I. Overview of the scope or indications of therapy
Cervicogenic vertigo is a clinical syndrome in which vertigo is the main symptom due to degenerative changes of cervical spine or traumatic injury, which causes imbalance of the internal and external balance of the spine, resulting in inadequate blood supply to the extracranial segment of the carotid artery, i.e., vertebrobasilar artery, and the concept of cervicogenic vertigo was introduced by Rya and Cope in 1955. It has a high incidence in China over 40 years old and accounts for a large proportion of vertigo diseases.
II. [Diagnostic criteria
1.History of previous neck injury or disease;
2.Vertigo, i.e., visual rotation and blurring, is often caused by head and neck activities and postural changes, etc.
3. Pain in the neck;
4. Positive neck twist test;
5.X-ray examination with change of cervical curvature or instability.
3.Technology introduction and operation method, may be accompanied by headache, nausea, vomiting, tinnitus and occipital neck pain and numbness of the upper limbs and other symptoms;
The occipital spinal muscles include four pairs of small muscles: the large posterior rectus muscle, the small posterior rectus muscle, the oblique muscle of the head, and the inferior oblique muscle of the head. Although these four pairs of muscles are small, they are well developed and deeply located, all starting and ending at the inferior collar line of the occipital bone and the posterior arch of the atlantoaxial vertebrae and the transverse pontine spinous process. The large posterior rectus muscle starts from the spinous process of the cardinal vertebra and ends at the lateral part of the inferior collar line; the small posterior rectus muscle starts from the posterior atlantoaxial tuberosity and ends at the medial part of the inferior collar line. The superior cephalic oblique muscle starts from the transverse process of the atlantoaxial vertebra and ends at the posterior part of the lateral part of the inferior collar line; the inferior cephalic oblique muscle starts from the spinous process of the cardinal vertebra and ends at the transverse process of the atlantoaxial vertebra. In the treatment of cervicogenic dizziness, the author found that the occipital spine muscle plays a key role in cervicogenic dizziness. In the treatment of cervicogenic dizziness, as long as the strain points of the four pairs of muscles of the occipital spine muscle at the junction with the bone are found, the purpose of treatment can be achieved by releasing them with a sharp needle.
During treatment, the patient lies prone on the treatment bed with the cervical spine flexed as much as possible and the forehead touching the bed surface. The patient is disinfected with iodophor from the lower neckline to the cervical 1 transverse process, and the physician washes his hands with disposable sterile gloves. Touch the small rectus muscle of the head, the large rectus muscle of the head and the oblique muscle of the head at the attachment point of the occipital bone with the finger of the left thumb, and experience it carefully to touch a hard nodule the size of a green bean; after touching the nodule with the finger of the left thumb, fix the nodule, and stab the center of the nodule with a disposable bladed needle in the right hand, straight to the bone surface, and feel the nodule spread out and disappear under the finger.
Touch both sides of the spinous process of the cardinal vertebrae with the left thumb, and compare the muscle tension on both sides of the spinous process of the cardinal vertebrae at the point where the posterior rectus muscle and the inferior oblique muscle of the head are located at the stop of the spinous process of the cardinal vertebrae, and look for the hard nodule point on the side with high muscle tension; also fix the nodule with the left thumb, stab the right hand with the bladed needle from the center of the nodule to release it, and feel the hard nodule disappear under the left thumb. At the point of the transverse process of the atlantoaxial vertebrae on both sides of the patient, the left thumb is used to find the hard nodal point, and after finding it, the left thumb is also used to fix it, and the right hand holds the bladed needle to pierce it, requiring the tip to pierce against the bone. Pay attention to bleeding during treatment, the head is rich in blood circulation, must be more pressure on the needle hole to prevent excessive bleeding, so as not to cause panic in patients, if individual patients appear subcutaneous hematoma, must do a good job of explaining the work, a few days later can be eliminated on its own, do not need to deal with too much. The whole treatment must be carried out in a clean and hygienic treatment room, and the air in the treatment room should be strictly disinfected every day to prevent other situations such as infection. Patients should be advised to strengthen the functional exercise of the collar and back muscles later on, to keep their heads down less and not to exert themselves.
Treatment cycle
The patient should be treated once every 3 days, 3 times as a course of treatment, and the treatment should be evaluated after 1 course of treatment. Generally, one course of treatment can completely solve the symptoms.
IV. Key technical aspects
In this treatment, it is the key to find the exact strain point at the connection between the 4 pairs of small muscles and the bone of the occipital spine muscle, the strain point is usually a hard nodule of the size of a grain of rice, the doctor must be familiar with the anatomy of the occipital spine muscle, familiar with the start and stop of the 4 pairs of small muscles. When cutting with the blade needle must be against the bone in order to completely loosen the nodes, in order to be able to prevent recurrence.
V. Contraindications and precautions differential diagnosis.
【Contraindications】.
1. Those who do not meet the diagnostic criteria of cervical vertigo;
2.Age over 75 years old;
3.Patients with serious heart disease, cerebrovascular, hemophilia;
4.Patients who are more than 3 months pregnant and not suitable for prone position;
Precautions]
1.Communicate with the patient before treatment to avoid tension;
2.Actively communicate with the patient during treatment to prevent the occurrence of needle sickness;
3, instruct patients not to get cold locally after treatment, 24 hours local not wet water, to prevent infection;
4, hyperglycemic patients, should control blood glucose in 7.1 or less before treatment;
5, patients must pay attention to the protection of the cervical spine, to avoid cervical strain or trauma.
Differential diagnosis
1. Meniere’s disease: Meniere’s disease is caused by imbalance of lymphatic metabolism in the inner ear, excessive lymphatic secretion or absorption disorder, causing water retention in the labyrinth of the inner ear, expansion of the inner ear lymphatic system and elevated pressure, resulting in hypoxia and degeneration of the inner ear end receptors. Meniere’s disease mostly occurs in young and middle-aged people and is associated with tinnitus, deafness, nausea, and vomiting during attacks. The vertigo caused by Meniere’s disease is peripheral vertigo, which is characterized by regular attacks of vertigo, accompanied by horizontal nystagmus; it can be asymptomatic after relief;
2, cerebral arteriosclerosis: cerebral arteriosclerosis is a common disease among middle-aged and elderly people, mostly appearing above the age of 40, gradually appearing with symptoms of cerebral cortex hypofunction A, such as dizziness, memory loss, sleep disorders, etc. Its symptoms are not significantly related to cervical activities. Cerebral arteriosclerosis is often a component of systemic atherosclerosis, so it may be accompanied by signs of atherosclerosis of the fundic arteries, aorta, coronary arteries or renal arteries.
3, neurasthenia syndrome: neurasthenia without any neurological signs, mental factors may be its main cause, and cervical spine X-ray shows normal.