Cervical spondylosis is a serious degenerative disease of the cervical spine. It is a degeneration of the cervical disc itself, including the adjacent vertebral segments and their secondary changes that irritate or compress the nerve roots, spinal cord or blood vessels and related tissues, and cause clinical symptoms and signs associated with them.
Major pathology: The most basic changes in this disease include nucleus pulposus herniation and prolapse, subperiosteal hematoma of the ligament, superfluous bone formation, and secondary spinal stenosis. Dynamic changes include cervical instability, such as intervertebral loosening, displacement, and changes in physiological curvature. The organic changes aggravate the dynamic changes, and the dynamic changes promote the organic changes, which are mutually related. These changes constitute the essence of cervical spondylosis.
The simple typing is cervical, neurogenic, spinal cord, vertebral artery, sympathetic and other types (at present, it mainly refers to esophageal compression), and the specialist typing (stage) is divided into cervical intervertebral disc disease stage (cervical spondylosis), osteogenic cervical spondylosis stage and spinal cord degeneration stage.
The early manifestations of different types of cervical spondylosis can be mainly local symptoms, such as neck pain, weakness, dizziness or numbness of upper limbs and fingers, difficulty walking or unstable gait. However, due to the different stimulation and compression of the adjacent cervical nerve roots, spinal cord, vertebral artery and sympathetic nerve by cervical spine lesions, various symptoms can occur, making the clinical manifestations complex and diverse, and misdiagnosis often occurs in clinical practice.
Cervical heart syndrome – The cardiac symptoms and electrocardiographic changes caused by cervical spondylosis are called cervical heart syndrome. Since cervical spondylosis and coronary artery disease are common in middle-aged and elderly people, they are often misdiagnosed as coronary artery disease.
Cervical heart syndrome–clinical manifestations
①Pin prick-like pain or distension in the precordial region, lasting more than 15 minutes, sometimes up to several hours; its attacks are often related to changes in the position of the head and neck.
The symptoms include chest tightness and shortness of breath, dizziness, chest and back tingling, palpitations, dizziness and weakness; the electrocardiogram shows myocardial ischemia, and some patients have premature beats, tachycardia or bradycardia and atrioventricular block; the disease is characterized by recurrent attacks.
(3) Nitrate preparations could not terminate cervicogenic pseudo-angina, and clinical symptoms and ECG abnormalities did not improve with conventional dilation, antiarrhythmic drugs and myocardial nutrients.
④The cervical spine X-ray has obvious pathological changes such as physiological bending straightening, vertebral hyperplasia and narrowing of the vertebral space.
⑤ After treatment according to cervical spondylosis, the abnormal cardiac manifestations may improve or disappear with the improvement of cervical spondylosis.
Cervical hypertension – Cervical spondylosis can cause an increase or decrease in blood pressure, with the increase in blood pressure being more common and referred to as cervical hypertension. Since cervical spondylosis and hypertension are both common diseases in middle-aged and elderly people, there are many opportunities for the two to coexist, making it easy to misdiagnose.
Cervical hypertension–clinical manifestations
(1) Typical symptoms and signs of cervical spondylosis, with increased blood pressure exceeding normal standards.
②Often accompanied by the manifestation of insufficient blood supply to the vertebrobasilar artery or cervical heart syndrome.
(iii) The 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 subsequently.
Cervical syncope – sudden syncope can occur in cervical spondylosis, called cervical syncope, which is easily misdiagnosed as cerebral arteriosclerosis or cerebellar disorders, etc.
Cervical syncope – clinical manifestations
①There is often a history of typical cervical spine disease;
②More often, the body loses support and suddenly falls to the ground when the head is suddenly twisted during walking, and can wake up quickly after falling due to the change of the neck position, without any consciousness impairment and 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 headache, nausea, vomiting, sweating and other symptoms of plant nerve dysfunction;
⑤Cervical spine X-ray can show signs of hypertrophic cervical spondylosis, and vertebrobasilar artery stenosis can be revealed by vertebral arteriography and TCD examination.
Cervical dysphagia–clinical manifestations
(1) Mainly manifesting dysphagia or foreign body sensation in the esophagus.
②The difficulty in swallowing is sometimes mild and sometimes severe, non-progressive, often accompanied by other manifestations of cervical spondylosis such as neck and shoulder pain and numbness of the upper limbs of varying degrees, often related to the position of the neck.
(iii) A few patients have symptoms such as swallowing pain, nausea, vomiting, hoarseness, dry cough and chest tightness.
(iv) changes such as obvious forward protruding bony flab can be seen in lateral cervical spine films, stenosis can be observed in barium esophagogram, 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 relieved after treatment, but are prone to recurrence.
Cervicogenic headache – a group of syndromes caused by organic or functional lesions of the cervical-occipital or (and) shoulder tissues with predominantly ipsilateral headache, called cervicogenic headache.
Cervicogenic headache – clinical manifestations
Patients with cervicogenic headache often have cervico-occipital or (and) shoulder symptoms, and the headache can be relieved or disappeared after treatment of cervical spondylosis. Most of the headaches are simply treated during the consultation and treatment, but the cervical-occipital or (and) shoulder symptoms are ignored, resulting in a lingering headache.
Cervical visual impairment – Cervical spondylosis can cause vision loss, eye distension, photophobia, lacrimation, unequal pupil size, and even reduced visual field and sharp loss of vision, and in a few patients, it can also cause blindness, which is called cervical visual impairment.
Cervical visual impairment – clinical manifestations
(1) vision loss, diplopia, headache, dizziness, ataxia, eye distension, reading difficulty, insomnia, memory loss, often accompanied by symptoms of cervical spondylosis, and the aggravation and reduction of visual impairment and cervical spondylosis symptoms are positively correlated.
