The clinical symptoms of cervical spondylosis are complex. Some patients only show neck and back pain, which is aggravated by exertion, while some patients not only have neck and back pain, but also have upper limb weakness, finger numbness, lower limb weakness and difficulty walking. Some patients show episodes of vertigo, nausea, vomiting, which is aggravated by turning to the side, and even blurred vision, while some patients show tachycardia and difficulty swallowing. In general, the clinical symptoms of cervical spondylosis are related to the location of the lesion, the degree of tissue involvement and individual differences. Clinically, cervical spondylosis is often divided into the following types.
1. Cervical cervical spondylosis
Although previous epidemiological studies have shown that the incidence of neurogenic cervical spondylosis is the highest (50-60%). In recent years, with the change of life and work style, there are more and more cervical cervical spondylosis that we see in the clinic. The common clinical manifestations are.
(1) head, neck, collar and back, shoulder stiffness pain or soreness, difficulty in turning the side in severe cases, poor sleep, often the more severe the pain the worse the sleep, and poor sleep will further aggravate the collar and back stiffness pain and other symptoms. During physical examination, it is common to see pressure pain in the trapezius and/or sternocleidomastoid muscles on one or both sides, and pressure pain in the back of the collar and shoulder muscles is obvious.
(2) X-rays show altered physiological curvature of the cervical spine or intervertebral joint instability, etc.
(3) In diagnosing this type of cervical spondylosis, the doctor will exclude or differentiate it from other disorders of the neck (drop pillow, frozen shoulder, rheumatic myofibrositis, neurasthenia and other shoulder and neck pain not caused by degenerative disc degeneration).
Ms. Zhao’s early presentation was consistent with the above symptoms and signs as well as imaging, so the doctor diagnosed cervical cervical spondylosis. This condition is mainly characterized by pain in the neck and shoulder, so it is also called “neck and shoulder syndrome”. If this condition does not heal, and if you do not pay attention to prevention and health care in your daily work life, further aggravation of cervical spondylosis can lead to some new problems.
2.Vertebral artery type cervical spondylosis
Due to degeneration and hyperplasia of the cervical spine, direct or indirect stenosis of the transverse foramen can cause compression of the vertebral artery; greater mobility of the cervical spine and rotation of the cervical spine pulling the vertebral artery; excitation of the cervical sympathetic nerve, reflexively causing spasm of the vertebral artery can affect the blood supply of the brain and cause symptoms such as vertigo. The manifestations of vertebral artery type cervical spondylosis mainly include the following aspects.
(1) Vertigo: It is the main symptom of this type and can be manifested as rotational, floating or shaking vertigo.
(2) Headache: It is manifested in the occipital and parieto-occipital areas, and may also radiate to the temporal area. It is mostly episodic distending pain, often accompanied by symptoms of autonomic dysfunction.
(3) Visual impairment: sudden amblyopia or blindness, diplopia, with automatic recovery within a short period of time.
(4) Sudden collapse episodes, mostly occurring when the head is suddenly rotated or flexed and extended, and normal activities can be achieved by standing up again after falling to the ground.
(5) Positive rotational neck test.
(6) X-rays show segmental instability or osteophytes in the pivotal joints.
(7) Most of the symptoms are sympathetic. It can also be caused by different degrees of motor and sensory disorders, as well as psychiatric symptoms.
(8) When diagnosing vertebral artery type cervical spondylosis, attention should be paid to exclude diseases such as oculogenic and otogenic vertigo.
Ms. Zhao’s subsequent condition was consistent with the above symptoms and signs, and the doctor made the diagnosis and treatment after excluding other diseases such as ophthalmogenic and otogenic diseases, so her condition quickly improved, and therefore there was no problem of early diagnosis and treatment errors.
3.Nerve root type cervical spondylosis
Cervical spondylosis is caused by lateral and posterior protrusion of the cervical disc, hyperplasia and hypertrophy of the hook vertebral joint or synovial joint, and stimulation and compression of the nerve root.
