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 require surgery because non-surgical treatment is ineffective or the condition is serious.
I. Non-surgical treatment currently reports that 90-95% of cervical spondylosis patients are cured or relieved by non-surgical treatment. Non-surgical treatment is currently mainly a combination of Chinese medicine, Western medicine, Chinese and Western medicine, and rehabilitation therapy, etc. Chinese medicine treatment means combined with Western medicine anti-inflammatory and analgesic, vasodilator, diuretic and dehydrating, nerve nutrition and other types of drugs.
(a), Chinese medicine treatment
1, Chinese medicine evidence-based treatment: Chinese medicine evidence-based treatment: should be the basic method of classification and evidence-based medicine.
(1) Cervical cervical spondylosis: it is appropriate to dredge the wind and relieve the surface, disperse the cold and ventilate the ligament, commonly used in Gui Zhi plus Ge Gen Tang (Gui Zhi, Paeonia, Licorice, Ginger, Jujube, Ge Gen) or Ge Gen Tang (Ge Gen, Ma Huang, Gui Zhi, Paeonia, Ginger, Jujube, Licorice), accompanied by inflammation of the throat, plus Yuan Shen, Pan Lan Gen, Jin Yin Hua, etc.
(2) neurogenic cervical spondylosis: divided into: pain-oriented, partial stasis blocking cold condensation, it is appropriate to dispel blood stasis and open the ligaments, commonly used in body pain and remove blood stasis soup (Angelica sinensis, Chuanxiong, myrrh, peach kernel, Qiangwu, safflower, Wu Lingliang, Gentiana, aromatic herb, cow’s knee, Di Long, roasted grass); such as partial damp-heat, it is appropriate to clear heat and dampness, with angelica fever soup (Angelica sinensis, Dang Shen, bitter ginseng, Cang X, Bai X, Sheng Ma, Fang Ji, Qiang Wu, Ge Ge Ge, Zhi Mu, pig ling, Yin Chen If accompanied by numbness, add spasm stopping powder (centipede, whole scorpion) to the above formula.) If numbness is predominant and accompanied by muscle atrophy, take the method of benefiting qi, resolving stasis and opening up the ligaments, and commonly use the formula of tonifying yang and returning to the fifth soup (astragalus, angelica, Chuanxiong, peony, peach kernel, safflower, di dragon) plus centipede and whole scorpion.
(3) vertebral artery type cervical spondylosis, divided into: dizziness with headache, blood stasis is appropriate to remove blood stasis and pass through the ligaments, dampness and liver, commonly used in Blood Mansions and Stasis Soup (angelica, Chuanxiong, red peony, raw earth, peach kernel, safflower, cow knee, Chai Hu, Citrus aurantium, orris, licorice); partial phlegm and dampness, appropriate Han Xia Bai Zhu Tian Ma Tang (Han Xia, Bai Zhu, Tian Ma, Fu Ling, Chen Pi, licorice, jujube), etc. Dizziness and head distension like wrapping, drowsiness, mouth pain, insomnia, is bile-stomach disharmony, phlegm-heat internal disturbance, it is advisable to regulate qi and resolve phlegm, clear bile and stomach, commonly used in warming bile soup (Radix et Rhizoma Polygonati, Poria, Chen Pi, Bamboo Roo, Citrus Aurantium, Glycyrrhiza glabra). For dizziness, fatigue and weakness, and less colorful face, take Beneficial Qi and Ying to resolve dampness, commonly used in Beneficial Qi Smart Tang (Astragalus, Radix Codonopsis, Radix Paeoniae Alba, Phellodendron, Radix et Rhizoma, Radix et Rhizoma Glycyrrhizae).
