Cervical spondylosis is a series of symptoms caused by degenerative changes in the bones, cartilage and ligaments of the neck that involve the surrounding or adjacent spinal cord, nerve roots, blood vessels and soft tissues. Cervical spondylosis is a common and frequent disease among middle-aged and elderly people, and with the change of people’s lifestyle, the disease is gradually increasing among young people.
The cervical spine is characterized by frequent activities, heavy load and structural weakness in daily life, coupled with long-term strain and aging with age, cervical disc protrusion, osteophytes, ligament calcification and other pathological changes easily occur, and the corresponding nerves, blood vessels and tissues are compressed, resulting in clinical symptoms. If you do not pay attention to good posture in daily life, such as whether the pillow is suitable when sleeping, long-term application of computer, watching TV, etc., it will aggravate the injury of cervical spine.
Cervical spondylosis subtypes
1.Cervical cervical spondylosis: It is the most common type. Acute attacks are often commonly known as “pillow”, mostly caused by improper head and neck position during sleep, cold or sprain. Patients are mostly persistent soreness or pain, and the pain is aggravated when the head and neck move. The pain is deep and can involve the collar, shoulder and upper back, and is often accompanied by stiffness in the neck.
2.Nerve root type cervical spondylosis: The incidence is second only to the cervical type. The pain is mostly confined to one side, and its nature is drilling pain or knife-cutting pain, or it can be continuous hidden pain or soreness, radiating to the shoulder, arm or even fingers. The pain is aggravated when the patient coughs, sneezes, or over-extends or flexes the neck. Some patients have numbness and ankylosis in the arm.
3.Vertebral artery type cervical spondylosis: Due to the formation of bone spurs or subluxation of the cervical spine and compression of the vertebral artery, the performance of insufficient blood supply to the vertebral basilar artery occurs, and the most common symptoms are vertigo, headache and visual disturbance. The headache is mostly in the occipital area, and vertigo often occurs when the head is twisted or turned excessively, and in severe cases, nausea, vomiting and sweating may occur. Visual impairment mainly manifests as diminished visual acuity.
4, sympathetic cervical spondylosis: cervical spine lesions directly or pseudo-indirectly compress sympathetic nerves leading to the disease. Symptoms such as pain, nausea, dizziness and vomiting may also occur. Characteristic cardiac flexural pain is characteristic and should be differentiated from angina pectoris. The pain is aggravated when the head and neck are turned, arms are raised, coughing and other movements, and nitroglycerin is not effective.
5, spinal cord cervical spondylosis: the incidence of this type is low, mainly caused by the direct compression of the spinal cord due to spinal stenosis caused by cervical spine lesions. The main characteristics are progressive numbness, coldness, pain and weakness of both lower limbs. Patients may have a “stepping on cotton”-like feeling, unstable gait and easy to fall.
6.Mixed cervical spondylosis: It is the most common clinically, and most cases are both neurogenic and sympathetic, and can be accompanied by several other types. However, the clinical manifestation is often dominated by one of the types.
Diagnosis
In recent years, due to the in-depth clinical understanding of the etiology and pathological mechanism of the disease and advanced diagnostic tools, especially through X-ray, especially the very magnetic resonance technology, and the typical clinical symptoms of the patient, it is not difficult to diagnose the disease. The age of the disease is also getting younger, and it is not only a common disease of the elderly.
Treatment
1.General treatment: In the acute stage, bed rest should be paid attention to, avoid strenuous activities. Local hot compress and neck brake can be used to relieve discomfort. Should avoid daily bad posture such as long time use of computer, television, poor sleeping posture, etc.. You can participate in activities that are beneficial to the cervical spine, such as swimming.
2.Physical therapy
3.Acupuncture
4.Medication: Initial internal medication has certain pain-relieving effect, and hormone treatment can be added in the acute stage. Vitamin B1 and B12 have the effect of nourishing nerves, and they have no adverse effects, so they can be used as regular auxiliary drugs.
5.Nerve block therapy: local anesthetic drugs and hormones or other anti-inflammatory drugs are injected directly into the lesion, which can rapidly relieve pain, followed by recovery of inflammatory tissues, muscle relaxation, and improvement of blood flow in the neck and upper chest.
6.Minimally invasive interventional treatment
(1) Minimally invasive interventional analgesia
Continuous epidural tube release and drug injection under C-arm or CT guidance is one of the most effective treatment methods, and epidural tube placement is a routine operation method with relatively safe, high efficiency and low treatment cost.
(2) Radiofrequency targeted thermocoagulation
First, thermal coagulation of inflammatory tissue; second, the increase in the temperature of the fibrous ring may reduce the afferent of its small nerves and nerve endings pain fibers. Therefore, PIRFT can reduce disc pain afferents, repair and protect the annulus fibrosus, prevent intervertebral space narrowing, and effectively treat disc herniation.
(3) Intradiscal ozone injection therapy
The intra-disc action of ozone is based on its direct action on the aqueous mucopolysaccharides that make up the nucleus pulposus, causing dehydration and contraction of the intervertebral disc. In addition, it improves oxygenation, reduces inflammation at the disease site, improves microcirculation and venous stasis through the oxidation of pain-producing inflammatory mediators, thereby improving local oxygen supply and reducing nerve root ischemia and edema.
(4) Spinal cord electrical stimulation therapy
SCS is a minimally invasive pain treatment technique that blocks the transmission of pain signals by implanting electrodes to deliver electrical stimulation without damaging the body’s tissue structure, which can not only effectively relieve pain but also continuously adjust the analgesic mode outside the body as the patient’s condition changes, thus enabling long-term effective pain control.
7.Surgical treatment