I. Concept
II. Diagnostic criteria in Chinese medicine
Chronic strain injury or history of trauma, congenital malformation of the cervical spine, degenerative lesions of the cervical spine.2 Most often occurs in middle-aged people over 40 years of age, long-term low-headed workers or those who are used to watching television or video for a long time, often with chronic onset.3 Neck, shoulder and back pain, headache and dizziness, stiffness of the neck, numbness of the upper extremities.4 Restriction of neck movement, lesions of the cervical spine, pressure pain in the upper corner of the scapula on the affected side, palpable striae There may be muscle weakness and muscle atrophy in the upper extremities, and the brachial plexus pull test is positive. The head press test is positive.5 X-ray orthopantomographs show hyperplasia of the hook vertebral joint, and the chisel-like protrusion may be skewed in the open position, while lateral radiographs show straightening of the cervical curvature, narrowing of the intervertebral space, osteophytes or ligament calcification, and small intervertebral foramen in the oblique position.5 CT and magnetic resonance examination are meaningful for qualitative localization and diagnosis.
Third, the classification of Chinese medicine evidence
1 Wind-cold-damp type: numbness in the neck, shoulder and upper limbs, mainly pain, heavy head, stiffness, unfavorable movement, cold and wind. Pale red tongue, thin white coating, tight pulse. 2 Qi stagnation and blood stasis: stabbing pain in the neck, shoulder and upper extremity with fixed pain, accompanied by numbness in the limbs. The tongue is dark and the pulse is stringent. 3 Phlegm-dampness blocking the ligaments: dizziness, head heavy as a wrap, numbness and insensitivity of the extremities, dullness. Dark red tongue, thick and greasy moss, smooth pulse.4 Liver and kidney deficiency: dizziness and headache, tinnitus and deafness, insomnia and dreaminess, numbness of the limbs, redness of the face and eyes. Red tongue with little fluid, stringent pulse.5 Qi and blood deficiency: dizziness, pale face. Palpitations and shortness of breath, numbness of the limbs, tiredness and fatigue. Pale tongue with little coating and weak pulse.
IV. Western medical diagnostic criteria
Neck type: ① complaints of head, neck, shoulder pain and other abnormal sensations such as pain, soreness, stiffness, popping sound or calcified tissue friction sound when moving the head and neck, heavier discomfort in the morning, at the attachment points of the musculofascial ligaments in the cervical occipital area, mostly with pressure pain and striae, and accompanied by corresponding pressure pain points. ②The cervical vertebrae on the X-ray film show changes in curvature or intervertebral joint instability and other manifestations. ③Other disorders of the neck should be excluded (drop pillow, frozen shoulder, rheumatic myofibrositis, neurasthenia and other shoulder and neck pain not caused by degenerative disc degeneration).
Nerve root type: ① with more typical root symptoms (numbness, pain), and the scope is consistent with the area innervated by the cervical spinal nerve, i.e. neck pain with upper limb radiating pain, aggravated by posterior neck extension, decreased sensation in the distribution area of the skin segment of the compressed nerve root, abnormal tendon reflex, muscle atrophy, muscle strength loss, and limitation of neck movement. (2) Positive head press test or brachial plexus pull test. ③The imaging findings are consistent with the clinical presentation. ④No significant effect of pain point block (this test may not be performed if the diagnosis is clear). ⑤ Exclude the disorders caused by extra-cervical spine lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps tenosynovitis, etc.) with upper limb pain as the main cause.
Spinal cord type: 1) Clinical manifestations of cervical spinal cord damage: early tightness of the lower limbs, unstable walking, such as walking on the beach, late paralysis of one lower limb or four limbs, incontinence or urinary retention. Sensory disturbance, increased muscle tone, hyperreflexia, and positive vertebral fasciculus sign are seen below the compressed spinal cord segment. ② X-ray shows osteophytes and spinal stenosis at the posterior edge of the vertebral body. The presence of spinal cord compression was confirmed by imaging. (③Except amyotrophic spinal cord sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
Vertebral artery type: ① headache, vertigo, tinnitus, deafness, blurred vision mostly accompanied by sympathetic symptoms or sudden collapse attack. ② Positive rotational neck test. CT examination may show asymmetric size of the left and right transverse foramina and relative narrowing on one side. Exclude ophthalmogenic and otogenic vertigo, and inadequate blood supply to the basilar artery caused by compression of vertebral artery segment I (the segment of the vertebral artery before entering the cervical 6 transverse foramen) and vertebral artery segment III (the segment of the vertebral artery before exiting the cervical spine into the skull). ⑤ Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) with tortuous, thinning or completely obstructive changes of the vertebral artery.
Sympathetic nerve type: eyelid weakness, blurred vision, pupil dilation, eye sockets distension, tearing, headache, migraine, dizziness, occipital and neck pain, tachycardia or bradycardia, precordial pain, increased blood pressure, cold extremities or red and hot fingers, excessive or little sweating on one extremity, etc. X-rays show hyperplasia of the hook vertebrae, narrowing of the intervertebral foramina, change in the physiological curvature of the cervical spine or different degrees of misalignment. There is compression on vertebral arteriogram.
Other types: cervical vertebrae with anterior bird’s beak-like hyperplasia compressing the esophagus causing dysphagia (confirmed by barium examination of the esophagus), etc.
V. Treatment options
1 Conservative treatment
2 Minimally invasive treatment
3Surgical treatment
Evaluation of efficacy (symptom change, pain score, function score, image change)
3.1 Cure: The original symptoms disappear, the muscle strength is normal, the neck and limb functions return to normal, and the patient can participate in normal labor and work.
3.2 Improved: the original symptoms of each type are reduced, neck and shoulder pain is reduced, and neck and limb function is improved.
3.3 Not healed: No improvement of symptoms.