(4) Spinal cord type cervical spondylosis: increased muscle tone, chest and abdomen with a feeling of girdling take the method of dispelling blood stasis and clearing the internal organs, with Fuyuan and invigorating blood soup (rhubarb, Chai Hu, red flowers, peach kernel, angelica, smallpox powder, piercing sorrel, roasted licorice). If the lower limbs are weak and the muscles are atrophied, take the method of tonifying the middle and benefiting the qi and nourishing the spleen and kidneys, Dihuang Drink (Radix et Rhizoma Polygonati, Gui Zhi, Cistanches, Cornu Cervi Pantotrichum, Radix Rehmanniae, Bacopa Monnieri, Acorus Calamus, Yuan Zhi, Dendrobium, Poria, Mai Dong, Wu Wei Zi) combined with Sheng Gui Tang (Astragalus, Radix Codonopsis, Radix Angelicae Sinensis, Radix Paeoniae Alba, Chuan Xiong, Radix Rehmanniae, Chai Hu). Sympathetic cervical spondylosis has more symptoms, so it is appropriate to treat the symptoms 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 tendons and activating the channels 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 performed by medical professionals. 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, as well as 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.
(B), rehabilitation treatment
1, physical factor therapy physical factor therapy is mainly used to dilate blood vessels, improve local blood circulation, release muscle and blood vessel spasm, eliminate inflammation and edema of nerve roots, spinal cord and surrounding soft tissues, reduce adhesions, regulate plant nerve function, and promote recovery of nerve and muscle function.
Commonly used treatment methods.
(1) DC ion introduction therapy is commonly used with various western drugs (glacial acetic acid, VitB1, VitB12, potassium iodide, nufocaine, etc.) or Chinese herbal medicines (Wu Tou, Wei Ling Xian, Safflower, etc.) placed on the back of the neck, connected to the anode or cathode according to the performance of the drug, opposed or obliquely opposed to another electrode, and energized for 20 minutes each time, applicable to all types of cervical spondylosis.
(2) Low-frequency modulated medium-frequency electrotherapy generally uses 2000Hz-8000Hz medium-frequency electricity as the carrier frequency and 1-500Hz low-frequency electricity of different waveforms (square wave, sine wave, triangle wave, etc.) as the modulating waveform, modulated in different ways and compiled into different prescriptions. The prescriptions are selected according to different conditions, and the electrodes are placed in the same way as DC. Each treatment generally lasts 20-30 minutes and is suitable for all types of cervical spondylosis.
(3) Ultrashort wave therapy uses ultrashort wave with a wavelength of about 7m for treatment. Generally, two medium-sized electrode plates are used, which are placed behind the neck and the extensor side of the forearm of the affected limb, or monopolar placed behind the neck. In the acute stage, no heat is applied once a day for 12 to 15 minutes, and in the chronic stage, micro heat is applied for 15-20 minutes. 10-15 times is the course of treatment. Suitable for nerve root type (acute phase) and spinal cord type (spinal edema phase).
(4) ultrasonic therapy frequency 800kHz or 1000kHz ultrasonic therapy machine, sound head and neck skin close contact, along the vertebral space and paravertebral movement, intensity with 08 ~ 1W/cm2, available hydrocortisone cream as a contact agent, once a day, each time 8min, 15-20 times a course of treatment. For the treatment of spinal cord type cervical spondylosis. Ultrasound frequency as above, sound head moving along both sides of the neck with two supraganglial fossa, intensity 08 ~ 1.5W/cm2, 8-12min each time, the rest as above, used for the treatment of neurogenic cervical spondylosis.
(5) ultrasonic conductivity targeted transdermal drug delivery treatment using ultrasonic conductivity instrument and ultrasonic conductivity gel patch, transdermal drug selection 2% lidocaine injection. The patch was first fixed in the treatment transmitter head of the instrument, and 1 ml of prepared lidocaine injection was added to the two coupling gel patches respectively, and then the patch was fixed to the front of the patient’s neck together with the treatment transmitter head. The treatment parameters were selected as conductivity 6, ultrasound intensity 4, frequency 3, treatment time 30 minutes, once a day, 10 days as a course of treatment. It is used to treat vertebral artery type and sympathetic nerve type cervical spondylosis.
(6) High potential therapy uses high potential therapy instrument, patient sits on the plate electrode or treatment seat, foot on the insulated pad, each treatment for 30-50 minutes. It can be used for all types of cervical spondylosis, among which sympathetic cervical spondylosis has the best effect.
