Cervical spondylosis, or cervical spine syndrome, is a combination of symptoms such as pain in the neck, shoulder, upper limbs, head, chest and other symptoms, even combined with limb malfunctions, caused by degeneration of the cervical spine, its intervertebral discs or surrounding soft tissues, resulting in imbalance of the internal and external balance of the spine, compression or stimulation of the neck muscles, blood vessels, sympathetic nerves, nerve roots and spinal cord.
1.Disorder of plant nerve function
Neck trauma or cervical spine, intervertebral disc, intervertebral ligament and other tissues, due to accumulative strain and degenerative changes, can make its stability correspondingly decreases. If trauma, even under the action of an insignificant external force, can cause the vertebral body in the frontal axis, the sagittal axis, the longitudinal axis of forward and backward tilt, left and right lateral flexion, left and right rotation and different joint changes in the three axes of position. This change in anatomical position can stimulate the supraglottic ganglion and sympathetic nerve endings in the vertebral artery, joint capsule, collateral ligament and other tissues as well as the spinal cord return branches in the spinal canal, resulting in a series of reflex symptoms such as blurred vision, eyelid weakness, eye socket distention, pupil dilation, and Hornor’s syndrome (Hornor’s syndrome is caused by sympathetic nerve paralysis in the neck). Hornor’s syndrome (Hornor’s syndrome is caused by sympathetic nerve paralysis in the neck and is characterized by sunken eyeballs, drooping eyelids, narrow pupils, may have ipsilateral facial congestion, and no sweating). Balance disorders, tinnitus, hearing impairment, intractable headache, palpitations, precordial pain, swollen fingers, excessive or no sweating, facial flushing, chills in the extremities, decreased local skin temperature, fever, elevated blood pressure, diarrhea, constipation, amenorrhea, abnormal secondary sexual characteristics, and many other symptoms. It should be distinguished from Meniere’s syndrome, coronary artery disease, and plant nerve dysfunction.
2.Blood circulation disorder
When the normal anatomical position of the cervical vertebrae is changed, especially the transverse foramen of the fifth cervical vertebra is close to the vertebral body, plus the anatomical weakness of the cervical 4 and 5, the positive pressure, torsional force and shear force are the greatest in biomechanical analysis, when the vertebral body is displaced, the vertebral artery is also directly compressed or stimulated to vasospasm, and the blood flow of the vertebrobasilar artery is reduced.
The first segment of the vertebral artery (cervical) emanates from the artery under the clavicle and travels upward in the cleft of the anterior oblique and long cervical muscles, and symptoms of vertebral artery compression can occur when the anterior oblique muscle is in spasm. The second segment (vertebral canal) is located in the anterior internal side of the vertebral artery. Osteomalacia or displacement of the vertebral body can narrow the lumen of the vertebral artery, increase resistance, reduce blood flow, and in severe cases, complete infarction and sudden collapse can occur. The third segment (lower part of the head) has a larger traveling curve, and when the head is turned, this artery is easily strained and narrowed to produce cerebral ischemic symptoms. The fourth segment (inside the skull) is the inner ear artery (labyrinth artery), which is the basilar artery and the thin and tortuous branches that supply blood to the inner ear. Therefore, in vertebral artery type cervical spondylosis, symptoms such as tinnitus and hearing loss can occur clinically because of insufficient blood supply to the vertebral artery.
3. Change of cervical curvature
The coordinated internal and external balance of the cervical spine is an important condition for the completion of various functional activities of the human body. The intrinsic balance of the cervical spine (balance of the intervertebral joints) refers to the balance between the tension of the nucleus pulposus of the intervertebral disc, the pressure of the synovial joint and the hook vertebral joint, and the tension of the intervertebral ligament when the cervical spine is in any position, and this balance can maintain the stability of the intervertebral joints. The extrinsic balance of the cervical spine is the balance of the forces of the anterior and lateral cervical muscle groups controlling the movement of the cervical spine. The balance between the two allows the cervical spine to maintain coordination and unity in all positions and to perform its normal physiological functions. The intervertebral discs and articular joints connected between the cervical vertebrae are the triangular support of the tripod. The intervertebral discs are mainly for weight-bearing function, and the synovial joints are mainly for stabilizing spinal function, which can be interchanged when the cervical spine is in motion, so that the bilateral or unilateral synovial joints can be temporarily weight-bearing to complete the normal functional activities of the cervical spine. If the weight is held for a long time, it will become pathological. The spine, intervertebral discs, intervertebral ligaments and tissues that make up the spine can weaken the stability of the spine due to cumulative strain or degeneration. If external forces or sudden torsional forces are applied, mild displacement of the vertebral body can occur. Mild displacement of the cervical spine, resulting in disruption or imbalance of the internal and external balance of the spine, is an important pathological change in injury spine disease and an important pathological basis for changes in cervical curvature.
