The main symptoms of cervical spondylosis include almost all types of clinical symptoms of cervical spondylosis, some symptoms such as neck pain and hand numbness seem to be easily associated with cervical spondylosis, but some symptoms such as headache, dizziness, heartburn and chest tightness, and various kinds of five sensory diseases are not thought of by clinicians in any way due to the limitations of their specialties. For example, most of the young patients’ headache and dizziness are caused by cervical spondylosis, but when the patients are seen, most of the doctors tend to let the patients undergo cranial CT or MRI examination, and the results are naturally all normal, but the patients’ headache and dizziness are still the same, they are at their wits’ end, and they can’t think of cervical spondylosis at all, which is the typical thinking of “treating the head when there is a headache and treating the foot when there is a pain”.
If the patient’s condition is just delayed, the most terrible thing is that once the diagnosis is wrong, the treatment will also be wrong, if the pharyngeal (esophageal) cervical spondylosis is misdiagnosed as esophageal cancer and a large area is cleaned up, then it is really wrong. So it is also very important as a patient to be able to roughly determine a certain disease based on their symptoms and to see a doctor in the relatively correct department.
1. Neck, shoulder and back pain.
Pain is the basic symptom of cervical spondylosis, and almost all cervical spondylosis has very significant pain symptoms in the early stage or throughout the whole process, and the site of pain can occur in the neck and shoulder back. A study found that 92% of the cervical spine patients complained of neck pain, 71% of shoulder pain, 44% of upper arm pain, 31% of forearm pain, and 37% of headache.
Among them, neck pain is the most common first symptom of all cervical spondylosis, mostly in the form of dull pain, vague pain or stabbing pain, mostly seen in the morning, accompanied by stiffness and stiffness in the neck.
Upper back pain is often easily misdiagnosed as a disease of the thoracic spine. Patients mainly present with pain in the scapular region of the upper back, most notably in the upper corner of the medial edge of the scapula, which can be characterized by a feeling of obvious striated tendons, or in some cases, widespread pain in the upper back scattered in a fan shape from the cervical spine downward, which is actually the typical distribution range of the trapezius muscle. There are many patients with shoulder pain as the main complaint symptom, which is easily misdiagnosed as frozen shoulder, but in fact, even with typical frozen shoulder manifestations, it is closely related to cervical spondylosis. Shoulder pain is intense in the early stage, with burning and stabbing sensations, and soreness and vague pain in the chronic stage.
2. Restricted activity.
The range of motion of the cervical spine is significantly reduced compared to normal or before, and it is felt that the muscles of the neck and back of the shoulder are stiff, stagnant and sore, and it is difficult to bend forward and backward and turn the neck, and sometimes when the neck is turned with a little force, there is severe pain and it radiates to the upper limbs and other places, and many patients have obvious dizziness symptoms when turning the neck, and in serious cases, they may even fall suddenly.
3. Upper limb pain and numbness
The pain in the upper limbs is mostly tingling, swelling, burning-like pain, and in severe cases, it radiates from the back of the neck to the arms (outer upper arm, inner and outer forearm, inner and outer elbow joints), and coughing, sneezing and deep breathing can induce unbearable radiating pain.
The numbness of the limbs is mainly manifested as numbness in the outer part of the upper arm, the deltoid area near the shoulder, and one or several fingers. Both neurogenic cervical spondylosis and spinal cord cervical spondylosis can cause it, with the former causing numbness in the upper limbs most often, and the latter starting with numbness and sinking in the lower limbs bilaterally or unilaterally, which gradually worsens, followed by numbness and pain in one or both upper limbs, and weakness in holding objects and other symptoms.
4.Cervical headache
Almost all patients with sympathetic cervical spondylosis almost without exception have headache, and up to 60~80% of patients with vertebral artery cervical spondylosis have headache, and a considerable number of patients with neurogenic cervical spondylosis also have headache symptoms. Headache and dizziness can coexist, but there are often primary and secondary symptoms, either headache mainly accompanied by dizziness, or dizziness mainly accompanied by headache, and most patients tend to have alternating attacks of headache and dizziness.
The pain site can be located in the posterior occipital region, lower occipital region, top of the head, temporal region on both sides of the head, around the orbits or one side of the migraine, posterior headache or head tingling, but most of them still have pain mainly in the cervical-occipital region and occipito-parietal region. The nature of the pain can be vague, dull, stabbing, throbbing, burning or sore. It is often accompanied by symptoms such as vertigo, eye swelling, black eyes, heartbeat, sweating, nausea and vomiting, tinnitus, etc. Neck stiffness and tightness of the head and face are very common.
