What is cervical spondylosis?
Various symptoms and signs caused by cervical disc degeneration and its secondary changes that irritate or compress the adjacent tissues are called cervical spondylosis. Patients often feel pain and numbness in the head, neck, shoulders and arms in mild cases, and in severe cases, it can lead to limb weakness and even urinary and fecal incontinence and paralysis. Office white-collar workers, computer operators, accountants, journalists, teachers and other professions, who often need to maintain a forward leaning posture for a long time in their work, should be aware that they belong to the “high-risk group” for cervical spondylosis. Once neck and back pain persists for more than 2 weeks without improvement, you should go to the hospital for examination.
According to the involved tissues and clinical manifestations of cervical spondylosis, it can be generally divided into the following types.
1.Nerve root type
This type has the highest incidence. As the cervical intervertebral disc protrudes outward, or due to hyperplasia and hypertrophy of the hook vertebral joint or synovial joint, the nerve roots are compressed or provoked, resulting in reflex pain or radioactive pain, abnormal sensation, muscle strength change and reflex change in the corresponding nerve root innervation area; neck hyperextension, coughing and sneezing can aggravate the pain; finger inflexibility and difficulty in fine movements.
2.Spinal cord type
The disease develops due to direct pressure on the spinal cord, or injury caused by repeated abrasion of degenerated tissues on the spinal cord, or impairment of blood supply to the spinal cord. The clinical manifestations of spinal cord disease are different due to the different nerves and degrees of involvement.
In spinal cord cervical spondylosis, where symptoms occur mainly due to mechanical compression, the symptoms appear unconsciously, with early unilateral or bilateral lower limb weakness and numbness, followed by unstable gait, difficulty walking, and numbness in the trunk and upper limbs. Intrinsic muscle atrophy in the hands, increased muscle tone and hyperactive tendon reflexes in the lower limbs are more common; in severe cases, there is urinary and fecal dysfunction. In the early stage, the symptoms are highly fluctuating; if the spinal cord is continuously compressed, the symptoms gradually worsen, and the spinal cord is irreversibly damaged after a longer period of time.
Spinal cord cervical spondylosis has a more rapid onset and more severe symptoms due to local instability or vascular factors. In spinal cord cervical spondylosis, the initial symptoms are usually numbness of the limbs or trunk, disobedience, sometimes unconscious falling of objects in the hands, urinary and fecal disorders, etc. These symptoms are always “up and down” and are obviously reduced after rest, so some patients think that they should have no problem, so they refuse the doctor’s treatment and miss the disease. More serious, some patients even to some informal massage hospital “treatment”, do not know that the most taboo spinal cord cervical spondylosis is traction and massage, not only can not play a therapeutic role, but will aggravate the disease.
3.Sympathetic nerve type
Cervical sympathetic nerve involvement can appear multi-organ, multi-system symptoms.
The important symptoms are as follows.
① Head and neck symptoms: neck pain, headache, vertigo, etc.
② Eye symptoms: eye swelling and pain, blurred vision, dilated or narrow pupils, or in severe cases, blindness.
③ Cardiac symptoms: anterior heart pain, tachycardia or bradycardia.
④ Other: pain or numbness in the limbs or top of the head, coldness in the limbs or flushing in the limbs, tinnitus or hearing loss, etc.
4.Vertebral artery type
The vertebral artery penetrates upward in the transverse foramen of the cervical spine, and when it is compressed or stimulated, it can cause a series of symptoms of blood supply insufficiency. In addition to the clinical manifestation of neck pain, pressure pain, functional limitation and aggravation of symptoms after neck activities, the main manifestation is the symptoms of vertebrobasilar artery insufficiency of blood supply
① Headache, usually behind the occiput or on one side of the head.
② Balance and inner ear symptoms: vertigo, tinnitus, hearing loss, etc.
③ Visual acuity loss or diplopia, or even blindness in severe cases.
④ Others: memory and mental decline, dysphonia, and in a few cases, sudden collapse may occur. If the symptoms are caused by spasm of the vertebral artery due to irritation, the application of traction and braking can eliminate the symptoms; while those caused by mechanical compression such as bone spurs, the symptoms are mostly persistent and non-surgical treatment is often ineffective.
5.Mixed type
Combination of the above two or more pathological changes and clinical manifestations
Non-surgical treatment of cervical spondylosis.
Most patients with cervical spondylosis can have their symptoms reduced or significantly improved or even cured by non-surgical treatment, especially for early cases. Non-surgical treatment of cervical spondylosis needs to be done under the guidance of a physician or by an experienced physical therapist, and it is not uncommon to see people whose condition is aggravated or even tetraplegia due to physical therapy and massage.
Which cervical spondylosis requires surgery?
For cases with severe symptoms and where strict non-surgical treatment is ineffective, appropriate surgical treatment can be used. Since surgery is performed around the cervical spinal cord, it is a major surgery that endangers the patient’s life or may cause serious disability, so it must be considered comprehensively, treated seriously, and the indications for surgery must be properly grasped.
The main surgical indications for cervical spondylosis: neurogenic cervical spondylosis is more likely to be cured by non-surgical treatment.
The indications for surgery are.
1. Those who have not been treated by regular non-surgical therapy for a long time.
2. Those whose symptoms persist or recurrently affect their work or normal life. Spinal cord cervical spondylosis Although non-surgical treatment for spinal cord cervical spondylosis has certain efficacy, it is difficult to eradicate it and should be closely observed; if necessary, surgery should be actively considered and should not be delayed too long to avoid irreversible damage to the spinal cord.
Surgery should be considered for anyone who has one of the following conditions.
① cervical spinal cord compression symptoms are obvious (acute, progressive), magnetic resonance, etc. has confirmed that the spinal cord is clearly compressed;
(ii) a long duration of the disease, the symptoms continue to worsen and the diagnosis is clear;
(3) The symptoms of spinal cord compression are moderate or mild, but the non-surgical treatment has not improved for more than 1 to 2 courses and affects work and normal life.