Part I Preface
Cervical spondylosis is a common and prevalent disease with a prevalence of about 3.8%-17.6% and a male to female ratio of about 6:1.
The Second National Symposium on Cervical Spondylosis in 1992, Qingdao, clearly defined cervical spondylosis: that is, degenerative changes in the intervertebral discs of the cervical spine and their secondary pathological changes involving the surrounding tissue structures such as nerve roots, spinal cord, vertebral artery, sympathetic nerve, etc., with corresponding clinical manifestations. Degenerative changes of the cervical spine without clinical manifestations are called cervical degenerative changes.
With the increase in the number of people working with their heads down in modern times, such as the widespread use of computers and air conditioners, the chances of people flexing their necks and suffering from wind, cold and dampness are increasing, resulting in a rising prevalence of cervical spondylosis, and the trend of a younger age of onset.
Part II Classification of cervical spondylosis
According to the different tissues and structures involved, cervical spondylosis is divided into: cervical type also known as soft tissue type,, nerve root type, spinal cord type, sympathetic type, vertebral artery type, and other types currently mainly referring to esophageal compression type,. If more than two types exist at the same time, it is called “mixed type”.
I. Cervical cervical spondylosis.
Cervical cervical spondylosis is caused by acute and chronic injury to the neck muscles, ligaments and joint capsule, degeneration of the intervertebral disc, instability of the vertebral body and misalignment of the small joints, etc. The body is attacked by wind and cold, cold, fatigue, improper sleep posture or inappropriate pillow height, which makes the cervical spine over-extend or over-flex, and certain muscles, ligaments and nerves in the neck are strained or compressed. It mostly develops at night or in the morning, and has the tendency of natural remission and recurrent attacks. 30-40 years old women are more common.
Nerve root type cervical spondylosis
Neurogenic cervical spondylosis is caused by irritation and compression of cervical nerve roots in the spinal canal or intervertebral foramen due to disc degeneration, herniation, segmental instability, osteophytes or bone redundancy formation. It has the highest incidence among all types, accounting for about 60-70%, and is the most common type in clinical practice. Mostly unilateral and single-root onset, but there are also bilateral and multi-root onset cases. It is most common in people aged 30-50 years and usually has a slow onset, but there are also cases with acute onset. There are more men than women.
C. Spinal cord type cervical spondylosis
The incidence of spinal cord cervical spondylosis accounts for 12-20% of cervical spondylosis and has a high disability rate because it can cause limb paralysis. It usually starts slowly and is more common in middle-aged people aged 40-60. When combined with developmental cervical spinal stenosis, the average age of onset is younger than that of patients without spinal stenosis. Most patients have no history of cervical trauma.
IV. Sympathetic cervical spondylosis
Due to factors such as disc degeneration and segmental instability, which cause stimulation of sympathetic nerve endings around the cervical spine, sympathetic nerve dysfunction is produced. Sympathetic cervical spondylosis has a wide range of symptoms, most of which are sympathetic excitation symptoms and a few are sympathetic inhibition symptoms. Since the surface of the vertebral artery is rich in sympathetic nerve fibers, when sympathetic nerve dysfunction occurs, the vertebral artery is often involved, resulting in abnormal diastolic function of the vertebral artery. Therefore, sympathetic cervical spondylosis is often accompanied by inadequate blood supply to the vertebrobasilar artery system in addition to the symptoms of several systems in the body.
V. Vertebral artery type cervical spondylosis
In normal people, when the head is tilted or twisted to one side, the vertebral artery on the same side is squeezed and the blood flow of the vertebral artery is reduced, but the vertebral artery on the opposite side can compensate, thus ensuring that the blood flow of the vertebrobasilar artery is not greatly affected. When segmental instability and narrowing of the intervertebral space occur in the cervical spine, the vertebral artery can be distorted and compressed; the bony bulge at the edge of the vertebral body and the hook vertebral joint can directly compress the vertebral artery or stimulate the sympathetic nerve fibers around the vertebral artery, causing spasm of the vertebral artery and instantaneous changes in vertebral artery blood flow, resulting in inadequate blood supply to the vertebrobasilar system and symptoms, so that there are no symptoms outside the vertebral artery system.