Due to acute injury to the soft tissues of the neck or fibrositis, the pain is severe and affects the normal posture and normal activities of the neck, where there are symptoms of radicular irritation, there is often lateral protrusion due to spinal fixation of the lesioned segment or a narrow front and wide back space; due to the different sites and inconsistent degrees of cervical disc degeneration, the above factors can make the internal and external balance of the cervical spine out of balance, resulting in forward and backward tilt of the vertebral body on the frontal axis, sagittal axis The above factors can cause the imbalance of the internal and external balance of the cervical spine, resulting in 14 directions of displacement, such as forward and backward tilt of the vertebral body on the frontal axis, left and right lateral curvature on the sagittal axis, left and right rotation on the longitudinal axis and tilt and left and right lateral curvature on the joint axis, left and right lateral curvature on the supine axis, left and right rotation on the tilt and left and left rotation on the supine axis. Changes in cervical flexion first reflect compensatory changes following injury or stimulation of nerve roots, spinal cord, blood vessels, sympathetic nerves, etc. Cervical flexion changes can occur in patients or adolescents with signs of cervical degeneration, or during recurrent cervical spondylosis with significant bony changes and loss of compensatory effects.
Vertebral displacement is manifested as an abrupt change in the sequence of non-displacement between the displaced vertebra and the adjacent vertebra. If a single vertebral body hook joint is asymmetrical on the orthopantomograph, it means that the vertebral body is tilted to the left and right in the coronal plane, and if a purely lateral phase is observed above the diseased vertebra on the lateral film, and the diseased vertebra appears “bilateral double protrusion” phenomenon or the above changes appear below the diseased vertebra, it means that the vertebral body has axial rotation in the sagittal plane; and if the cervical curve above the diseased vertebra on the lateral film becomes straight, and the diseased vertebra at the forward or backward direction. If the cervical curvature above the diseased vertebra is straight, and the diseased vertebra is angled forward or backward, this compound cervical curvature change indicates that the vertebra has a frontal tilt, and the above changes combined with clinical signs, then the signs of vertebral displacement on the X-ray film can become an important basis for cervical spine fixed-point manipulation correction.
4.Nerve root compression
Acute injury pathological changes for cervical disc protrusion can directly compress the nerve root, while the posterior longitudinal ligament tears and separates, causing bleeding and exudation between the vertebral body and the posterior longitudinal ligament triangular space to stimulate and compress the nerve root, resulting in radicular pain. Chronic injury causes degeneration of the intervertebral disc, resulting in narrowing of the intervertebral space, ligamentous laxity, instability of the intervertebral joints, and irregular activity; this in turn can be secondary to injury and produce osteophytes; the small joint capsule is relaxed and subluxed or dislocated, and the superior articular eminence protrudes into the intervertebral foramen, all of the above changes can narrow the intervertebral foramen; the nerve root cuff edema, inflammation, adhesions and the above-mentioned osteopathy simultaneously compress the nerve root. Acute injury and chronic strain eventually result in the development of a conformal vertebral articulation that protrudes into the intervertebral foramen and compresses the nerve root.
The brachial plexus nerve is often compressed as it traverses the oblique angle muscle space. The anterior oblique muscle is innervated by C3~8 nerve, and when the nerve root is stimulated in cervical spondylosis, the anterior oblique muscle is tense and contracted or spasmodic, the muscle gap is narrowed, and the brachial plexus nerve is involved, showing multi-segmental nerve symptoms and signs clinically.
5.Cervical spinal cord compression
It is generally believed that the posterior protrusion of the cervical disc, degeneration, hyperplasia of the posterior edge of the vertebral body, hypertrophy of the ligamentum flavum, folding, calcification, etc. protrude into the spinal canal and narrow it, compressing the spinal cord and its arteries; or the sympathetic nerve is stimulated and narrowed, compressing the spinal cord and its arteries; or the sympathetic nerve is stimulated causing spasm of the spinal cord blood vessels, thrombosis, impaired blood circulation in the spinal cord, ischemia, edema; vertebral body slippage, small joint dislocation or semi The spinal canal is relatively narrowed and the spinal cord is compressed. After the compression of the cervical spinal cord appears.
