Diagnostic criteria of cervical spondylosis I. Clinical diagnostic criteria 1. Cervical type: with a typical history of fallen pillow and the above-mentioned cervical symptoms and signs; imaging may be normal or only have physiological curvature changes or mild intervertebral space narrowing, with little bone formation. 2. Nerve root type: symptoms (numbness, pain) and signs with radicular distribution; positive intervertebral foramen squeeze test or/and brachial plexus pull test; imaging findings are basically consistent with clinical manifestations; pain caused by extra-cervical pathologies (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps long head tenosynovitis, etc.) is excluded. Zhang Qian, Department of Orthopedic Surgery, Liaocheng Second People’s Hospital 3. Spinal cord type: clinical manifestations of cervical spinal cord damage; imaging shows cervical degenerative changes, cervical spinal canal stenosis, and confirms the presence of cervical spinal cord compression compatible with clinical manifestations; except for progressive amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, multiple peripheral neuritis, etc. 4. Sympathetic type: diagnosis is difficult, and there is a lack of objective diagnostic indicators. Clinical manifestations of sympathetic nerve dysfunction and imaging show segmental instability of the cervical spine are present. In some patients with atypical symptoms, if the symptoms are reduced after planetary ganglion closure or high cervical epidural closure, it will help the diagnosis. Vertigo due to other causes: (1) Otogenic vertigo: Vertigo due to vestibular dysfunction in the inner ear. For example, Meniere’s syndrome and embolism of the auditory artery in the ear. (2) Ophthalmogenic vertigo: refractive error, glaucoma and other ophthalmic disorders. (3) Brain-derived vertigo: inadequate blood supply in vertebrobasilar artery due to atherosclerosis, lacunar cerebral infarction; brain tumor; sequelae of traumatic brain injury, etc. (4) Vertigo of vascular origin: vertebrobasilar artery insufficiency due to stenosis of V1 and V3 segments of vertebral artery; hypertensive disease, coronary heart disease, pheochromocytoma, etc. (5) Other causes: diabetes mellitus, neurosis, overexertion, long-term sleep deprivation, etc. (5) Vertebral artery type: previous sudden collapse attack with cervical vertigo; positive spin neck test; imaging shows segmental instability or hook joint hyperplasia; except for other causes of vertigo; positive neck motion test. Second, imaging and other auxiliary examinations X-ray examination is an important means for the diagnosis of cervical spine injury and certain disorders, and is also the most basic and commonly used examination technique for the neck, and is an important examination method that cannot be ignored even under the highly developed conditions of imaging technology. X-rays provide an imaging basis for determining the severity of injury, treatment selection, and treatment evaluation. The whole cervical spine frontal and lateral radiographs, cervical extension and flexion dynamic lateral radiographs, oblique radiographs, and cervical 1-2 open radiographs and tomography films are often taken when necessary. Orthopantomographs can be seen as acromegaly or transverse hyperplasia of the hook vertebral joint and narrowing of the intervertebral space; lateral films can be seen as poor compliance of the cervical spine, retroflexion, narrowing of the intervertebral space, formation of bone redundancy at the anterior and posterior edges of the vertebral body, osteosclerosis of the upper and lower edges of the vertebral body (motion endplate), and developmental cervical spinal stenosis; hyperflexion and hyperextension lateral positions can have segmental instability; left and right oblique films can be seen as narrowing and distortion of the intervertebral foramen. Sometimes high-density striae can be seen at the posterior edge of the vertebral body – ossification of the posterior longitudinal ligament of the cervical spine. Cervical spinal canal measurement: On lateral cervical radiographs, the ratio of the midsagittal diameter of the spinal canal to the midsagittal diameter of the vertebral body is diagnosed as developmental cervical spinal stenosis if the ratio is less than or equal to 0.75 for any of the vertebral segments C3 through C6. Segmental instability is important in the diagnosis of sympathetic cervical spondylosis and is measured (see Figure 2): i.e., on a lateral cervical hyperflexion and hyperextension film, the sum of the distance from the point where the extension of the posterior border of the vertebral body line intersects the inferior border of the slipped vertebral body to the posterior border of the same vertebral body ≥ 2 mm; the angle between the vertebral bodies is > 11°. CT can show the shape of the spinal canal and the extent of OPLL and the degree of encroachment on the spinal canal; myelography with CT examination can show the compression of the dural sac, spinal cord and nerve roots. MRI examination of the neck, on the other hand, can clearly show changes within the spinal canal and the spinal cord, as well as changes in the site and morphology of spinal cord compression, which is of great value for the diagnosis of cervical spine injury, cervical spondylosis and tumor. When the cervical intervertebral disc degenerates, its signal intensity also decreases, and the diagnosis of disc herniation can be accurately made in both the sagittal and cross-sectional planes. In the diagnosis of cervical spine diseases, magnetic resonance imaging can not only show the extent and degree of backward compression of the dural sac by cervical spine fractures and disc herniation, but also reflect the pathological changes after spinal cord injury. Intraspinal hemorrhage or substantial damage generally appears as a dark and gray image on T2-weighted images. In contrast, spinal cord edema often appears as a uniformly dense striated or pyknotic signal. Transcranial color Doppler (TCD), DSA, and MRA can probe basilar artery blood flow and intracranial blood flow in the vertebral artery and presume vertebral artery ischemia, which is an effective means of examining inadequate blood supply to the vertebral artery and is a common test for clinical diagnosis of cervical spondylosis, especially vertebral artery cervical spondylosis. Vertebral arteriogram and vertebral artery “ultrasound” can be helpful in diagnosis.