1.Cervical muscle type cervical spondylosis
1.1 What is cervical cervical spondylosis
Cervical cervical spondylosis is extremely common clinically and is the earliest cervical spondylosis, as well as the early manifestation common to all other types of cervical spondylosis. The symptoms are mainly in the neck, so it is also called the localized type. Because the symptoms are light, not enough attention is often paid to them, resulting in recurrent attacks and aggravation of the disease, and many patients who repeatedly fall into the pillow belong to this type. In the past, many people did not recognize this type. Therefore, it is less mentioned in the literature.
Cervical cervical spondylosis, also known as ligamentous joint capsule cervical spondylosis, is often commonly referred to as “falling pillow” during acute attacks. This type of cervical spondylosis is mostly caused by inappropriate pillow height or improper sleeping posture during sleep, cervical spine rotation exceeds its own movable limit, or because the cervical spine is bent for a long time, part of the intervertebral disc tissue gradually moved to the extension side, irritating the nerve root, and causing pain. Pillow” does not exclude non-cervical spine factors. Such as cold rheumatic myositis, strain on the collar and back muscles or sudden twisting of the neck, etc., can also lead to “pillow” like symptoms.
1.2 Symptoms of cervical cervical spondylosis
Neck instinct, pain, swelling and discomfort are the main symptoms, which often appear in the morning after waking up or when waking up, patients often complain that they do not know where to put their head and neck. About half of the patients have limited neck movement or forced position, and individual patients may have transient sensory abnormalities in the upper limbs. The pain increases with activity and can be relieved by rest.
The duration of this type of cervical spondylosis is long, lasting for months or even years, and often recurring or light at times. Patients with chronic disease complain of a strange ringing sound when their heads are turned. During an attack, the patient’s head is tilted to the affected side to relieve pain and discomfort.
A large number of clinical observations have confirmed that this type is actually the initial stage of cervical spondylosis and the most favorable time for treatment. Therefore, the introduction of this type is of great significance to the prevention and treatment of cervical spondylosis.
The disease originates from the beginning of cervical spine degeneration due to dehydration, degeneration and reduction in tension of the nucleus pulposus and the annulus fibrosus, which in turn causes loosening and instability of the vertebral space. The instability of the vertebral segment not only causes local imbalance of the internal and external balance of the cervical spine and cervical muscle spasm, but also directly stimulates the sinus vertebral nerve endings distributed in the posterior longitudinal ligament and the two case root cuffs, and causes cervical symptoms.
The clinical onset of the disease is mostly in young adults, and a few people may develop the disease for the first time after the age of 45. The main manifestations are localized pain, neck discomfort and limitation of movement. The symptoms often increase suddenly in the morning, after exertion, improper posture and cold stimulation. In the early stage, there may be head, neck, shoulder and back pain, and sometimes the pain is severe. About half of the patients are afraid to turn their head and neck or tilt to one side, and when they turn, they often turn together with their trunk.
There may be spasm in the neck and neck muscles, and there is obvious pressure pain. After the acute phase, the neck, shoulder and upper back are often sore. Patients often complain of easy fatigue in the neck. Sometimes they may feel headache, pain in the back of the occipital area, or “neck tightness” or “stiffness” in the morning after waking up, and the neck may not move well or there is a sound in the neck when moving. Swelling and numbness.
1.3 Treatment of cervical cervical spondylosis
Cervical cervical spondylosis is mainly treated with non-surgical therapy, and various self-therapies are effective, especially self-traction therapy, physical therapy of shoulder and neck, massage and external application of Chinese herbs. Patients with more obvious symptoms can also be protected with a neck circumference, and it is more effective if intermittent cervical traction therapy is chosen.
Cervical cervical spondylosis generally does not require surgery, unless the symptoms persist and the treatment is ineffective for a long time, and the patient wants to be cured in the short term so as not to affect the work, but the operation should be performed by an experienced doctor, because the success rate of the operation is high, otherwise it will be more than worth the loss.
The vast majority of patients can be cured or self-healed. In daily life and work, various triggering factors should be avoided, especially attention to sleep and work position, avoid trauma, strain and cold and other adverse stimuli. As long as attention is paid to protecting the neck and avoiding various triggering factors, there are generally few recurrences; however, if attention is not paid to the way of nurturing the neck or if the load on the neck continues to increase, there is a possibility of recurrence and further development of the disease or prolongation of the course of the disease.