(7) phototherapy ultraviolet therapy: the back of the neck on the flat hairline down to the second thoracic vertebra, the amount of erythema (3-4 biological amount), once every other day, 3 times a course of treatment, with ultra-short wave treatment of nerve root type acute stage. Infrared therapy: various infrared instruments are available, irradiation behind the neck 20 ~ 30min / time. Used for soft tissue type cervical spondylosis, or with cervical traction therapy (infrared therapy before cervical traction).
(8) Other therapies: such as magnetic therapy, electrical excitation therapy, audio electrotherapy, interference electrotherapy, wax therapy, laser irradiation and other treatments are also frequently used in the physical therapy of cervical spondylosis, and the proper choice can achieve certain results.
2, traction therapy cervical spine 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; release 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 stimulation and compression of the nerve roots; enlarge the vertebral space and reduce the pressure in the intervertebral disc. Adjust the microscopic abnormal changes of the small joints, so that the synovial membrane of the joint embedment or the misalignment of the synovial joint can be reset; the three major elements of the direction of traction force (angle), weight and traction time must be mastered when cervical spine traction treatment is carried out in order to obtain the best therapeutic effect of traction.
(1) traction mode: commonly used occipito-maxillary band traction method, usually using sitting traction, but the condition is heavy or can not sit traction horizontal traction. Continuous traction, intermittent traction or a combination of both can be used.
(2) traction angle: generally according to the lesion site, such as lesions mainly in the upper cervical segment, traction angle should be 0-10 °, such as lesions mainly in the lower cervical segment (neck 5-7), traction angle should be slightly forward, can be between 15-30 °, while pay attention to the combination of patient comfort to adjust the angle.
(3) Traction weight: the weight of intermittent traction can be determined by 10%-20% of its own body weight, and continuous traction should be reduced appropriately. Generally, the initial weight is light, such as 6 kg to start, and then gradually increase.
(4) traction time: traction time to continuous traction 20 minutes, intermittent traction is 20-30 minutes is appropriate, once a day, 10-15 days for a course of treatment.
(5) precautions: individual differences should be fully considered, the elderly and frail people should traction weight lighter, traction time shorter, young and strong can hold heavier and longer; traction process should pay attention to observe and ask the patient’s reaction, such as discomfort or aggravation of symptoms should immediately stop traction, find the cause and adjust, change the treatment plan.
(6) traction contraindications: traction after there is obvious discomfort or symptoms aggravated, after adjusting the traction parameters still no improvement; spinal cord pressure is obvious, segmental instability is serious; aging vertebral bone and joint degeneration is serious, spinal canal is obviously narrow, ligament and joint capsule calcification ossification is serious.
3.Manipulation therapy is one of the important means of cervical spondylosis treatment. It is based on the anatomical and biomechanical principles of the cervical spine and joints, and for its pathological changes, passive activities such as pushing, pulling and rotating the spine and small joints 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 smoothed to improve The aim 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 techniques (Maitland technique), chiropractic (chiropractic) and so on. Special emphasis should be placed on the fact that manipulative treatment of cervical spondylosis must be performed by trained medical professionals. It is advisable to control the strength of the manipulation according to the individual situation, to be as gentle as possible, and to avoid 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 vertebral body and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occipital area, 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 of cervical spine refers to the exercise of the neck and other related parts as well as the whole body by means of suitable exercise. 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 applicable to 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 brace for cervical spine is mainly used to fix and protect the cervical spine, correct the abnormal mechanical relationship of the cervical spine, reduce neck pain, prevent over-extension, over-flexion and over-rotation of the cervical spine, avoid further damage to the spinal cord and nerves, reduce spinal edema, reduce the traumatic reaction of the intervertebral joints, help repair the tissues and relieve the symptoms, and carry out simultaneously with other treatment methods to consolidate the therapeutic effect and prevent recurrence. It can be used in conjunction with other treatments to consolidate the effect and prevent recurrence. The most commonly used are cervical braces and neck braces, which can be applied to patients in the acute stage or with severe symptoms of all types of cervical spondylosis. Cervical braces are also used for patients with cervical fractures and dislocations who still have intervertebral instability or subluxation 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 vast 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 with progressive development (mostly spinal cervical spondylosis), early surgery is required as a matter of urgency.