Part III Clinical manifestations of cervical spondylosis
I. Cervical cervical spondylosis.
1, cervical straightness and pain, there may be pain and stiffness in the whole shoulder and back, and it is impossible to nod, tilt the head and turn the head, and it is in a sloping neck position. When the neck needs to be turned, the trunk must be turned at the same time, and the symptoms of dizziness may also appear.
2. A few patients may have reflex shoulder, arm and hand pain, swelling and numbness, and the symptoms do not worsen when coughing or sneezing.
3.Clinical examination: In the acute stage, the cervical spine activity is absolutely limited, and the range of motion of the cervical spine in all directions is nearly zero. There is pressure pain in the cervical paraspinal muscles, thoracic 1 to thoracic 7 paraspinal or rhomboid muscles, sternocleidomastoid muscles, and there may also be pressure pain in the supraspinatus and infraspinatus muscles. If there is secondary spasm of the anterior oblique muscle, the spastic muscle can be found on the medial side of the sternocleidomastoid muscle, which corresponds to the level of the transverse process of cervical 3 to cervical 6, and with slight pressure, radiating pain can appear in the shoulder, arm and hand.
II. Nerve root type cervical spondylosis
1. Neck pain and stiffness of the neck are often the earliest symptoms. Some patients also have pain in the shoulder and the medial edge of the scapula.
2.Radiation pain or numbness in the upper extremities. This pain and numbness radiates along the course and innervation area of the affected nerve root and is characteristic, hence the term root-type pain. The pain or numbness can be episodic or persistent. Sometimes there is a clear relationship between the appearance and relief of symptoms and the position and posture of the patient’s neck. Neck movement, coughing, sneezing, exertion and deep breathing can cause aggravation of symptoms.
3. The affected upper extremity feels heavy, has reduced grip strength, and sometimes appears to hold objects falling down. There may be vasomotor nerve symptoms, such as swelling of the hand. Muscle atrophy can occur in the late stage.
4. Clinical examination: neck stiffness and restricted movement. Tension in the affected neck muscles, pressure pain in the spinous process, paraspinal process, medial edge of the scapula and muscles innervated by the affected nerve roots. The presence of pressure pain in the intervertebral foramina with radiating pain or numbness in the upper extremities, or aggravation of existing symptoms, has localizing significance. A positive intervertebral foramen compression test and a positive brachial plexus nerve pull test are indicated. Careful and comprehensive neurological examination can help localize the diagnosis.
C. Spinal cord type cervical spondylosis
1. Most patients first experience numbness and heaviness in one or both lower limbs, and then gradually experience difficulty in walking, tightness of various groups of muscles in the lower limbs, slow lifting and inability to walk fast. Then, when going up and down the stairs, it is necessary to hold the handrail with the upper limb in order to ascend the steps. In severe cases, the gait is unstable and walking is difficult. Patients have the feeling of stepping on cotton in both feet. Some patients start insidiously, often trying to catch a bus that is about to leave, but suddenly find that their legs cannot walk fast.
2. Numbness and pain in one or both upper limbs, weakness and inflexibility in both hands, difficulty in completing fine movements such as writing, fastening, holding chopsticks, etc., and easy to drop objects. In severe cases, the patient cannot even eat by himself.
Patients often feel a belt-like binding sensation in the chest, abdomen, or both lower limbs, called “belt sensation”. At the same time, there may be burning and cold sensation in the lower extremities.
4. Some patients have bladder and rectal dysfunction. Such as weak urination, frequent urination, urgent urination, incomplete urination, urinary incontinence or urinary retention and other urinary disorders, constipation. Sexual function is reduced.
Further development of the disease, the patient must be crutches or with the help of others to walk, until the emergence of spastic paralysis of both lower limbs, bedridden, unable to take care of their own lives.