(2) Intermittent blurred vision in the early stage, swelling and pain in one or both eyes, followed by other eye symptoms.
(③) The ophthalmologic examination cannot find the cause, and the treatment according to ophthalmologic treatment is ineffective, but after treatment according to cervical spondylosis, the vision can be significantly improved with the remission of cervical spondylosis.
④Cervical spine X-ray and CT show the manifestation of cervical spondylosis.
Cervicogenic breast pain – cervical spine bones can cause intractable breast pain or pain in the pectoralis major muscle when they compress the C6/7 nerve roots that innervate the breast area.
Cervicogenic breast pain – clinical manifestations
(i) The onset is slow, the degree of pain is sometimes related to the position of the neck, and is often proportional to other cervical nerve symptoms.
②Mostly unilateral breast or pectoralis major muscle pain, often accompanied by neck and shoulder pain, limited neck movement, etc.
(iii) There may be pressure pain in the pectoralis major muscle or changes in muscle strength and sensation in the involved nerve root innervated segments.
(iv) There are no abnormal findings in the breast and the pectoralis major muscle itself as well as on electrocardiography.
⑤Treated as cervical spondylosis, the breast and pectoralis major muscle pain may improve or disappear with the improvement of cervical spondylosis.
Cervicogenic hypoglycemia syndrome – clinical manifestations
In the early stage, the sympathetic nerve excitation symptoms may appear, and clinical syndromes such as hunger, pallor, tachycardia, arrhythmia, excessive sweating, weakness, dizziness, limb tremor, anxiety and nervousness may appear.
Anterior spinal artery syndrome – clinical manifestations
(1) Acute onset, with symptoms worsening to paralysis in bed within a short period of time; dysfunction of the lower extremities is greater than that of the upper extremities; loss of pain and temperature sensation below the level of damage, but the presence of deep sensation and recognition; sphincter dysfunction, mostly manifested as urinary retention.
MRI showed that the anterior 2/3 of the spinal cord was edematous and dilated; the T1-weighted phase showed low signal and the T2-weighted phase showed high signal.
(③After anterior cervical osteotomy and decompression within 30 hours of the peak of onset, all had good results.
Spastic slanting neck and abnormal limb movements – There are few reports of cervical spondylosis with this as the main manifestation, but some findings suggest a definite association between some postural activity abnormalities and cervical spondylosis.
Spastic squint and abnormal limb movement – clinical manifestations
① Recurrent neck discomfort, gradual appearance of clonic involuntary twisting of the neck, increased frequency of involuntary movements during emotional or work stress, disappearing during sleep; inability to look forward with both eyes level when walking, no refractive error in both eyes, normal visual acuity.
(ii) Physical examination: displacement of the cervical vertebrae, swelling of the corresponding joint capsule; stiffening of the sternocleidomastoid, rhomboid and cervical muscles, negative root sign of both upper limbs, negative Hoffman’s sign.
③Laboratory examination: X-ray and MRI showed cervical spondylosis manifestations.
④Treatment for cervical spondylosis, cervical spondylosis was cured while spastic squint disappeared.
Spinal cord cervical spondylosis (CSM) syndrome – clinical manifestations
(1) CSM has an insidious onset and complex manifestations, which may include tremors and twitches in one limb, burning sensation in one finger or palm, fear of cold, morning stiffness, hard of hearing in one ear, pain in both ears, numbness of limbs, ataxia, dysfunction of vegetative nerves and sphincter muscles, etc.
②Sometimes the early stage manifests as lower limb pain, weakness and claudication, and the late stage manifests as unilateral or bilateral lower limb paralysis.
Spinal cord cervical spondylosis (CSM) syndrome – clinical manifestations
③ Although it may manifest as bilateral lower limb paresis, triple limb paresis, quadriplegia or crossed paresis, there is no cranial nerve or speech impairment, and the symptoms fluctuate.
④The plane of sensory changes may not be consistent with the plane of the lesion, and sometimes the sensory disorder is segmentally distributed.
⑤ Individual patients may have lower extremity symptoms as the first manifestation of cervical spondylosis, while the neck symptoms are very mild, which is easily misdiagnosed.
(6) Urination and defecation disorders, such as urinary frequency, urinary urgency, incomplete urination or urinary and fecal incontinence, may be associated.
(7) Hoffman’s sign is positive or suspicious, with or without increased muscle tone in the lower limbs.
(8) X-ray is consistent with cervical spondylosis, and CT or MRI films show dural and spinal cord compression or deformation, especially MRI is most helpful for confirming the diagnosis of the disease and understanding the exact site of spinal cord compression.
Summary: In order to reduce misdiagnosis and underdiagnosis, the possibility of cervical spondylosis should be considered for anyone over 40 years of age who has one of the following symptoms:
(1) anterior cardiac pain or arrhythmia related to the position of the head and neck, and anti-angina or anti-arrhythmic drug treatment is ineffective.
(ii) hypertension with ineffective antihypertensive medication.
(iii) sudden collapse without impairment of consciousness, and awake and standing up soon after collapse.
(iv) non-progressive dysphagia or foreign body sensation in the pharynx, or recurrent severe pain at the base of the tongue and pharynx associated with neck activity.
⑤ Intractable headache with cervical-occipital and/or shoulder region.
(6) acute unilateral or bilateral loss of visual acuity for which no ophthalmologic reason can be found and for which treatment by ophthalmology is ineffective
(vii) Intractable pain in the breast and pectoralis major muscle without lesions of their own.
(8) Diabetic patients with recurrent sympathetic excitation symptoms similar to hypoglycemia, and whose blood glucose is not low on timely examination.
⑨ dissociative upper limb dyskinesia; spastic diastasis and abnormal limb movements.
⑩High spinal cord-related symptoms.