2.Neurogenic cervical spondylosis
2.1 Clinical symptoms of neurogenic cervical spondylosis
(1) Pain in the neck and shoulder and numbness in the fingers
Pain is the main symptom of radiculopathy. In the acute stage, the patient’s head and neck can cause pain in the neck, shoulder and arm, or radiating pain in the upper limbs, often accompanied by numbness in the fingers, and heavy pain at night, affecting rest. A few patients use their hands to protect the affected area to prevent touching the neck from aggravating the symptoms. For patients with acute onset, attention should be paid to check whether the lesion is a cervical disc herniation. Patients with chronic onset tend to feel soreness in the neck or back of the shoulder, radicular pain in the upper limbs or numbness in the fingertips.
In addition, there is also muscle weakness and muscle atrophy in the upper limbs. Some patients may have swelling of the affected limbs and dark red or pale skin. Wind-cold and strain can be the trigger for the onset of the disease, and some patients gradually develop the disease without obvious triggers.
Different lesions of the brachial plexus nerve roots cause different pain areas: cervical 5 nerve root lesion causes pain in the distribution area of the deltoid muscle; cervical 6 nerve root lesion radiates to the deltoid muscle and the radial side of the forearm and the thumb; cervical 7 nerve lesion radiates to the middle finger along the back of the upper arm and forearm; cervical 8 nerve root lesion radiates to the ring finger and little finger along the inner side of the upper arm and forearm; and the nerve root lesion of the chest lapel causes pain in the inner side of the upper arm.
(2) Weakness of muscle strength
Weakness of the upper limb muscles is a symptom caused by motor nerve damage, which is manifested by the patient’s difficulty in holding objects, and some patients tend to fall off when holding objects. The skeletal muscles of the limbs are jointly innervated by more than two nerves, and damage to individual nerves may result in mild muscle weakness, while involvement of the main nerve root may result in significant motor dysfunction.
(3) Tension in the neck muscles
Patients with cervical spondylosis often have symptoms of cervical tense plate. Stimulation of the cervical nerve roots may reflexively cause increased muscle tone or spasm in the innervated cervical and shoulder muscles. In the acute stage, examination can mostly show that the patient has tension in one or both flaps of the posterior neck and localized pressure pain.
2.2 Diagnosis of neurogenic cervical spondylosis
Diagnosis of neurogenic cervical spondylosis is mainly based on the radicular symptoms in the patient’s complaints, physical signs such as tendon reflexes and nociceptive changes in the upper limbs, palpation such as the position of the spinous process in the posterior cervical region and cervical spine X-ray films, and most patients can be diagnosed in time.
(1) Symptoms and signs
Patients usually complain of pain in the neck, shoulder and arm and numbness of the fingers. In the acute stage, cervical muscle tension and limitation of neck movement may occur. The symptoms can be triggered or aggravated by changes in the neck position. Some patients show atrophy of the forearm and hand muscles. Intervertebral foraminal compression test is positive, and brachial plexus nerve pull test may be positive. Some patients are accompanied by vertigo symptoms.
(2) Posterior cervical palpation examination
Most of the spinous processes of the affected vertebrae have pathological displacement and pressure pain, and the corresponding articular synovial joints are swollen with obvious pressure pain, which is an important diagnostic basis.
(3) Cervical spine X-ray plain film examination
By observing the patient’s frontal and lateral radiographs and oblique radiographs, in addition to finding osteophytes at the posterior edge of the vertebral body and the Luschka joint, the position of the cervical spine can be changed due to displacement of the affected vertebra in some cases. The clinician can make a diagnosis of cervical spondylosis based on the symptoms and signs of cervical spondylosis.
2.3 Pathogenesis of cervical spine neurogenic type
(1) Local irritation and compression of the nerve root
The cervical spine is prone to cervical spine osteophytes because of degenerative pathological changes, and the patient’s cervical spine is transformed into one of the factors of nerve root pathology when the disease is of long duration. The dural cuff of the bony nerve root in the Luschka joint or synovial part of the intervertebral foramen can be secondary to inflammatory reactions leading to increased local vascular permeability and impaired circulation, and secondary hypertrophy, adhesions and fibrotic lesions in the root cuff. The nerve root may be distorted and deformed, which is an important factor in causing neurogenic cervical spondylosis.
