Cervical spondylosis is a comprehensive set of symptoms stimulated or caused by gradual degeneration of the cervical intervertebral disc, osteophytes of the cervical spine, or changes in the normal physiological curve of the cervical spine. Patients often feel 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. It is common in middle and old age.
Etiology
1, strain injury: long-term head and neck in a single position, such as prolonged head-down work, prone to cervical spondylosis.
2, head and neck trauma: 50% of medullary cervical spondylosis is related to neck trauma. Some patients with cervical spine osteophytes, cervical disc herniation, soft tissue lesions in the spinal canal, etc. make the cervical spinal canal in a narrow critical state, and cervical trauma often triggers the symptoms.
3, bad posture: such as lying in bed watching TV, reading books, high pillow, sleeping in a sitting position, etc.; sleeping on a recumbent car, poor muscle protection when sleeping, easy to have neck injury and disc protrusion when braking.
4, chronic infection: mainly pharyngitis, followed by dental caries, periodontitis, otitis media, etc.. Inflammation in these areas stimulates the soft tissues of the neck or causes soft tissue lesions in the neck and occipital area through the rich lymphatic system.
Pathogenesis]
It is mainly caused by degenerative changes of the cervical intervertebral disc and cervical spine and its accessory structures.
1, disc nucleus pulposus dehydration thinning, narrowing of the intervertebral space, so that the fiber ring and surrounding ligaments become relaxed, cervical spine stability is weakened, more prone to further strain and degenerative changes. Degeneration of the fibrous annulus and narrowing of the intervertebral space make the disc easily protrude posteriorly and laterally. Cervical 4-5, cervical 5-6 intervertebral mobility is the largest, the stress is also the most concentrated, the most vulnerable to injury.
2, the vertebral body and its accessory structures When the disc thinning causes cervical instability, the surrounding ligaments are often stretched by abnormal stress, resulting in damage to their attachment points and causing osteophytes. The narrowing of the vertebral space also increases the stress on the posterior joint and the hook joint, causing damage and hyperplasia. The segments prone to hyperplasia are cervical 5, cervical 6, cervical 4 and cervical 7 in that order.
3, disc herniation, vertebral body posterior margin hyperplasia, yellow ligament hypertrophy, etc. can cause spinal canal stenosis, resulting in spinal cord type cervical spondylosis. Hook vertebral joint, posterior joint hyperplasia, and disc protrusion to the lateral posterior can compress or stimulate the nerve root, vertebral artery and sympathetic nerve, causing corresponding symptoms.
【Typing and symptoms】
The symptoms of this disease are variable, thus causing difficulties in diagnosis. The age of onset is usually above 40 years old, and younger age is rare. The onset of the disease is slow, and it is not noticed at the beginning, it may only be neck discomfort, some manifest as frequent “pillow”, and after a period of time, it gradually shows some of the following symptoms. The first three subtypes are mainly.
1, cervical type: that is, local type, caused by degenerative changes in the cervical intervertebral disc caused by local or reflex cervical pain, neck and shoulder pain, neck movement is limited.
2, nerve root type This is caused by the irritation or compression of the cervical spinal nerve root by the protrusion occurring in the posterior and external side of the cervical spine, and there is paroxysmal or persistent hidden or severe pain in the cervical occipital area and neck and shoulder. There is burning or cutting-like pain along the direction of travel of the affected cervical spinal nerve, or electroshock-like or pins-and-needles numbness, and the symptoms worsen when the neck is moved or the abdominal pressure increases. At the same time, the upper limbs feel sunken and weak. The neck has different degrees of stiffness or painful oblique neck deformity, muscle tension and restricted movement.
3.Spinal cord type This is caused by the compression of the spinal cord by the protruding object. The clinical manifestation is spinal cord compression, with different degrees of tetraplegia, mainly numbness, soreness, burning sensation, stiffness and weakness of the limbs, which mostly occurs in the lower limbs and then develops to the upper limbs; however, it also occurs in one upper or lower limb first. In the later stage, the symptoms are spastic paralysis with different degrees of upper motor neuron or nerve bundle damage, such as limb inflexibility, clumsy gait, unstable walking, even bedridden, constipation and difficulty in urination.
The symptoms of insufficient blood supply to the vertebral artery include episodes of vertigo, nausea, vomiting, etc. The symptoms appear every time the head is extended or turned to a certain position, and disappear when the head is turned away from that position. When the head is turned, the patient suddenly feels the weakness of the limbs and falls down, and when he falls down, he is mostly conscious.
5. Sympathetic type is caused by stimulation of sympathetic nerve fibers on cervical spinal nerve roots, spinal membrane and small joint capsule. Symptoms include dizziness, wandering headache, blurred vision, hearing changes, difficulty in swallowing, cardiac arrhythmia and sweating disorder.
6.Other type: refers to esophageal compression type (mainly manifested as difficulty in swallowing), etc.
7.Mixed type: symptoms of those who suffer from more than two of any of the above subtypes. In clinical practice, it is often seen that the symptoms and signs of each type are mixed with each other.
【Treatment】
Surgery for cervical spondylosis is the most important part of the treatment of cervical spondylosis and the ultimate and complete treatment method.
The treatment concept of our department: minimally invasive surgery is the main treatment for cervical spondylosis, and other means are supplemented by personalized treatment.
1.Percutaneous cervical disc laser pneumatization (PLDD)
Through X-ray fluoroscopic positioning, the surgical vertebral space is determined, and after local anesthesia, under X-ray fluoroscopic supervision, a puncture trocar needle with a needle core is directly punctured through the skin into the anterior surface of the cervical disc, avoiding important structures such as the carotid artery. The trocar is then secured and the needle core is withdrawn. A laser needle is inserted into the trocar and inserted into the intervertebral space, and a certain power pulsed laser is administered to vaporize the nucleus pulposus tissue and aspirate out the gas. Percutaneous cervical disc pneumatization is more effective than other non-surgical treatment methods such as traction, massage, acupuncture and internal and external medicine. Compared with conventional resection surgery, it has the advantages of high safety, small trauma, no bleeding, light pain, fast recovery and low cost. Since the vertebrae, posterior longitudinal ligaments and joints and other structures are not destroyed, the stability of the cervical spine is maintained to the maximum extent.
2.Posterior spinal canal expansion decompression surgery
The use of single-opening, double-opening and laminoplasty can expand the spinal canal to achieve decompression, which is safe and effective. It is suitable for long-segment spinal stenosis cases.
3.Anterior micro decompression surgery
Professor Xiu Bo has been engaged in neurosurgery and microsurgery for many years, so unlike general spine surgeons, he has introduced advanced neurosurgery and microsurgery concepts and techniques into spinal cord surgery, making surgery for cervical spondylosis more effective and safer. When removed by the naked eye alone, one has to rely on the surgeon’s experience and sense of touch, which makes the surgery more dangerous. Once damage occurs, it is irreversible. A fraction of a centimeter less will not remove the bone, and a fraction of a cent more will hit the nerve tissue and cause the patient to become paraplegic. Under the magnified illumination of the operating microscope, the surgeon’s ability to discriminate is increased. The surgery is performed at a depth of between 2.3-2.5 cm in the 6-8 mm vertebral space to completely remove the bone fragments. It is also not limited by depth and allows clear identification of important structures such as the dural sac nerve roots and vascular plexus, thus ensuring accurate surgical operations with minimal damage and the best surgical results. In addition, movement under the microscope is usually performed in millimeters, so the surgical precision is very high.