5. Clinical examination: There are no signs in the neck. The upper extremities or trunk have segmental distribution of superficial sensory disorders, deep sensation is normal, muscle strength is reduced, and grip strength of both hands is reduced. Tendon reflexes are active or hyperactive: including biceps, triceps, radial membrane, knee tendon and Achilles reflex; patellar clonus and ankle clonus are positive. Positive pathological reflexes: such as Hoffmann’s sign, Rossolimo’s sign in the upper extremity, Barbinski’s sign and Chacdack’s sign in the lower extremity. Superficial reflexes such as abdominal wall reflex and tic reflex are diminished or absent. If the tendon reflexes of the upper extremity are diminished or absent, it suggests that the lesion is at the level of that nerve segment.
IV. Sympathetic cervical spondylosis
1. Head symptoms: such as dizziness or vertigo, headache or migraine, head sinking, occipital pain, poor sleep, memory loss, difficulty in concentration, etc. Occasionally, people may fall down due to dizziness.
2. Eye, ear, nose and throat symptoms: eye swelling, dryness or tearfulness, vision changes, blurred vision, fog in front of the eyes, etc.; tinnitus, ear blockage, hearing loss; nasal congestion, “allergic rhinitis”, foreign body sensation in the throat, dry mouth, vocal cord fatigue, etc.; taste changes, etc.
3, gastrointestinal symptoms: nausea or even vomiting, bloating, diarrhea, indigestion, belching, and foreign body sensation in the throat, etc.
4, cardiovascular symptoms: palpitations, chest tightness, heart rate changes, arrhythmia, blood pressure changes, etc.
5. Excessive sweating, no sweating, chills or fever on the face or a certain limb, sometimes pain and numbness but not according to the distribution of nerve segments or travels.
The above symptoms are often clearly related to the neck activity, aggravated when sitting or standing, and alleviated or disappeared when lying down. It is obvious when there are many neck activities, prolonged head bowing, long working hours in front of computer or exertion, and improves after rest.
6.Clinical examination: the neck activity is normal, and the soft tissue around the interspinous process of the cervical spine or the paravertebral small joints is painful. Sometimes it may also be accompanied by changes in heart rate, heart rhythm, blood pressure, etc.
V. Vertebral artery type cervical spondylosis
1. Episodic vertigo with diplopia accompanied by nystagmus. Sometimes accompanied by nausea, vomiting, tinnitus or hearing loss. These symptoms are related to the change in the position of the neck.
2.Sudden weakness of lower limbs and sudden collapse, but consciousness, mostly occurs when the head and neck are in a certain position.
3. Occasionally, there is numbness and abnormal sensation in the limbs. Transient paralysis and episodic coma may occur.
Part IV Diagnostic criteria of cervical spondylosis
I. Clinical diagnostic criteria
1, cervical type: with a typical history of falling pillow and the above-mentioned cervical symptoms and signs; imaging examination can be normal or only have physiological curvature changes or mild spinal space narrowing, with little bone formation.
2, nerve root type: with root distribution of symptoms numbness, pain, and signs; intervertebral foramen squeeze test or / and brachial plexus pull test positive; imaging seen and clinical manifestations are basically consistent; exclude extra-cervical lesions thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps long head tenosynovitis, etc., caused by pain.
3, spinal cord type: clinical manifestations of cervical spinal cord damage; imaging shows degenerative changes in the cervical spine, cervical spinal stenosis, and confirms the presence of cervical spinal cord compression consistent with clinical manifestations; except for progressive amyotrophic lateral sclerosis, spinal cord tumors, spinal cord injury, secondary adhesive arachnoiditis, multiple peripheral neuritis, etc.
4, sympathetic type: diagnosis is more 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 besides.
1, otogenic vertigo: vertigo is caused by vestibular dysfunction in the inner ear. Such as 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 of vertebrobasilar artery and lacunar cerebral infarction caused by atherosclerosis; brain tumor; sequelae of traumatic brain injury, etc.
4.Vascular origin vertigo: vertebrobasilar artery supply insufficiency due to V1 and V3 segment stenosis of vertebral artery; hypertension, coronary heart disease, pheochromocytoma, etc.