(2) Displacement of the affected vertebra
Soft tissue strain such as the cervical intervertebral disc, synovial joint, joint capsule and its surrounding ligaments can often cause part of the cervical spine to lose its stability. Injury to the muscles of the neck and shoulders can cause a loss of balance in the muscles of the soft tissues bilaterally and cause the cervical vertebrae to shift. Clinically, it is common for the affected vertebrae to rotate and shift to one side, making the transverse diameter of the intervertebral foramen smaller, thus stimulating and compressing the nerve roots and producing symptoms.
(3) Insufficient blood supply to the nerve root artery
The cervical nerve root artery is a nutritive artery, which can become smaller in the transverse diameter of the intervertebral foramen due to muscle redundancy of the Luschka joint or rotation and posterior displacement of the affected vertebrae, causing compression of the anterior root artery in front of the nerve root, thus causing symptoms due to ischemic lesions of the nerve root.
(4) Anterior oblique muscle spasm of the neck
When the anterior oblique muscle contracts, the brachial plexus nerve and the subclavian vein located between the anterior and middle oblique flaps are compressed, and the patient has symptoms of radiating pain from the shoulder to the upper limb, numbness in the ulnar nerve innervation area, low skin temperature in the upper limb, and limited neck movement because of muscle spasm.
2.4 How to treat neurogenic cervical spondylosis
Nerve root type cervical spondylosis is mainly treated with non-surgical therapy, and more than 98% of patients can be cured or improved. Traction therapy combined with appropriate cervical braking and pain relieving and antispasmodic drugs such as Somitone have obvious effects. Massage and other manipulative operations also have certain efficacy, but should be treated by regular physicians with clinical experience and gentle operation, do not operate roughly, otherwise it is easy to cause accidents, especially in patients with cervical spinal stenosis and bone spur hyperplasia should be more careful, medical disputes caused by massage errors can be encountered every year.
At present, surgery accounts for only about 1% of this type of patient, but with the improvement of people’s demand for quality of life and the reform of the health insurance system, the proportion of surgery is gradually increasing. Surgery should be considered for those who have the following conditions: first, patients whose non-surgical therapy has been ineffective for more than 4 weeks and whose clinical manifestations, imaging examinations and neurolocalization examinations are consistent; second, those with progressive muscle atrophy and severe pain with a clear diagnosis; third, those with recurrent symptoms that affect work, study and life despite the effectiveness of non-surgical therapy.
3.Vertebral artery type cervical spondylosis
3.1 What are the diagnostic criteria for vertebral artery cervical spondylosis?
(1) Patients above middle age often suffer from vertigo, nausea, headache and vision loss due to changes in head and neck position. In addition, the patient may have symptoms of nerve root irritation.
(2) At the onset of the disease, the patient’s neck movement is often restricted; when the neck is rotated or extended, it causes vertigo symptoms.
(3) When palpation examination of the posterior cervical region is performed, some patients can be found to have displacement of the upper cervical vertebrae or other affected vertebrae, and swelling and pressure pain in the corresponding joint capsule.
(4) The cervical spine can be found to be pathologically displaced in frontal and lateral and oblique X-rays.
(5) In some patients, the sound of obstruction of vertebral artery blood flow can be heard in the upper clavicle of the affected side.
3.2 What are the typical symptoms of vertebral artery type cervical spondylosis?
(1) Vertigo
Vertigo is a common symptom in patients with vertebral artery cervical spondylosis. Patients change position due to neck extension or rotation to induce vertigo symptoms. Vertigo caused by ischemic lesion of the vestibular nerve nucleus usually lasts for a short period of time and disappears in a few seconds to a few minutes, and the patient may have mild disorientation and movement disorder at the onset, manifesting as unstable walking or tilting to one side; vertigo caused by ischemic lesion of the vestibular nerve nucleus is not accompanied by impaired consciousness.
The vertigo caused by vestibular neuropathy is central vertigo; the vagal ischemic lesion is peripheral vertigo. Some patients feel nauseous and cannot raise their heads during acute onset. A few patients have symptoms such as diplopia, eye tremor, tinnitus and deafness.
