The cardiac symptoms and ECG changes caused by cervical spondylosis are called cervical heart syndrome. Since cervical spondylosis and coronary artery disease are both common diseases in middle-aged and elderly people, they are easily misdiagnosed as coronary angina. The reason for this is that cervical spondylosis can cause compression of the medial branch of the anterior thoracic nerve and the lateral branch of the anterior thoracic nerve from C7 to Tl, which can cause pseudo-angina; or when the spasm of the anterior oblique muscle caused by it compresses the brachial plexus nerve or the spasm of the oblique muscle compresses the posterior branch of the spinal nerve, it can cause spasmodic pain of the left intercostal muscle and produce pseudo-angina. Compression of nerve roots by cervical spondylosis can directly cause spasm of the left thoracic major muscle, resulting in pseudo-angina. Compression of cervical spine joint osteophytes stimulates cervical sympathetic nerves, and the stimulating impulses spread downward through the subcardiac and cardiac sympathetic branches, producing visceral sensory reflexes and causing angina pectoris.
Clinical features
(1) Needle-like pain or distension in the precordial region, lasting more than 15 minutes, sometimes up to several hours.
(2) Nitrates cannot stop cervicogenic pseudo-angina, and the electrocardiogram does not change significantly in the cardiac stress test, and antiarrhythmic drugs cannot control cervicogenic arrhythmia.
③Cervical spine radiographs all showed obvious pathological changes.
④After treatment according to cervical spondylosis, the abnormal cardiac manifestations can be improved with the improvement of cervical spondylosis.
If a patient with arrhythmia of unclear etiology is encountered clinically, accompanied by dizziness, sweating, neck and shoulder pain, soreness and numbness, or easily triggered by head and neck rotation, and the effect of regular antiarrhythmia is not satisfactory, the possibility of cervical spondylosis should be thought of, and X-ray or CT examination should be given in time to clarify the diagnosis.
Cervical hypertension
Cervical spondylosis can cause an increase or decrease in blood pressure, with an increase in blood pressure being more common, called cervical hypertension. Its occurrence may be related to the dysfunction of the vertebrobasilar artery supply and sympathetic nerve stimulation caused by cervical spondylosis.
Clinical features
①There are typical symptoms and signs of cervical spondylosis, and the blood pressure increases beyond normal standards.
②It is often accompanied by inadequate blood supply to the vertebrobasilar artery or cervical heart syndrome.
③The duration of cervical spondylosis is usually more than 1 year.
④Antihypertensive drugs are usually ineffective, and after treatment of cervical spondylosis, blood pressure often decreases to normal.
Cervical syncope
Sudden syncope, called cervical syncope, can occur in cervical spondylosis and is easily misdiagnosed as cerebral arteriosclerosis or cerebellar disorders. The cause of syncope is due to insufficient blood supply to the basilar artery caused by proliferative changes in the cervical spine compressing the vertebral artery.
Clinical features
①There is often a history of typical cervical spine disease.
②Most of the time, the body loses support and suddenly falls to the ground when the head is suddenly twisted during walking, and after the fall, due to the change in the position of the neck, it can wake up quickly without sequelae.
③It is often accompanied by repeated episodes of vertigo, the occurrence of which is related to the change of neck position.
④There may be symptoms of plant nerve dysfunction such as headache, nausea, vomiting and sweating. Signs of hypertrophic cervical spondylosis can be seen by taking cervical spine photographs, and vertebral arteriogram and TCD examination can show vertebrobasilar artery stenosis.
Cervical dysphagia
Swallowing difficulty caused by cervical spondylosis is also called cervical dysphagia. The mechanism.
(1) Stenosis spasm caused by direct compression of the posterior wall of the esophagus by the anterior border of the cervical spine bone.
②Cervical spondylosis causes spasm or excessive relaxation of the esophagus due to plant nerve dysfunction.
(③) Excessive length of bone spur formation causes soft tissue irritation response around the esophagus.
④The bone spur is located at the level of the opening of the esophagus, and it is easy to obstruct the movement of the esophagus, even if the bone spur is also easy to produce symptoms.
Clinical characteristics
①The main symptoms are dysphagia and foreign body sensation in the esophagus.
②The difficulty in swallowing is sometimes mild and sometimes severe, non-progressive, often accompanied by other manifestations such as neck and shoulder pain and numbness of the upper limbs of varying degrees.
③A few patients have symptoms such as swallowing pain, nausea, vomiting, hoarseness, dry cough and chest tightness.
④ The lateral cervical spine film can see obvious changes such as forward protruding bones, barium meal examination of the esophagus can observe the stenosis site, and CT can clearly show the hyperplasia of the anterior edge of the cervical spine and the degree of esophageal compression.
⑤ Hormones and anti-inflammatory drugs (such as anti-inflammatory pain) can be used to relieve the symptoms, but they are prone to recurrence.
Cervicogenic headache
Cervicogenic headache is a group of syndromes caused by organic or functional lesions of the cervical-occipital or (and) shoulder tissues, mainly ipsilateral headache. Pathogenesis.
(1) The posterior branches of C1, C2 and C3 nerves and their branches from the cervico-occipital region are distributed in the corresponding ipsilateral head.
The C1, C2 and C3 nerves and their branches in the cervical region are connected to or converge with certain ganglia or nuclei that innervate the head and face. The headache is caused by abnormalities of single or multiple tissue structures in the cervical-occipital region or (and) the shoulder region, resulting in localized organic or functional changes of the nerves.
Clinical features
Patients with cervicogenic headache are often associated with cervico-occipital or (and) shoulder symptoms, and the headache can be relieved or disappears after treatment of cervical spondylosis. Most of the headaches are simply managed during the consultation and treatment, but the cervico-occipital or (and) shoulder symptoms are ignored, resulting in a lingering headache.
Cervical visual impairment
Cervical spondylosis can cause loss of vision, eye swelling and pain, photophobia, tearing, unequal pupil size, and even reduced visual field and vision, and in a few patients, blindness, which is called cervical visual impairment. The cause may be related to ischemic lesions of the visual center of the occipital lobe of the brain secondary to the vegetative nerve dysfunction caused by cervical spondylosis and insufficient blood supply to the vertebrobasilar artery.
Clinical features
①Ocular symptoms and cervical spondylosis occur simultaneously or sequentially, and the two conditions are closely related to each other.
(2) Intermittent blurred vision and swelling and pain in one or both eyes in the early stage, followed by other ocular symptoms.
③The cause cannot be found by ophthalmic examination, and treatment according to ophthalmology is ineffective. After treatment according to cervical spondylosis, the vision can be significantly improved with the remission of cervical spondylosis.
Spinal cord type cervical spondylosis (CSM)
Spinal cord-type cervical spondylosis has an insidious onset and extremely atypical clinical symptoms, which can easily lead to clinical misdiagnosis and mistreatment. In recent years, due to the continuous improvement of the diagnosis level, it is found that this disease is not uncommon, and the incidence accounts for 5% of the total incidence of cervical spondylosis. CSM has an insidious onset and complex clinical manifestations, which can be manifested as tremor of one limb, twitching, burning sensation in one finger or palm, fear of cold, morning stiffness, weakness of lower limbs, heavy hearing in one ear, pain in both ears, incomplete sensation of urination and defecation, etc. The physical examination and history taking were not careful enough, and there was a lack of comprehensive analysis of the collected clinical data. Some pathogenic factors often do not show up on cervical spine X-ray films, so the diagnosis cannot be excluded implicitly based on X-ray plain films alone, and further myelography, CT or MRI should be done.