5.Other causes: diabetes, 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.
II. Imaging and other auxiliary examinations
X-ray examination is an important tool 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 the injury, treatment selection, and treatment evaluation. The whole cervical spine is often photographed in frontal and lateral views, cervical extension and flexion dynamic lateral views, oblique views, and cervical 1-2 open views and tomograms when necessary. In the orthopantomogram, we can see that the hook vertebral joint becomes sharp or lateral hyperplasia and the intervertebral space is narrowed; in the lateral film, we can see that the cervical vertebrae are poorly aligned and retroflexed, the intervertebral space is narrowed, the vertebral body is bony at the anterior and posterior edges, the vertebral body is moving at the upper and lower edges, osteosclerosis, and the developmental cervical spinal canal is narrowed; in the hyperflexion and hyperextension lateral position, there may be segmental instability; in the left and right oblique films, the intervertebral foramen is narrowed and deformed. Sometimes high-density striations can be seen at the posterior edge of the vertebral body – Ossification of posterior longitudinal ligament, OPLL,.
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 on any of the vertebral segments C3 through C6. Segmental instability is important in the diagnosis of sympathetic cervical spondylosis and is measured: i.e., on a lateral cervical hyperflexion-hyperextension film, the sum of the distance between the point where the extension of the posterior border of the vertebral body line and the inferior border of the slipped vertebral body intersect 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 CT can show the shape of the spinal canal and the extent of OPLL and its encroachment on the spinal canal; myelography with CT can show compression of the dural sac, spinal cord and nerve roots.
MRI 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 tumors. 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.
Part V. Treatment of cervical spondylosis
The treatment of cervical spondylosis is divided into surgical and non-surgical.
Most patients with cervical spondylosis have excellent results with non-surgical treatment, and only a small percentage of patients need surgery because non-surgical treatment is ineffective or the condition is serious.
I. Non-surgical treatment
At present, it is reported that 90-95% of patients with cervical spondylosis are cured or in remission after non-surgical treatment. At present, non-surgical treatment mainly adopts comprehensive therapies such as Chinese medicine, Western medicine, combination of Chinese and Western medicine and rehabilitation treatment, and Chinese medicine treatment means combined with Western medicine such as anti-inflammatory and analgesic, vasodilator, diuretic and dehydrating, and nerve-nourishing drugs.
1.Chinese medicine treatment
1, Chinese medicine evidence-based treatment.
Dialectical treatment of Chinese medicine: the basic method should be to use drugs in a typological dialectical manner.
1, cervical cervical spondylosis: it is appropriate to remove wind and relieve the surface, disperse cold and open the ligaments.
2, nerve root type cervical spondylosis: divided into.
Pain is the main cause, and it is appropriate to dispel stasis and open the ligaments.
3.Vertebral artery type cervical spondylosis, divided into
Dizziness with headache, biased by blood stasis, it is advisable to dispel blood stasis and pass through the ligaments, to remove dampness and calm the liver.
For dizziness with headache, it is advisable to dispel stasis and clear dampness and calm the liver.
If you are dizzy, tired and weak, and have a less florid face, take the method of benefitting the qi and ying to resolve dampness.
4, spinal cord type cervical spondylosis: those with increased muscle tone and a feeling of banding in the chest and abdomen should take the method of dispelling blood stasis and clearing the internal organs.
Sympathetic cervical spondylosis has more symptoms, so it is appropriate to treat according to the condition.
2.Therapeutic method of Chinese herbal medicine: Chinese herbal medicines with different effects such as promoting qi and dispersing stasis, warming the meridians and dispersing cold, relaxing the tendons and activating the collaterals or clearing heat and detoxifying the toxins are made into different dosage forms and applied to the relevant parts of patients with cervical spondylosis. The common treatment methods of external treatment of cervical spondylosis Chinese medicine include teng medicine, compress medicine, spray medicine, etc.