Some patients can hear murmur of the vertebral artery due to distortion and negative blood flow on the affected clavicle on auscultation. The thumb palpation of the posterior neck can feel the affected vertebrae rotating and shifting to one side, and there is obvious pressure pain in the spinous process and the displaced synovial joint.
(2) Headache
In patients with vertebral artery type cervical spondylosis, headache and vertigo are usually present at the same time. Occipital neuropathy is the main cause of headache. Because the vertebral artery branches the occipital artery to supply the occipital greater nerve, clinically the vertebral artery spasm causes the occipital greater nerve ischemia and the occipital greater nerve, clinically the vertebral artery spasm causes the occipital greater nerve ischemia and the occipital greater nerve innervation area headache symptoms, intermittent throbbing pain, radiating from the back of one side of the neck to the occipital area and half of the head, and a burning sensation, a few patients have nociceptive hypersensitivity, and the pain is obvious when touching the part.
In addition, the rhomboid muscle, which is innervated around the paravertebral nerve, can cause spasm of the rhomboid muscle after root lesion or trauma to the muscle, and the occipital nerve branch that penetrates from the rhomboid muscle can be squeezed to induce clinical symptoms, and when the atlantoaxial or pivotal spine is displaced, the occipital nerve that penetrates from it can be stimulated to cause headache.
3.3 How to recognize the physiopathology of vertebral artery type cervical spondylosis?
(1) Influence of bone spurs
When there are hyperplastic bone spurs above cervical 6, such as intervertebral disc lesions, they can stimulate the spasm of vertebral artery and also compress it to narrow the lumen.
(2) Vascular variation
Under normal circumstances, the size of the vertebral artery canal is one-half of the carotid artery. It is about 4mm, and the left and right arteries are equal to ensure the normal blood supply to the brain. In pathological conditions, if the vertebral artery is irritated. Spasm or stenosis occurs, and symptoms of insufficient blood supply can occur.
(3) Lesions of blood vessels
The age of onset of cervical spondylosis and atherosclerosis is the same, both in middle age or above. Atherosclerotic atheromatous plaques are good in the vertebral artery from the branch of the subclavian artery that the first segment is seen between the two transverse processes; the third and fourth segments are more inferior. The basilar artery does not turn in the middle, and due to the convergence of blood and the formation of vortex at its beginning, end and branches, it is easy to damage the intima of the vessel and form atheroma. In this way, the atherosclerosis is easily affected by the cervical spine spurs after the atherosclerosis and produces symptoms of insufficient blood supply.
In addition, when the intervertebral space narrows because of the degeneration of the cervical disc, the cervical spine becomes shorter while the vertebral artery becomes relatively longer. When the vertebral artery has deformity or atherosclerosis, both the pulling of the neck activity and the impact of the blood flow can make the carotid artery longer and distort to affect the normal blood circulation.
3.4 What is the relationship between neck activity and the development of vertebral artery cervical spondylosis?
(1) Under normal circumstances, although turning the head can reduce blood flow to one vertebral artery, the other vertebral artery can compensate and thus no symptoms will occur. Under pathological circumstances, there are two explanations for the reduction of blood flow to one vertebral artery caused by turning the head.
(i) ipsilateral reduction in blood supply: when to the right, the left subatlantoaxial articular surface slides forward and downward, and the right vertebral artery is twisted and narrowed.
(ii) Reduced contralateral blood supply: The vertebral artery is relatively fixed because it passes around the transverse atlantoaxial process and penetrates the dura mater through the foramen magnum. When the head is turned, the atlantoaxial spine also moves, pushing the contralateral vertebral artery out of the transverse foramen and obstructing blood flow.
3.5 Treatment of conus arteriosus cervicis
Non-surgical treatment can lead to improvement and cure in 80-90% of patients. In mild cases, the patient can be protected by a cervical collar, while in severe cases, traction therapy is required, usually 3-4 weeks of continuous traction in bed and 4-6 weeks of neck braking with a jaw-neck cast, with an efficiency of more than 90%. 10-20% of patients require decompressive surgery. Decompression surgery is required for 10% – 20% of patients.
Surgery is suitable for those whose treatment has been ineffective for a long time or whose recurrent attacks have affected their work and life, especially when accompanied by compression of the spinal nerve roots or spinal cord.
