Definition of cervical spondylosis: degenerative changes of the cervical disc tissue and its secondary pathological changes involving the surrounding tissue structures (nerve roots, spinal cord, vertebral artery, sympathetic nerve, etc.), with corresponding clinical manifestations.
Degenerative changes of the cervical spine without clinical manifestations are called cervical degenerative changes. The diagnosis is confirmed in patients whose clinical manifestations and X-ray findings are consistent with cervical spondylosis.
Differential diagnosis of cervical spondylosis
Thoracic outlet syndrome
The main etiology includes cervical assistance, hypertrophy of the anterior oblique muscles and malformed healing or non-healing of the clavicle, rostral process of the scapula or the 1st rib. The most common symptoms are pain, numbness or fatigue in the upper extremity, followed by pain in the shoulder and scapula, and again in the neck. Depending on the components of compression, the symptoms can be mainly nerve, arterial or venous compression, most of which are mainly nerve compression symptoms, with the lower trunk of the brachial plexus being involved more often, so the symptoms are often manifested as damage to the ulnar nerve innervation area. Commonly used physical examination methods include Morley test, Adson test, Wright test, Eden test and Roos test. The diagnosis of this disease should be based on the clinical symptoms and the results of the above tests, and the diagnosis should be made by routine radiography, angiography or brachial plexus imaging and neurophysiological examination if necessary.
Meniere’s syndrome
Meniere’s disease is also known as episodic vertigo, which is caused by lymphatic metabolism disorder in the inner ear, excessive lymphatic secretion or absorption disorder, resulting in fluid accumulation in the labyrinth of the inner ear, swelling of the lymphatic system of the inner ear, and increased pressure, resulting in hypoxia and degeneration of the end receptors of the inner ear. Meniere’s disease mostly occurs in young and middle-aged people, and the attacks are accompanied by tinnitus, deafness, nausea and vomiting, so it is easy to misdiagnose with vertebral artery cervical spondylosis. Cervical vertigo caused by vertebral artery type cervical spondylosis is a kind of central vertigo, which is mainly characterized by a series of symptoms and signs of brainstem ischemia, short attack time, and mostly related to neck rotation. Vertigo caused by Meniere’s syndrome is peripheral (also known as inner ear) vertigo, characterized by regular vertigo attacks with horizontal nystagmus: it can be asymptomatic after relief; no abnormal findings in neurological examination.9 Vestibular function test is abnormal.
Motor neuron disease
Motor neuron diseases are a group of neurodegenerative diseases of unknown origin, mainly spinal muscular atrophy, spinal lateral sclerosis, and mixed amyotrophic lateral sclerosis of both kinds.
Distinguishing features.
Atrophy of the muscles of the upper limbs and hands is particularly pronounced and progresses from distal to proximal.
lesions can be high, invading nerves emanating directly from the brain, and can present with slurred speech and swallowing difficulties.
tremors in the muscles of the whole body (flesh jumping), atrophy of the tongue muscles and tongue tremors may occur
absence of sensory disturbances throughout the body.
electromyography of the lingual and sternocleidomastoid muscles may be abnormal, showing spontaneous potentials and large electrical amplitude waves.
On imaging, there is no significant degeneration of the cervical spine on X-ray, no obstruction on myelography, no abnormalities seen even on MRI, and no imaging signs of spinal cord compression.
Migraine
One kind of migraine can be caused by cervical spondylosis, mostly due to stimulation or compression of the greater occipital nerve by misalignment of the upper cervical spine. Swollen tissues are often palpated at the paravertebral C2 and 3 vertebrae and at the outlet of the greater occipital nerve in the posterior occipital region, and pressure pain is evident.
The other type of migraine is predominantly female, and most of them start around puberty and last for several years or even decades. The symptoms usually resolve gradually and resolve on their own by the time they reach menopause. The symptoms tend to come on during menstruation and resolve spontaneously during pregnancy. There may be a family history.
Intraspinal tumors
In general, the progression of symptomatic changes in cervical intradural tumors is much faster than in spinal cervical spondylosis. Although spinal cord cervical spondylosis may also show progressive development, the rate of progression is generally slower, with sporadic changes, especially in the early stages. Unless the onset is followed by trauma to the neck, complete paralysis of the extremities is less likely to occur.
Differential features.
MRI can confirm the diagnosis of intradural tumor and can show the boundary between tumor and normal tissue, the size and extent of tumor, and basically distinguish whether the tumor is located in the spinal cord or epidural and the degree of cervical medullary compression, which is the most ideal test.
Spinal cord tumor
Patients have pain or numbness in the neck, shoulder, arm and fingers, ipsilateral upper limb for lower motor neuron damage and lower limb for upper motor neuron damage. The symptoms gradually progress to the contralateral lower extremity and finally reach the contralateral upper extremity. Sensory loss and motor deficits below the plane of compression begin as Brown_Sequard syndrome and eventually progress to the phenomenon of transverse spinal cord damage.
Differential features.
Radiographs show enlarged intervertebral foramina and destruction of the vertebral body or arch.
Spinal iodine oil imaging with an inverted cup shape at the site of obstruction and a negative Queckenstedt test for spinal puncture.
In cases of complete obstruction, the cerebrospinal fluid is yellow, easily coagulated, and has an increased protein content.