3.Tui na and orthopedic manipulation: it has the function of adjusting the internal organs, balancing yin and yang, promoting the generation of qi and blood, activating blood circulation and eliminating blood stasis, promoting tissue metabolism, releasing muscle tension and managing tendon reset. The basic techniques include massage, kneading, pointing, pressing and wrenching.
Special emphasis is placed on the fact that massage must be carried out by a medical professional. Cervical spondylosis treatment should be gentle, avoid violence. The vertebral artery type and spinal cord type patients should not apply posterior joint manipulation. It is difficult to exclude lesions such as tumors in the spinal canal, developmental stenosis of the spinal canal, spinal cord compression symptoms, bony destruction of the vertebral body and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occiput, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is prohibited.
4, acupuncture therapy: including acupuncture and moxibustion method. Acupuncture is the use of refined metal needles into certain parts of the body, with appropriate techniques to stimulate, while moxibustion is the use of moxa or moxa cones ignited and smoked acupuncture points for stimulation, through stimulation to achieve the adjustment of the human meridian organs qi and blood function, prevention and treatment of disease.
Second, rehabilitation treatment
1.Physical factor therapy
The main function of physical factor therapy is to dilate blood vessels, improve local blood circulation, release the spasm of muscles and blood vessels, eliminate inflammation and edema of nerve roots, spinal cord and surrounding soft tissues, reduce adhesions, regulate the function of vegetative nerves, and promote the recovery of nerve and muscle functions. Commonly used treatment methods.
1.Direct current ion introduction therapy
2.Low frequency modulated medium frequency electrotherapy
3.Ultra-short wave therapy
4.Ultrasonic therapy
5.Ultrasonic electroconduction targeted transdermal drug delivery therapy
6.High potential therapy
7.Light therapy
8.Other therapies.
2.Traction therapy
Cervical traction is a common and effective method to treat cervical spondylosis. Cervical traction helps to release the muscle spasm of the neck, relax the muscles and relieve the pain; loosen the soft tissue adhesions, stretch the contracted joint capsule and ligaments; improve or restore the normal physiological curvature of the cervical spine; increase the intervertebral foramen and relieve the nerve root stimulation and compression; enlarge the vertebral space and reduce the pressure in the intervertebral disc. Adjusting the microscopic abnormal changes of small joints, so that the synovial membrane of joint embedment or the misalignment of synovial joint can be reset.
Cervical spine traction treatment must master the three major elements of traction force direction angle,, weight and traction time in order to obtain the best therapeutic effect of traction.
3.Manipulation treatment
It is based on the anatomical and biomechanical principles of cervical spine bones and joints, and for its pathological changes, passive activities such as pushing, pulling and rotating the spine and small joints of the spine are performed to adjust the anatomical and biomechanical relationship of the spine, and at the same time, the muscles and soft tissues related to the spine are loosened and rationalized to improve joint function, relieve spasm and reduce pain. The purpose is to improve joint function, relieve spasm and reduce pain.
Commonly used methods are Chinese and Western techniques. Chinese techniques refer to the traditional Chinese massage and tui-na techniques, which generally include bone and joint repositioning techniques and soft tissue massage techniques. Western-style techniques commonly used in China are McKenzie Mckenzie, method, joint loosening Maitland technique, chiropractic, and so on.
Special emphasis should be placed on the fact that manipulative treatment of cervical spondylosis must be carried out by trained medical professionals. It is advisable to control the strength of the manipulation according to the individual situation and to be as gentle as possible, avoiding violence. It is difficult to exclude lesions such as tumors in the spinal canal, developmental stenosis of the spinal canal, spinal cord compression symptoms, bony destruction of the vertebrae and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occiput, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is cautiously used or prohibited.
4.Exercise therapy
Exercise therapy for the cervical spine refers to the use of appropriate exercise methods to exercise the neck and other related parts as well as the whole body. Exercise therapy can enhance the muscle strength of the neck, shoulder and back muscles, stabilize the cervical spine, improve the function of the joints between the vertebrae, increase the range of motion of the cervical spine, reduce nerve stimulation, reduce muscle spasm, eliminate pain and other discomfort, correct abnormalities or deformities in the alignment of the cervical spine, and correct poor posture. Long-term adherence to exercise therapy can promote the body’s adaptation to the compensatory process, thereby achieving the purpose of consolidating the therapeutic effect and reducing recurrence.