The prognosis of vertebral artery cervical spondylosis is mostly good, especially for patients with instability of vertebral segments. Most of the patients with severe symptoms are treated by surgery, and the results are satisfactory, and there are few recurrences.
4.Sympathetic cervical spondylosis
4.1 How to recognize the physiopathology of sympathetic cervical spondylosis?
Because of the degeneration of the intervertebral disc and the reduction of local stability in cervical spondylosis, coupled with the smaller intervertebral foramen, overlapping small joints, increased stress on the joint capsule and osteophyte factors, a local traumatic reaction occurs, which provokes the sympathetic nerve endings on the nerve roots and joint capsule and collateral ligament as well as the meningeal anterior branch in the spinal canal, producing a series of pathological reflex symptoms. There are two main reflex pathways.
(1) Spinal reflex
After the afferent fibers transmit information to the lateral anterior horn cells of the spinal cord, the reflex signal reaches the lower, middle and upper cervical segments via the preganglionic fibers of the lateral horn cells, where they alternate and then send out multiple groups of postganglionic fibers.
The first group innervates the sweat glands and blood vessels of the face through the external carotid artery; the second group innervates the blood vessels of the brain and eyes and the sweat glands of the pupil and smooth muscle appendages of the eyelids through the internal carotid artery; the third group innervates the blood vessels of the brainstem, cerebellum, temporal and occipital lobes of the brain, and inner ear through the vertebral artery; the fourth group is the postganglionic fibers from the three ganglia of the neck, which form the cardiac branch and control the heart rhythm.
(2) Brain a spinal cord reflex
The pathological stimulus of cervical spondylosis reaches the cerebral cortex through sympathetic afferent fibers and sensory fibers of somatic nerves, and then signals are sent from cortical cells to the cervical sympathetic ganglia for alternation through the middle and lower part of the optic thalamus, the midbrain periaqueduct, the red nucleus and the reticular structures below, and then postganglionic fibers are sent to the effector organs.
4.2 What are the clinical signs of sympathetic cervical spondylosis?
(1) Symptoms of sympathetic excitation
(1) Head symptoms: headache or migraine, head sinking, dizziness, occipital pain or posterior neck pain; however, these symptoms are not aggravated when the head moves.
②Facial symptoms: enlarged eye fissures, blurred vision, dilated pupils, swelling and pain in the eye sockets, dry eyes, and blinding of the eyes.
(iii) Cardiac symptoms: rapid heartbeat, disturbed heart rhythm, precordial pain and increased blood pressure.
④Peripheral vascular symptoms: coldness and fear of cold in the limbs due to vascular spasm, low local temperature, or tingling sensation when the limbs are cold, or redness, swelling and pain aggravation. Symptoms of numbness in the neck, face and limbs are also seen, but the hyperalgesia is not distributed according to nerve segments.
⑤ Sweating disorder: manifests as excessive sweating. This phenomenon may be confined to one limb, head, neck, both hands, both feet, distal extremities or half of the body.
(2) Sympathetic inhibition symptoms
Sympathetic inhibition is also vagal or parasympathetic excitation. Symptoms are dizziness, drooping eyelids, tearing and nasal congestion, bradycardia; low blood pressure, increased gastrointestinal motility, etc.
4.3 Which diseases should be differentiated from sympathetic cervical spondylosis?
(1) Inadequate coronary artery blood supply
The symptom is severe pain in the precordial region. It is accompanied by chest tightness and shortness of breath, and only reflex pain on one or both sides of the ulnar side of the upper limbs without symptoms of irritation of the upper fatty cervical spinal nerve roots. There are abnormal changes in the electrocardiogram. The symptoms can be reduced when taking oil nitrate drugs.
(2)Neurosis
No X-ray changes of cervical spondylosis. No symptoms of nerve root and spinal cord compression, and the application of drug therapy has certain effect. However, long-term observation and repeated examination are required for differential diagnosis.
4.4 Treatment of sympathetic cervical spondylosis
Sympathetic cervical spondylosis should also be treated mainly by non-surgical treatment, and most patients can be relieved and cured by non-surgical treatment. Treatment methods include bed rest, cervical traction, cervical collar brake protection and physical therapy. Bed rest, cervical collar brake protection and cervical traction can relieve the spasm of cervical muscles, increase the vertebral space and reduce the stimulation of sympathetic nerves.
