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Abstract: Degenerative changes of the spine, also known as spinal degeneration, are part of the aging process of the spine and can manifest as osteophytes at the vertebral edges, narrowing of the vertebral space, and loss of physiological curvature. In this case, a 47-year-old middle-aged male patient had neck and shoulder pain for many years, and a radiograph showed mild osteophytes at the edge of the cervical spine and narrowing of the vertebral space, which was finally diagnosed as degenerative changes of the spine. After physiotherapy such as hot compresses, physiotherapy and baking electricity, and with drug treatment, the symptoms of neck and shoulder pain were relieved and the mobility of the cervical spine was restored.
Basic information】Male, 47 years old
Disease Type】Degenerative changes of the spine
Hospital】The First Hospital of Harbin Medical University
Date of consultation】May 2022
Treatment plan】Oral medication (acetaminophen extended-release tablets) + topical medication (flurbiprofen gel paste) + physical therapy (neck heat, physiotherapy, baking electricity) + life and driving habits adjustment
Treatment period】10 days of outpatient treatment, review after 6 weeks
Treatment effect]: Relief of neck and shoulder pain symptoms, recovery of cervical spine mobility
I. Initial consultation
The patient is a cab driver who has been driving for more than 10 years. In recent years, he always felt pain, soreness and swelling in his neck and shoulder when driving on weekdays. On outpatient examination, it was found that the patient’s neck was stiff and difficult to rotate, and there was obvious pressure pain and percussion pain at the back of the neck, and a pressure pain point could be clearly pressed on the back of the neck. A frontal and lateral X-ray of the cervical spine showed the presence of physiological curvature of the cervical spine, mild osteophytes at the edges of the cervical 3-7 vertebrae, and narrowing of the cervical 5-7 intervertebral space. The patient was diagnosed with degenerative changes of the spine.
II. Treatment history
The patient underwent outpatient examination and treatment, and a cervical disc CT scan was further refined. After ruling out the possibility of cervical spine pathology and nerve entrapment, the patient was given treatment instructions. First of all, bad posture should be avoided. Recently, driving time should be reduced, and cervical spine should be protected by wearing a neck brace or collar when driving, avoiding driving habits such as incentive driving and emergency braking, and not driving night cabs. It can also be combined with oral non-steroidal anti-inflammatory and analgesic drugs, giving the patient acetaminophen extended-release tablets and topical flurbiprofen gel paste to be applied to the affected area to relieve pain in the neck and shoulder. In addition, patients are advised to avoid getting cold in the neck and pay attention to keeping warm. Physical therapy methods such as neck heat, physiotherapy and baking can be performed, and do not sleep with high pillows at night.
III. Treatment effect
On the 3rd day of outpatient treatment, after taking acetaminophen extended-release tablets orally and applying topical flurbiprofen gel paste, the patient felt relief of neck and shoulder pain and neck stiffness; the above symptoms were significantly relieved on the 10th day of treatment, after which the patient stopped taking medication, resumed driving work, and insisted on wearing a collar under the premise of ensuring driving safety. 6 weeks later, the patient’s pain symptoms disappeared and cervical mobility was restored upon review.
IV. Notes
We are glad that the patient’s symptoms were recovered, but this does not mean that the treatment is over. Since degenerative changes in the spine will gradually worsen, it is likely that similar symptoms will occur again in the future. Therefore, it is recommended that patients need to adhere to long-term treatment and protection of the neck in their daily life to slow down the rate of spinal degeneration as much as possible. Avoid bad posture, avoid prolonged head down, avoid incentive driving, emergency braking and other bad driving habits, avoid getting cold in the neck, pay attention to keeping warm, and do not sleep with a high pillow at night. You can review the cervical spine X-ray once a year to observe the progress of degenerative spine changes by comparison.
V. Personal insight
Degenerative spine changes are a manifestation of the aging spine and are therefore irreversible once they occur. Therefore, the treatment of this patient is not to cure the degenerative spine changes, but to relieve a series of discomfort symptoms caused by degenerative spine changes, such as neck and shoulder pain, muscle stiffness, etc. Through physical therapy, the application of non-steroidal anti-inflammatory and analgesic drugs, the purpose of relieving symptoms and delaying degenerative spine changes can be achieved.