I. What is cervical spondylosis?
Cervical spondylosis refers to a variety of symptoms and/or signs caused by degeneration of the cervical disc itself and its secondary changes that irritate or compress adjacent tissues, called cervical spondylosis. The cervical spine is the smallest, but most flexible and most frequently active segment of the spine. Therefore, since birth, degenerative changes gradually occur as the body develops, grows and matures, and is constantly subjected to various loads, strains and even trauma.
1. Common causes of cervical spondylosis
(1) chronic strain and trauma.
(2) poor sleep position such as high pillow.
(3) improper work posture: long-term sitting position, especially low head work, resulting in strain on the muscle ligament tissue at the back of the neck. In addition, the internal pressure of the intervertebral disc is greatly increased in the case of flexion of the neck, which causes the nucleus pulposus to move back and degeneration occurs.
(4) inappropriate physical exercise: sports that exceed the neck endurance cause trauma, so the head and neck practice should be careful, not brutal practice, the cervical spine has degenerative changes do not advocate exercise.
(5) other diseases of the body can cause cervical spine lesions such as diabetes, hypothyroidism and other endocrine diseases can also contribute to degenerative changes in the cervical spine.
2.Symptoms of cervical spondylosis
(1) Restriction of head and neck movement, rotation of head and neck to the left and right when eyes are closed, causing migraine or vertigo.
2) Pain when moving around.
3) having stiffness in the neck.
4) accompanied by abnormal pain in hand and shoulder arm sensation (skin irritation, ankylosis, hot and cold fingers, etc.). Weakness of the fingers.
5) A series of head symptoms, such as migraine, visual impairment, tinnitus, hearing loss, etc., may be manifested due to ischemia in the posterior part of the brain caused by unprompted intracranial blood supply.
(6) Those with spinal stenosis may suddenly cause numbness of the whole body when lowering the head, or have an over-electricity-like sensation.
Second, cervical spondylosis is a common disease that seriously endangers the physical and mental health of patients
The survey shows that the prevalence of cervical spondylosis is gradually increasing, and 25% of people around 50 years old have suffered or are suffering from this disease, then up to 50% at the age of 60, and almost close to 100% after the age of 70. This is not only because doctors have a better understanding of the disease, but with the increase in life expectancy of our population, such degenerative-based diseases are bound to increase exponentially with age. Cervical spondylosis seriously affects the physical and mental health of patients, affecting their daily life and work, some patients can not even get out of bed and walk, life can barely take care of themselves, so the majority of patients urgently require medical treatment.
Second, the treatment of cervical spondylosis
Focus on surgical treatment
Non-surgical treatment has an important and obvious therapeutic effect on acute cervical disc herniation, and also plays an important role in the improvement of symptoms in patients with neck/upper limb pain. However, because cervical disc herniation with disc degeneration, bone formation, spinal canal and foraminal stenosis will result in bony compression and dynamic instability of the neural tissue, these factors cannot be improved by non-operative treatment. Therefore, in patients with persistent pain, non-surgical treatment has less practical utility. The pathological changes in the spinal cord itself depend on the intensity and duration of the compression, and the pressure beyond the tolerance of the spinal cord itself gradually leads to edema, softening, fibrosis, and later to cavitation and cystic degeneration. Therefore, once cervical spinal cord degeneration is diagnosed, early surgery should be performed.
Selection of the target of surgery.
1, under the guidance and observation of the clinician, patients whose inpatient or outpatient treatment for more than 2 courses is really ineffective or without significant improvement.
2.Patients with no serious lesions of major organs (liver, heart, kidney, lung, etc.) and normal coagulation mechanism.
3.Patients with local infection and pregnancy should, in principle, suspend surgery and wait until the situation allows before performing surgery.
Contraindications to surgery.
1.Patients whose major organs are accompanied by obvious organic changes and cannot withstand surgical blows.
2.Patients with unclear diagnosis.
3.Patients of advanced age, who have lost the ability to handle work life.
4. Patients whose spinal cord has been deformed for too long.
Timing of surgery
The timing of surgery and the length of the disease have a great impact on the surgical effect, and the shorter the course of the disease, the better the surgical effect. It is generally believed that the effect of spinal cord cervical spondylosis is better within 1 year, and the effect is worse for those with long disease duration.
Pre-operative preparation
1. Trachea and esophagus nudge training: for anterior cervical surgery, the patient uses his or her 2-4 fingers to insert the viscus (trachea and esophagus) and blood nerve gap on the side of the incision extracutaneously and continuously nudge it toward the non-operative side or pull it with the other hand to pull the trachea across the midline. It lasts 10-20 minutes each time at the beginning and gradually increases to 30-60 minutes thereafter, so trained for 3-5 days.
2.Training to urinate and defecate in bed.
3, prone training: mainly used for posterior cervical surgery, let the patient’s whole body in prone position, chest padding quilts or pillows, head and neck can be suspended from the head of the bed, 1-2 hours each time, last 3-5 days.
Surgical methods
1.Anterior cervical fusion
There are three main types of surgery: discectomy + intervertebral bone graft + anterior plate fixation (single segment, multi-segment); discectomy + titanium mesh placement + anterior plate fixation; discectomy + artificial disc replacement; sub-total dissection of vertebral body + intervertebral bone graft + anterior plate fixation.
The patient is placed in the supine position under general anesthesia with the shoulders elevated and the head slightly tilted back. A small transverse incision is usually made on the right side, and the vertebral body is exposed anteriorly layer by layer, taking care not to damage the laryngeal return and the superior laryngeal nerve. The anterior fascia is cut to fully expose the anterior part of the vertebral body to be fixed, and one to three discs and the upper and lower endplates are excised according to the condition of the vertebral body of the diseased segment.
2.Posterior cervical fusion
Posterior cervical single-opening spinal canal enlargement is suitable for cases of multi-segmental spinal stenosis to enlarge the cross-sectional area of the spinal canal and achieve effective decompression and symptom relief.