Cervical brace and collar can limit the excessive activities of cervical spine, and gentle massage and physical therapy can accelerate the local inflammatory edema, relax the muscles and improve local blood circulation. For recalcitrant cases where conservative treatment is ineffective, surgery can be considered after a clear diagnosis of high epidural closure of the cervical spine or sympathetic ganglion closure. The protruding disc and part of the hyperplastic hook vertebral joint and bone spur are removed surgically, and intervertebral bone graft is implanted to stabilize the unstable cervical spine, so as to achieve the treatment purpose.
5.Spinal cord type cervical spondylosis
5.1 Sensory disorders of spinal cord type cervical spondylosis
(1) Sensory disorder in the trunk and normal sensation in the lower extremities. In this kind of patients, there may be stripes of pain allergy, pain hyperalgesia and pain disappearance in the trunk; there are also cases where pain allergy and pain hyperalgesia exist at the same time, often showing pain allergy in the upper stripes and pain hyperalgesia or pain disappearance in the lower stripes.
(2) There are sensory disorders in the trunk and sensory disorders in the lower extremities, often the sensory disorders in the trunk are connected with the sensory disorders in the lower extremities, and the sensory disorders in the lower extremities can be unilateral or bilateral.
(3) There is sensory disorder in the trunk and only local sensory disorder in the upper or lower limbs, and the sensory disorder in the limbs is either coat-like, lamellar, or only in the finger (toe) end.
5.2 Diagnosis of spinal cord type cervical spondylosis
(1) It mostly occurs in middle age or above, and the symptoms are initially numbness, weakness and signs of upper motor neuron damage in the limbs or trunk. The symptoms are recurrent, while progressive aggravation is observed.
(2) Spinal cord type cervical spondylosis neck pain and signs of restricted movement are unknown as simple lower limb movement disorders (such as weakness, shaking, leg weakness or easy to fall); there are those who show simple lower limb sensory disorders (such as abnormal sensation in both feet and numbness in both lower limbs) and also those who have sensory and motor disorders at times.
(3) Lateral symptoms: sensory-motor disorders in the upper and lower extremities, such as swelling of the right arm, along with pain and muscle tremor in the right lower back and right lower extremity.
(4) Crossed symptoms: Sensory or motor disorders appearing in one side and the contralateral lower extremity, such as numbness in the lateral upper extremity and pain in the contralateral lower extremity.
(5) Extremity symptoms: nerve dysfunction in the extremities, including simple sensory dysfunction (such as numbness in the little toe of both feet and ulnar side of both hands); sensory and motor dysfunction in the extremities one after another in a short period of time, such as a patient who had numbness in the 4 or 5 fingers of the left hand the next day after a long period of low work, numbness in the 4 or 5 fingers of the right hand on the third day, numbness in both lower extremities on the fourth or fifth day, weakness, difficulty in lifting the legs, and unstable gait. unstable gait.
(6) Head symptoms include headache and dizziness.
(7) Sacral nerve symptoms: manifested as urination or defecation disorders, such as abnormal sensation in the head of the turtle, frequent urination, incomplete urination, lumbar and leg weakness, weakness in defecation or constipation, etc.
5.3 How to treat spinal cord type cervical spondylosis
Non-surgical treatment can be tried in the early stage of spinal cord cervical spondylosis, mainly rest, neck traction, neck circumference protection and drug therapy. Light hand massage or physical therapy is feasible for the neck, but pushing and holding, especially heavy-handed pushing and moving and resetting, etc., should not be avoided.
Surgery should be considered for anyone with one of the following conditions.
①Cervical spinal cord compression symptoms are obvious (acute, progressive), and MRI or CTM has also confirmed that the spinal cord is clearly compressed;
(ii) Longer duration of the disease, with increasing symptoms and a clear diagnosis;
③Those who have moderate or mild spinal cord compression symptoms but have not improved in more than one to two courses of non-surgical treatment and have affected their work and normal life.
Since the condition of spinal cord cervical spondylosis is generally serious and the scope of surgery is generally larger, patients and their families should pay attention to the preparation before surgery and the precautions after surgery, and actively cooperate with the medical staff for the best results.
