A 39-year-old friend, Ms. Zhang, is an employee of a foreign company and has always been energetic, working as a “desperate man”. But recently, I feel like menopause, not only insomnia and dreaminess, irritability, impulsiveness, eye pain, ear blockage, dry throat, a while sweating, a while panic …… After careful questioning of medical history and film examination, I told her that this is actually caused by the cervical spine. Ms. Zhang was confused, she said she only knew that cervical spondylosis would have neck pain, arm numbness, how this menopause-like symptoms are also caused by cervical spondylosis, so I gave her a detailed introduction about the typology, clinical manifestations and related treatment of cervical spondylosis.
I. What are the clinical manifestations of cervical spondylosis?
Due to the complex anatomy and physiology of the cervical spine and its surrounding tissues, the clinical manifestations of cervical spondylosis vary according to the location of the lesion, the compressed tissue and the degree of compression, and are generally clinically divided into the following five types.
1. Cervical cervical spondylosis: It is the initial stage of cervical spondylosis. It is characterized by stiffness and discomfort in the neck, pain behind the neck and occiput, as well as inflexible activities and restricted head flexion and rotation.
2 Neurogenic cervical spondylosis: mainly pain and numbness in the neck, shoulders and upper limbs, sinking, soreness and weakness, numbness and pain in the fingers and forearms. Occipital pain, weakened grip strength, loss of holding and muscle atrophy can be induced when coughing or sneezing, and paroxysmal intensification of symptoms in the affected limbs.
3.Vertebral artery type cervical spondylosis: The manifestations are complicated, commonly vertigo, which can be triggered by cervical rotation; sudden collapse attack and impaired consciousness, tinnitus, deafness, headache, nausea, vomiting, epigastric discomfort, excessive sweating or no sweating, blurred vision, diplopia, etc.
4.Spinal cord type cervical spondylosis: there are various manifestations of sensory, motor, sympathetic nerve and vascular involvement.
5.Sympathetic cervical spondylosis: there are eye distension and pain, blurred vision and loss of vision; tinnitus and deafness, hearing loss; throat discomfort and foreign body sensation; headache and dizziness, cold limbs, sweaty or sweatless skin; panic and heartbeat, high and low blood pressure; thin stools or constipation; some patients also have emotional symptoms such as insomnia and dreaminess, irritability and impulsiveness.
The above-mentioned types can be divided into several subtypes, and there are often mixed types. Clinically, cervical spondylosis is complicated and difficult to diagnose, so the doctor needs to have a comprehensive and in-depth understanding of cervical spondylosis, grasp the characteristics of each type of cervical spondylosis and the key points of diagnosis, and change the complexity into simplicity, so that the treatment can be done with ease.
Second, cervical spondylosis should be differentiated from those diseases?
1.Migraine: migraine without pressure pain at Fengchi point, without neck pain, and without cervical spondylosis features in imaging.
2. Inner ear vertigo: relatively young age of onset, regularity of vertigo attacks with horizontal nystagmus, everything normal after symptom relief. There is no abnormality in the neurological examination, and the vestibular function test is abnormal. There is no abnormality in the neck examination.
3, neuritis: polyneuritis with terminal sensory impairment of extremities, not related to neck activity, and no imaging changes of cervical spine. Single neuritis may have painful numbness, but it is not related to neck activity, no paravertebral pressure pain, and no imaging changes.
4.Cervical tumor: mostly in the elderly, wasting or cachexia, slow onset, progressive aggravation, no self-remission. Imaging often reveals abnormalities.5 Coronary artery disease; cervical spondylosis with pain in the precordial region, similar to the clinical manifestations of coronary angina attack, also known as pseudo-angina, but not as effective as coronary artery disease with electrocardiographic changes and coronary expansion drug therapy.
Third, how to treat and prevent cervical spondylosis?
The treatment of cervical spondylosis is mainly divided into non-surgical therapy and surgical therapy. Most patients can recover by non-surgical treatment, and according to statistical data, the efficiency of non-surgical treatment reaches 98% and the symptom cure rate reaches about 70%. Indications for non-surgical treatment include.
1, mild cervical disc herniation and cervical pain type cervical spondylosis.
2, neurogenic cervical spondylosis.
3, early spinal cord type cervical spondylosis.
4, the diagnosis of cervical spondylosis has not yet been confirmed and needs to be observed while being treated.
5.Patients with poor general condition who cannot tolerate surgery.
6.Patients who are recovering from surgery.
In clinical practice, we mainly focus on non-surgical treatment, and according to the different performance of different types of cervical spondylosis in different stages, we choose appropriate comprehensive treatment such as acupuncture, massage, traction, acupoint injection, physiotherapy, internal and external Chinese medicine treatment, and small needle knife, etc., and have achieved satisfactory results.
For patients in the acute stage of the disease, patients are advised to
1, pay attention to rest, stop the neck from blowing and getting cold, correct bad habits of life and work, especially pay attention to the pillow height, softness and sleep posture.
2, neck braking, so that the neck muscles get sufficient rest, relieve the pain caused by muscle spasm, reduce the protruding disc or bone superfluous to the nerve roots, vertebral artery, spinal cord stimulation compression, facilitate the elimination of inflammatory edema of the spinal cord, nerve roots.
3.Appropriate local hot compress can help relieve muscle spasm, dilate blood vessels and eliminate inflammatory edema. In the chronic stage, those without contraindications should have appropriate activities and exercises for the neck, such as “rice” exercise, neck extension, shoulder and neck massage, etc. It should be noted that the amplitude of activities in each direction of the neck should not be too large, so as not to cause new injuries and trigger or aggravate cervical spondylosis.