We should remember that cervical spondylosis is the primary cause of cervical headache, of which migraine can be up to 70% or more, and is most common in women. Cervical headache can be caused by direct pressure on the spinal nerve due to superior cervical spine lesion, excessive tension on the muscles of the neck and collar, pressure on the sympathetic nerve next to the cervical vertebrae, narrowing or spasm of the vertebral artery due to pressure on the bone.
5.Dizziness and lightheadedness
Dizziness, patients have the illusion that they or the surrounding scenery rotate in one direction, the body stands unstable, and feel objects tilt and sink. It is often triggered when changing position, excessive flexion and extension of the head or rotation. Episodes can be very brief or last for several hours or longer. Vertigo attacks may be accompanied by tinnitus, nausea and vomiting, cold sweats, palpitations and panic, and cold extremities. Some patients may experience dizziness in the head, feeling heavy, drowsy and unmotivated.
Studies have found that more than 95% of patients with disorders of the first two cervical vertebrae (atlantoaxial joint) have dizziness of varying severity, more than 70% of dizziness of unknown origin is closely related to atlantoaxial joint disorders, and more than 50% of patients with dizziness or lightheadedness are accompanied by visual and hearing impairment. Therefore, it is believed that atlantoaxial joint disorder is one of the main factors causing vertigo.
6. Swelling and pain in the throat.
It is mainly seen in patients with pharyngeal type (esophageal type) cervical spondylosis, which is caused by the stimulation or compression of the posterior pharyngeal wall or esophagus by osteophytes on the anterior edge of the cervical vertebrae or forward protrusion of intervertebral discs, with pharyngeal and esophageal symptoms such as dryness of the throat, pain in the throat, obvious foreign body, difficulty in swallowing and mute voice as the main manifestations, and it is very easy to be misdiagnosed as chronic pharyngitis, esophageal cancer or neurosis, and the misdiagnosis rate can be as high as 80~90% or more before confirmation.
In the early stage or exacerbation of cervical cervical spondylosis, almost all patients have symptoms of redness and pain in the throat, especially in young and middle-aged patients. Of course, it should be distinguished from the sore throat caused by many other diseases, such as cold, chronic pharyngitis, purulent tonsillitis, rheumatism-induced sore throat.
7. Heartburn and insomnia
It is mostly caused by the formation of vertebral osteophytes and bone spurs in cervical spondylosis, or the disorder and misalignment of cervical joints and herniated intervertebral discs, which stimulate or compress the sympathetic ganglion or carotid sinus in the neck, resulting in a series of symptoms of sympathetic nerve disorder innervating internal organs.
If the upper cervical sympathetic ganglion is stimulated, symptoms such as tachycardia, blurred vision, drowsiness, epilepsy, persistent insomnia (difficulty in falling asleep or waking up easily, daytime dizziness, mental fatigue and drowsiness, but lying in bed with a clear mind and no sleepiness) may occur.
If the middle cervical sympathetic ganglion and the carotid sinus are stressed, symptoms such as bradycardia, erratic reflux, goiter, and increased or decreased blood pressure may occur.
If the lower cervical sympathetic ganglion is pressurized, symptoms such as atrial fibrillation, early awakening, early waking, abnormal sweating (generalized or restricted sweating or no sweating) may occur. Heartburn and chest tightness: arrhythmia, pain in the precordial region, chest tightness and chest pain.
8, head and facial five senses
Because the nerves and blood vessels that innervate the head and facial organs and soft tissues all pass through the cervical spine or are emitted from the cervical spine, when cervical spondylosis occurs to stimulate or compress the above nerves and blood vessels or even directly compress the corresponding soft tissues, different symptoms of five sensory pathologies will appear. In particular, if no significant abnormalities are found after the corresponding specialist examination and the corresponding specialist treatment is ineffective, and if there are also typical manifestations of cervical spondylosis, it should be considered as a result of cervical spondylosis.
Eye symptoms: blurred vision, eye pain, dry eyes, blurred vision, decreased vision, photophobia and tearing, reluctance to open eyes, drooping eyelids, eyelid fluttering, dilated pupils, myopia, glaucoma, etc. When the cervical 1~3 and cervical 6~7 joints are misaligned, vision loss due to inflammatory stimulation or compression of the superior cervical sympathetic ganglion and shape ganglion, which increases the excitability of their nerve fibers and spasm of the central optic nerve artery; the pupil does not adjust to light and vision loss, blurred vision, and diplopia.