The prognosis of the same spinal cord type may vary greatly depending on the condition and the timing of treatment. Generally speaking, the prognosis of patients with herniated or prolapsed discs is mostly better, and there are few recurrences if they can pay attention to protection after healing; the treatment of central cervical spondylosis is fast and effective; if the sagittal diameter of the spinal canal is obviously narrow, and if it is accompanied by large bone spurs or calcification of the posterior longitudinal ligament, the prognosis is generally poor; the prognosis is worst for those who are in a severe state at a late stage of development, especially those whose spinal cord is close to complete degeneration and has lost the possibility of recovery. The prognosis is the worst for patients with severe disease, especially those who have lost the possibility of recovery.
Therefore, it is important not to delay the development of the disease. In addition, patients with severe systemic diseases or poor function of major organs (heart, lung, liver, kidney, etc.) also have a poor prognosis. For the latter two types of patients, doctors are more cautious when choosing surgical treatment.
6.Medication for cervical spondylosis
Cervical spondylosis is mainly treated with comprehensive treatment. Any method that can release muscle spasm, increase the vertebral space, reduce the pressure on the intervertebral disc, reduce the pressure on the stimulation of the blood vessels supplying the brain relative to the nerves, reduce inflammatory edema, etc., can play a therapeutic role. These methods include: cervical traction, cervical collar fixation, tui na, massage, physical therapy, frequent posture changes in the neck, and sometimes surgery.
There is no specific medicine for cervical spondylosis. The treatment of some drugs is symptomatic, which can make the pain reduce, but cannot fundamentally lift the cause of the disease. These drugs are broadly as follows
1. non-steroidal anti-inflammatory and analgesic drugs. This class of drugs is mainly aimed at the nerve root stimulation caused by the damage of inflammation, to play the role of anti-inflammatory analgesia. The main drugs are: aspirin, paracetamol, botaxone, anti-inflammatory pain, naproxen, ibuprofen, fenbuterol, chinolide, futalin and so on. Among them, Fenbid capsule has less damage to the gastrointestinal, long action time, each time to take 0.3-0.9 grams, 2 times a day, after the symptoms disappear gradually stop, often can achieve better therapeutic effect, commonly used in patients with neck pain, shoulder pain, upper limb numbness.
2. Drugs that make the muscles relax. This kind of medicine makes the muscle spasm relieved and relieves the stimulation of spinal cord, nerves and blood vessels. Myna is one such oral tablet, which is taken 50 mg at a time, 3 times a day.
3. Sedatives. Sedatives can reduce the excitability of the nerves, but also to relieve muscle tension, suitable for patients with mental excitement, tension and excitement. Generally used Valium 2.5-5.0 mg, taken orally at bedtime, or Puddle Jing Valium 0.8 mg, taken orally at bedtime, also can be used to strengthen the brain and tranquilize the Chinese medicine.
4. Drugs to improve blood flow to the brain. Commonly used drugs include: Vibramotone tablets: 0.2g each time, taken orally 3 times a day. Vibramotone injection: 0.4 gram, intravenous drip once a day. Nimotone tablets: 30 mg each time, 3 times a day by mouth. Nimoton injection: 10 mg, intravenous drip once a day. Nimoton tablets: 10 mg each time, 3 times daily by mouth. Nimoton injection: 4 mg, 1 time daily intravenous drip.
5. Neurotrophic drugs. This is a medication that has therapeutic significance for any type of cervical spondylosis. Common medications include vitamin B1 tablets, 10 mg each time, 3 times a day, and other multivitamins.
6. Chinese herbal hot compresses. Use Chinese herbs that dispel wind, invigorate blood, promote circulation and relieve pain, such as 50 grams each of angelica, cinnamon stick, safflower, elderberry, lutong and Chuanqiangwu, and 100 grams each of wujiapi, tiger stick root and luo shi vine, put them in a cloth bag and steam them in a steamer, take them out after the water boils for 15 minutes, and place them on the neck for 30 minutes as a hot compress.
7. Topical dosage form of medicine. For some neck pain, stiffness, etc. has a certain effect. For example, Bofill to be liquid film (topical form of ibuprofen), Fotarine cream, etc., applied to the affected area 3-5 times a day, can play an anti-inflammatory and pain-relieving effect.