go out in a car, you should wear a seat belt and avoid sleeping in the car to avoid injury to the cervical spine due to relaxation of the neck muscles when braking sharply. When neck, shoulder and arm pain occurs, after a clear diagnosis and excluding cervical spinal stenosis, a gentle massage is feasible, avoiding overly heavy rotation techniques to avoid damage to the intervertebral disc.
5.Avoid wind and cold, humidity
In summer, avoid fans and air conditioners blowing directly on the neck, do not blow cold wind directly after sweating, or rinse the head and neck with cold water, or sleep on a cool pillow.