Cervical spine exercise therapy is commonly used in the form of freehand exercises, stick exercises, dumbbell exercises, etc. Mechanical training is also available when available. Types usually include cervical spine flexibility exercises, cervical muscle strength training, cervical spine correction training, etc. In addition, there are whole-body exercises such as running, swimming, ball games, etc. are also common therapeutic exercises for cervical spine disorders. Patients with cervical spondylosis can be instructed to adopt the “Neck and shoulder disease exercise prescription”.
Exercise therapy is suitable for patients with all types of cervical spondylosis in remission and post-operative recovery. The specific methods and approaches vary according to different types of cervical spondylosis and different individual physiques, and should be carried out under the guidance of a specialist.
5.Orthopedic support application
Orthopedic brace of cervical spine is mainly used for fixing and protecting cervical spine, correcting abnormal mechanical relationship of cervical spine, reducing neck pain, preventing over-extension, over-flexion and over-rotation of cervical spine, avoiding further damage to spinal cord and nerves, reducing spinal edema, reducing traumatic reaction of intervertebral joints, helping to repair tissues and alleviate symptoms, and cooperating with other treatment methods at the same time can consolidate therapeutic effect and prevent recurrence.
The most commonly used ones are neck circumference and neck brace, which can be applied to patients in the acute stage or with severe symptoms of all types of cervical spondylosis. Cervical brace is also mostly used for patients with cervical fracture or dislocation and intervertebral instability or subluxation even after early treatment. Wearing a neck brace for protection is necessary when riding in high-speed cars and other means of transportation, whether with or without cervical spondylosis. However, unreasonable long-term use should be avoided as it may lead to cervical muscle weakness and poor cervical mobility.
Regardless of that type of cervical spondylosis, the basic principle of its treatment is to follow the basic principle of non-surgical treatment first and then surgery after it is ineffective. This is not only because of the pain and injury and complications associated with surgery itself, but more importantly because the majority of cervical spondylosis itself can be stopped, improved or even cured through non-surgical treatment. Unless there are a few cases with clear indications for surgery, regular non-surgical treatment should be started and continued for 3 to 4 weeks, which is generally effective. For individual cases of progressive development, which are mostly spinal cord type cervical spondylosis, it is necessary to make an immediate decision and perform surgery early.
II. Surgical treatment
The main purpose of surgical treatment is to relieve the serious compression on the spinal cord or blood vessels due to disc herniation, bone flab formation or ligament calcification, and to rebuild the stability of the cervical spine. Once the diagnosis of spinal cord cervical spondylosis is confirmed, those whose condition is increasingly aggravated and invalidated by non-surgical treatment should be actively treated surgically; those whose symptoms of neurogenic cervical spondylosis are heavy and affect patients’ life and work, or those with muscle movement disorders; and other types of cervical spondylosis whose conservative treatment is ineffective or whose efficacy is not consolidated and recurrent, should be considered for surgical treatment.
The indications for minimally invasive treatment such as myelolysis, percutaneous aspiration, PLDD, radiofrequency ablation, etc. must be strictly mastered.
The surgical procedures are divided into anterior and posterior cervical approaches.
1.Anterior surgery.
2.Posterior surgery.
3.Rehab treatment
The rehabilitation treatment in the “perioperative period” of cervical spondylosis is conducive to consolidating the efficacy of surgery, making up for the deficiency of surgery, and relieving the local and systemic trauma brought about by surgery, so as to achieve the purpose of restoring the physical and mental health of patients.
The basic method of perioperative treatment cannot be separated from the rehabilitation medical treatment of cervical spondylosis such as traditional Chinese medicine, physical therapy, sports therapy, hyperbaric oxygen, etc., and cannot ignore some new pathological factors, such as the mental burden of anxiety and panic brought by surgery to patients, and the trauma of surgery and postoperative weakness.