1, dysfunction: is the early manifestation of spinal cord compression, manifesting numbness, weakness, and increased muscle tone in the distal lower extremities, with the development of symptoms and signs of centripetal progression, and eventually paralysis of the limbs; also appear diaphoresis, etc. The symptoms are aggravated after exertion and alleviated after rest. If the treatment is timely and the symptoms are released early, the pathological changes of the spinal cord can be recovered.
2, spinal cord degeneration: after the symptoms of spinal cord compression in cervical spondylosis, long-term failure to receive reasonable treatment, the lesion continues to develop, spinal cord degeneration, softening and cavity formation can occur, resulting in damage that is difficult to recover. The degenerative response of the motor cells in the anterior horn of the spinal cord is severe in such patients.
Causes of spinal cord degeneration: When patients with cervical spondylosis suffer from osteophytes or displacement of vertebrae, hypertrophy of the ligamentum flavum and disc herniation can cause the cervical spinal cord to expand to the left and right, with the lateral cords and anterior horn showing significant deformation. The transverse vessels in this region also elongate from side to side, narrowing their lumen and causing symptoms of ischemia in the anterior horn and lateral cord. Compression of the vertebral artery or ischemia of the anterior spinal cord artery is one of the causes of spinal cavernous disease. Narrowing of the spinal canal and poor venous return in the canal lumen produce congestive hypoxia in the spinal cord, which affects the function of the spinal cord. Vascular spasm ischemia can also affect the function of the spinal cord. Cervical spondylosis is an important cause of impaired blood flow to the spinal cord. In addition, anyone with spinal stenosis may have varying degrees of spinal cord dysfunction, and the manifestations of spinal cord compression vary with the degree of stenosis.
Treatment
1.Manipulation: one-finger meditation, kneading, holding, pushing, pulling, stretching, wrenching, rubbing, shaking, shaking, pointing.
2.Acupuncture points: Fengchi, Tianzhu, cervical spine, Dazhi, Daqiu, shoulder well, Tianzong, Quchi, Waiguan, Hegu.
3.Operation.
1.With the patient sitting upright and the practitioner standing behind him, first use the one-finger meditation from the Fengchi downward along the cervical pinch spine to the Da Loom point, round trip 5-7 times, alternating sides.
2.Knead along the cervical spine with a large fish interval for 5-7 times, alternating between the two sides.
3.Take the kneading method at the occipital, cervical and shoulder wells.
4.Knead the affected vertebrae with the thumb.
5.Resetting techniques
(1) Cervical spondylosis oblique trigger method
Different positions are adopted according to the disease location. When operating, the patient sits on a low stool, the doctor first release the cervical muscle spasm by kneading, the operator stands on the right rear side (to the left oblique as an example) with the left thumb against the oblique spinous process, the right hand with the elbow to hold the lower jaw, the palm of the hand around the left ear behind the occiput, and then the cervical vertebrae right rotation to the position of resistance, the right elbow and palm force at the same time for controlled, sudden to the right after the upper wrench, then often hear the click a sound, indicating successful reset. If the diseased vertebra is above the 4th cervical vertebra, take the flexed cervical position when pulling obliquely; below the 4th cervical vertebra is a good site for cervical spondylosis, take the posterior extension position when pulling; in C4.5, take the posterior extension position 5°±; in C5.6, take the posterior extension position 10°±; in C6.7, take the posterior extension position 15°±, if the disease is on the left side, it should be pulled to the left first, then to the right. This method is often used in cervical spondylosis of the nerve root type or posterior joint disorder (misalignment) caused by cervical instability due to degeneration. This method can also be used for patients with drop pillow. However, for patients with synovial imbrication in the posterior joint, the method should be taken in the forward flexion position (10°-15°) to release the synovial imbrication.
(2) Oblique traction method for single spinous process deviation
Firstly, check on which side the spinous process is tilted and whether the lateral process is located in the upper or lower cervical segment. If the upper cervical segment is tilted to the right, the patient should be placed behind the right side of the patient after the operation, with the left thumb against the cervical 5 spine and the right hand holding the left lower jaw.