In the case of malformation of the stem, which is too long and extends to the transverse process of the first cervical vertebra, the occipito-atlanto-axial joint is misaligned, which distorts the nearby soft tissues and affects blood circulation, resulting in eye distention, myopia and glaucoma. Occipito-atlanto-axial joint misalignment can also stimulate the trigeminal spinal cord bundle, causing periocular neuralgia or forehead pain. Inadequate blood supply to the vertebral artery can cause damage to the optic center and cerebral nerves, resulting in retinopathy due to impaired ocular circulation.
Nasal symptoms: mainly allergic rhinitis, with symptoms such as nasal congestion, runny nose, nasal itching, sneezing, and even temporary loss of sense of smell, accompanied by head swelling and hearing impairment. It is often triggered by cervical spondylosis when the corresponding nerve is stimulated by the change of position while working with the head down or up.
When the upper cervical spine, especially cervical 1~4, is misaligned forward or sideways due to acute injury or chronic strain, it is easy to push and pull the tension or compress the soft tissues of the cervical sympathetic ganglion or the base of the skull (stem mammary foramen) due to the tension of the deep fascia, causing the stimulation or compression of sympathetic or parasympathetic nerve fibers and physical stimulation of neural excitation or inhibition, which causes the function of the innervated organs to become The organ under its innervation becomes dysfunctional. If this temporary physical irritation is not eliminated in time and repeated irritation and compression form traumatic inflammation and become aseptic inflammatory edema, the organ it innervates becomes dysfunctional for a long time.
Ear symptoms: Tinnitus, deafness, ear swelling, and hearing loss. Tinnitus can occur unilaterally or bilaterally, with a sound like a cicada or even like the roar of a machine. The symptoms of tinnitus and deafness caused by cervical spondylosis are often accompanied by sympathetic nerve dysfunction and various manifestations of cervical spondylosis, such as headache, dizziness, nausea, panic, insomnia, blurred vision, neck pain, restricted movement, and numbness and weakness of both upper limbs.
Due to the misalignment of small joints in cervical spondylosis, the vertebral artery is stimulated or compressed, or the sympathetic nerves around the ligament of the cervical capsule or the wall of the vertebral artery are stimulated, which reflexively causes spasm of the vertebral artery and leads to tinnitus or deafness due to reduced blood flow to the inner ear caused by insufficient blood supply to the vertebrobasilar artery.
Oral symptoms: Most of them cause temporomandibular joint disorder, restricted opening movement, pain in the temporomandibular joint when chewing, and popping or murmur when the joint moves. Due to foreign trade, strain, degeneration, inflammation and other factors, the atlanto-occipital, atlanto-axial and cervical 2~3 joints can be misaligned. The mechanical compression and chemical stimulation of sterile inflammation caused by soft tissue lesions in the cervical-occipital area after misalignment can affect the supra-cervical sympathetic ganglion and the spinal nucleus of the trigeminal nerve in the upper cervical segment, thus causing the function of the masticatory muscle branch of the mandibular nerve in the trigeminal nerve to be affected, causing the temporalis, occlusal, internal and external pterygoid muscles innervated by it to be affected. This causes hyperfunction and spasm of the temporomandibular muscle, internal pterygoid muscle, and external pterygoid muscle, resulting in functional disorder of the temporomandibular joint in the early stage, structural disorder in the middle stage, and even development of organic destruction of the joint in the late stage.
9.Gait instability
Gait instability is a typical feature of spinal cord cervical spondylosis. Patients mostly exhibit drifting walking, with one foot heavy and one foot light, like stepping on cotton. A large proportion of patients start with unilateral or bilateral numbness and sinking of the lower limbs, followed by difficulty in walking, muscle atrophy of the tissues of the lower limbs, slow lifting and inability to walk quickly, and in severe cases, gait instability gradually appears, moreover, they cannot run and their feet feel like stepping on cotton. Most of the gait instability is due to degeneration of the cervical disc, joint instability, formation of bone spurs, and the protruding mixture keeps stimulating and compressing the spinal cord, together with the posterior hypertrophic ligamentum flavum that folds when the neck is posteriorly extended to stimulate or compress the spinal cord from the posterior, resulting in the symptoms of typical spinal cord cervical spondylosis.