(1) It starts mostly with neck and shoulder pain, which worsens in a short period of time and radiates to the upper extremities. It has typical radicular symptoms (i.e., we usually say that it radiates from the neck to the arm like a tendon, numbness and pain), and the scope is consistent with the area innervated by the cervical spinal nerve. It may be accompanied by decreased muscle strength in the upper extremities and poor finger movement. When the posture of the head or upper extremity is improper, or sudden pulling, severe lightning-like sharp pain can occur.
(2) Examination shows muscle spasm of the affected side of the neck, head preference to the affected side, and shrugging of the shoulder. The muscles of the upper limbs may be atrophied if the disease is prolonged. There is pressure pain in the transverse process, trapezius, long and short head of biceps, rotator cuff and deltoid. There are varying degrees of limitation of supination, abduction, or posterior extension of the affected limb. The pressure top test or brachial plexus pull test is positive.
(3) X-ray examination of the cervical spine shows signs of degenerative changes such as loss of physiological anterior convexity, narrowing of the intervertebral space, osteophytes at the anterior and posterior edges of the vertebral body, hyperplasia of the hook vertebral joint and synovial joint, and stenosis of the intervertebral foramen, etc. CT or MRI shows disc herniation, narrowing of the spinal canal and nerve root canal, and compression of the spinal nerve. (As shown in the figure, we can see arthrogryposis, crotal joint bulge and herniated discs compressing nerve roots)
(4) No significant effect of painful point closure (this test may not be performed if the diagnosis is clear).
(5) To diagnose this type of cervical spondylosis, doctors usually differentiate it from extra-cervical spine pathologies (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps tenosynovitis, etc.) that cause mainly upper limb pain.
4.Spinal cord type cervical spondylosis
It accounts for about 10-15% of cervical spondylosis. The main causes of spinal cord compression are the nucleus pulposus of the central posterior process, the bone superfluous at the posterior edge of the vertebral body, the hyperplastic and hypertrophic ligamentum flavum and the posterior longitudinal ligament with calcification. Since the lower cervical spinal canal is relatively small (spinal cord neck expansion) and mobile, degeneration occurs earlier and more severely, and spinal cord compression is likely to occur in the lower cervical segment.
(1) In the early stage of spinal cord compression, neck pain is not obvious, and the first symptoms are weakness of the limbs and unsteadiness in walking and holding things. As the condition worsens, bottom-up motor neurogenic paralysis occurs.
(2) The radiographic presentation is similar to that of neurogenic cervical spondylosis. Myelogram, CT and/or MRI may show spinal cord compression. Cerebrospinal fluid kinetics, nuclear medicine, and biochemical analysis may reflect the degree of spinal canal patency.
(3) Exclude amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
5. Sympathetic cervical spondylosis
The pathogenesis of sympathetic type is less clear. Clinical manifestations are mostly divided into two conditions.
(1) sympathetic excitation symptoms: headache or migraine, dizziness, blurred vision, tinnitus, hand numbness, cardiac
(1) Sympathetic excitation symptoms: headache or migraine, dizziness, blurred vision, tinnitus, hand numbness, tachycardia, precordial pain, elevated blood pressure, abnormal sweating of the head and neck and upper extremities, tinnitus, hearing loss, dysarthria; blurred vision, decreased visual acuity, and posterior eye distention.
(2) Sympathetic depression symptoms: dizziness, blurred eyes, nasal congestion, bradycardia, decreased blood pressure and gastrointestinal distension, etc. X-ray film with instability or degeneration, negative vertebral arteriogram.
6. Other types
Cervical vertebrae with anterior bird’s beak-like hyperplasia compressing the esophagus causing dysphagia (confirmed by barium examination of the esophagus), etc. Sometimes the manifestation of cervical spondylosis can appear simultaneously with two or more types of symptoms, and some people call this “compound” or “mixed” cervical spondylosis.