The “cervical spine rehabilitation and health care work” is used for the prevention and supplementary treatment of cervical spine disease, and can be planned to promote to the community, reflecting the academic idea of rehabilitation and prevention.
4.Efficacy assessment
The Japanese Orthopaedic Society has developed a standard for assessing the spinal cord function of patients with cervical spinal cord disease, referred to as the 17-point method and table, and it has been accepted by international scholars. According to China’s national conditions, the corresponding standard has also been developed, referred to as the 40-point method, Table II, and has been promoted and applied in China.
Part VI Prevention of cervical spondylosis
Degenerative changes in the cervical spine discs are almost inevitable as we grow older. However, if attention is paid to avoiding some factors that promote degenerative disc degeneration in life and work, it will help prevent the occurrence and development of cervical degenerative degeneration.
First, the correct understanding of cervical spondylosis, establish confidence to overcome the disease. The course of cervical spondylosis is relatively long, the degeneration of the intervertebral disc, the growth of bone spurs, ligament calcification, etc. is related to ageing and aging of the body. The disease is often recurrent, and the symptoms may be heavy during the attack, affecting daily life and rest. Therefore, on the one hand, we must eliminate the fear of pessimism, and on the other hand, we must prevent the mentality of getting by and giving up active treatment.
Second, about rest: patients with acute attacks or first attacks of cervical spondylosis should pay proper attention to rest, and those with serious conditions should rest in bed for 2-3 weeks. From the perspective of cervical spondylosis prevention, it is better to choose a bed that is conducive to the stability of the disease and to maintain the balance of the spine. The position, shape and material of the pillow should be selected, and a good sleep position is also needed to maintain the physiological curvature of the entire spine and to make the patient feel comfortable, so as to relax the muscles of the whole body and adjust the physiological state of the joints.
Third, on health care.
1, medical sports health exercises exercise: without any symptoms of cervical spondylosis, you can perform slow flexion, extension, left and right lateral flexion and rotation of the neck several times a day in the morning and evening. Strengthen the cervical back muscle isometric resistance contraction exercise.
It is significant for cervical spine patients to quit smoking or reduce smoking to relieve their symptoms and recover gradually. Avoid overexertion resulting in recurrent inflammation of the throat, avoid excessive weight bearing and human vibration and thus reduce the impact on the intervertebral disc.
2, avoid long-term low posture: to avoid prolonged low work, banking and accounting professionals, office ambulatory work, computer operations and other personnel, this position so that the neck muscles, ligaments are strained for a long time and strain, prompting the cervical disc degeneration. Change the position after about 1 hour of work. Change the bad work and life habits, such as lying in bed reading, watching TV, etc.
3, the neck is placed in the physiological state of rest: the general adult neck padding about 10 centimeters higher is better, high pillow so that the neck is in a state of flexion, the result is the same as the low head posture. When lying on the side, the pillow should be raised to the height of the head does not appear lateral flexion.
4, to avoid neck trauma: take a car to go out should wear a good seat belt and avoid sleeping in the car, so as to avoid injury to the cervical spine due to relaxation of the neck muscles when the emergency brake. When neck, shoulder and arm pain occurs, after a clear diagnosis and excluding cervical spinal stenosis, a gentle massage is feasible, avoiding overly heavy rotation techniques to avoid damage to the intervertebral disc.
5, avoid wind and cold, humidity: summer attention to avoid fans, air conditioners blowing directly to the neck, do not blow cold wind directly after sweating, or rinse the head and neck with cold water, or sleep on a cool pillow.
6, pay attention to adolescent cervical spine health: with the intensification of the competitive pressure of adolescent schooling, long hours of reading and studying have caused great harm to the cervical spine health of the majority of adolescents, resulting in the trend of cervical spondylosis at a younger age. It is recommended that in primary and secondary schools and even universities, vigorously promote health care knowledge about the cervical spine, educate students to establish awareness of cervical spine health care, pay attention to cervical spine health, establish the concept of scientific learning and healthy learning, and intercept cervical spondylosis at the source.