(2) Surgery is mainly to relieve the serious pressure on the spinal cord or blood vessels due to disc herniation, bone formation or ligament calcification, and to rebuild the stability of the cervical spine. Once the spinal cord type cervical spondylosis is diagnosed, 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 the patient’s life and work, or those who have muscle movement disorders; and other types of cervical spondylosis whose conservative treatment is ineffective or whose efficacy is not consolidated and who have recurrent attacks should be considered for surgical treatment. The indications for minimally invasive treatment (myelolysis, percutaneous aspiration, PLDD, radiofrequency ablation, etc.) must be strictly mastered. The surgical procedure is divided into anterior cervical approach and posterior cervical approach.
1.Anterior cervical surgery: the anterior cervical approach to remove the diseased disc and posterior spur and intervertebral bone graft. The advantage is that the spinal cord is directly decompressed and the cervical spine is permanently stabilized after fusion of the bone graft. The use of titanium plates for internal fixation at the same time as the bone graft can improve the fusion rate of the bone graft and maintain the physiological curvature of the cervical spine. Indications for anterior discectomy interbody bone graft fusion surgery: nerve root or spinal cord ventral compression due to disc herniation or bone bulge in 1-2 segments; segmental instability. Bone graft materials can be autologous iliac bone, allogeneic bone, artificial bone such as hydroxyapatite, calcium phosphate, calcium sulfate, coral ceramic, etc. The intervertebral fusion device (Cage) has the function of maintaining the intervertebral height, enhancing local stability, and improving the fusion rate. At the same time, due to its advantages of low incision, it can significantly reduce the postoperative foreign body sensation in the pharynx and swallowing difficulties, and the special iliac bone extraction device can achieve minimally invasive bone extraction. For isolated OPLL; limited spinal stenosis, etc., subtotal laminectomy, large intervertebral bone graft, and titanium plate internal fixation can be used. If the titanium cage is filled with autologous bone (resected vertebral body) and the titanium plate is internally fixed, bone retrieval can be avoided. For patients with mild intervertebral joint degeneration and no significant narrowing of the intervertebral space, artificial disc replacement can be performed after removal of the diseased disc.
2.Posterior surgery: The cervical spinal canal is enlarged through the posterior cervical approach so that the spinal cord can be decompressed. The commonly used surgical procedures are single-opening and double-opening spinal canal enlargement. Indications for surgery: spinal cord cervical spondylosis with developmental or multi-segmental degenerative spinal stenosis; multi-segmental OPLL; cervical yellow ligament hypertrophy or ossification caused by ventral and dorsal compression of the spinal cord. Those who have segmental instability can also perform lateral block titanium plate screws or internal fixation via pedicle screws and bone graft fusion.
3, rehabilitation treatment of cervical spondylosis “perioperative” rehabilitation treatment is conducive to consolidating the efficacy of surgery, making up for the shortcomings of surgery, and relieving the local and systemic trauma caused by surgery, so as to achieve the purpose of restoring the physical and mental health of patients. The basic method of perioperative treatment is inseparable 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 to patients by surgery, as well as the trauma of surgery and postoperative weakness. The “cervical spine rehabilitation health care work” is used for the prevention and supplementary treatment of cervical spine disease, and can be planned to be extended to the community, reflecting the academic idea of rehabilitation and prevention.
The Japanese Orthopaedic Society has established the standard of spinal cord function assessment for patients with cervical spinal cord disease (referred to as the 17-point method), which has been accepted by international scholars. According to China’s national conditions, the corresponding standard (referred to as the 40-point method) has also been formulated and has been promoted and applied in China.
The sixth part, prevention of cervical spondylosis is almost inevitable as the cervical intervertebral disc degenerates with age. However, if attention is paid to avoiding some factors that promote degenerative changes of the intervertebral disc in life and work, it will help prevent the occurrence and development of cervical degenerative changes.
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, also need a good sleep position, to maintain the physiological curvature of the entire spine, but also should make the patient feel comfortable, to achieve the role of the whole body muscle relaxation, adjust the physiological state of the joints.
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.