Cervical spondylosis, as the people often call it, is actually the sum of almost all the problems of the cervical spine, and the most common ones here are: cervical spondylosis, cervical disc herniation, cervical posterior longitudinal ligament ossification, etc., and they are divided into several types. The treatment is divided into conservative treatment and surgical treatment, and it is important to understand some general knowledge about them for treatment and rehabilitation.
I. Cervical disc herniation
What is an intervertebral disc
The intervertebral disc is one of the components of the crestal column, and it has both the function of a spring cushion to cushion vibration and conduct stress, and the function of a joint to maintain the mobility of the crestal column. The intervertebral disc has a central nucleus pulposus and a peripheral fibrous annulus, which is composed of a water-rich peptide-like substance, and a fibrous annulus, which is composed of sturdy bands of collagen fibers that repeatedly overlap and surround the central nucleus pulposus.
Why do intervertebral discs protrude
The intervertebral disc supports body weight and is usually subjected to a large mechanical load. The blood flow of the disc itself begins to shut down around the age of 15; as age increases and stress is repeatedly stimulated, the nucleus pulposus gradually becomes less watery and degenerates, and the annulus fibrosus develops small chafing or fractures. When the nucleus pulposus comes out from the small fibrous ring fracture when it is in a bad posture for a long time or when it is subjected to a sprain, a disc herniation is formed. If the herniated disc compresses or stimulates the nerve roots or crestal medulla in the back and the corresponding symptoms occur, it is called herniated disc disease. It is more common in the cervical and lumbar spine and less common in the thoracic spine.
What are the symptoms of cervical disc herniation?
The incidence of cervical disc herniation is high among various disorders of the cervical spine, and although it is mostly seen after middle age, it is actually not uncommon in young people. The symptoms vary depending on the direction of the herniated disc. Because the herniation is mostly to one side, the nerve root, a branch of the crestal medulla, is compressed, causing pain and numbness in one side of the neck, from the shoulder to the scapula, and dispersive pain and muscle weakness to the upper extremities. If there is a large herniated disc right in the center, it can compress the cremaster itself and cause symptoms such as clumsy fine finger movements, unstable walking, and bladder and rectal dysfunction (frequent urination, dysuria, urinary incontinence, and constipation).
What to do if you have this disease
Treatment is in principle conservative, but when nerve damage is caused by crural compression, early surgery is required; prolonged delay makes recovery difficult and may also lead to paralysis. If the symptoms described above occur, it is recommended to seek consultation with a crestal specialist as soon as possible.
II. Cervical spondylosis
What is cervical spondylosis
Due to degeneration and aging of the cervical spine itself or intervertebral discs, bone and cartilage proliferation is caused to form bone spurs, which compress and stimulate the surrounding crest, nerves and blood vessels, resulting in different symptoms such as neck, shoulder and arm pain in some people, numbness and instability in some people, headache, dizziness, panic and nausea in some people. It mostly occurs in middle-aged and elderly people and has a slow and insidious onset, which is different from cervical disc herniation.
What tests are needed for diagnosis
X-rays and MRI are usually done to see the location and size of the bone spur, and MRI (magnetic resonance imaging) is used to see the degree and location of deformation and degeneration of the crestal medulla under pressure. Sometimes a CT is done to see the exact condition of the bone spur.
What to do if you have this disease
If it is only a stiff neck and dull pain on the inner or upper side of the scapula, oral anti-inflammatory and pain-relieving medication, a neck brace and rest are usually sufficient. If this state develops and neck, shoulder and arm pain, or numbness in the hands and feet, especially movement disorders and difficulty in urination, it is necessary to consult a crest specialist.
Classification of cervical spondylosis and different treatments
In China, cervical spondylosis is generally divided into four types: nerve root type, cremaster type, vertebral artery type, and sympathetic nerve type. Cervical spondylosis with mainly neck and shoulder upper limb pain is of the nerve root type, and most conservative treatments work well, but most of the symptoms will have recurrence. If symptoms are repeatedly prolonged, or if conservative treatment is ineffective for a few cases of severe pain, surgery is required. Cervical spondylosis with symptoms such as weakness and numbness of the limbs, inflexibility of the hands, and unstable walking is a crestal type, and if left untreated, most patients (60-80%) will become increasingly ill and the final result will be paralysis; therefore, surgery is the main treatment for this type of cervical spondylosis as soon as it is diagnosed; the lighter the disease, the earlier the surgery, the better the result. Cervical spondylosis with symptoms such as dizziness and headache, panic and chest tightness, nausea and vomiting is sympathetic and vertebral artery type, and is generally treated mainly by conservative treatment. These patients have a variety of subjective symptoms and are prone to recurrent attacks, which need to be treated with great care and endurance. Most patients can be treated conservatively for a long time; a few patients with severe recurrent symptoms can be operated.
C. Osseointegration of the posterior longitudinal ligament of the cervical spine
OPLL is a disease in which the posterior longitudinal ligament, which is located behind the cervical vertebrae and immediately adjacent to the cremaster, becomes abnormally ossified and presses on the cremaster.
As the ossification progresses and the compression of the cremaster increases, pain in the neck and shoulder, numbness in the hands and feet, impaired finger movement, and difficulty walking occur, and are most common in men aged 40 to 50. When it comes to its causes, despite studies conducted at the molecular level of genetic chromosomes, there is still no clear conclusion. Diagnosis is most sensitive with CT examinations and most effective with MRI examinations to observe the degree of compression of the crural medulla, although simple X-rays are sometimes possible. When the symptoms are mild, conservative treatment such as wearing a brace to maintain rest and medication are used. Surgery is necessary when there is difficulty in finger movement and walking. It is also important to emphasize that even if there are no symptoms or mild symptoms, OPLL is still a high-risk cervical spine and care should be taken not to fall to prevent crestal marrow injury. (See the figure below)
IV. Conservative treatment of cervical spondylosis
Principles of conservative treatment of cervical spondylosis – clear typological diagnosis, strict functional scoring, scientific evidence-based treatment; health education, formulation of treatment course, whole course guidance; establishment of follow-up files. The course of treatment is 3 weeks to 3 months.
Basic treatment – rest (bed rest, duck down pillow), intermittent relaxation (neck brace, soft cervical collar), traction; conventional drugs – painkillers, NSAIDs, myorelaxants, neurotrophic drugs, vasodilators, anti-anxiety drugs; special treatment — Chinese medicine, manipulation, acupuncture, cervical spine exercises, cervical epidural closure; acute treatment — hormones, dehydrating drugs, energy combination, hyperbaric oxygen when necessary.
Early milder ones can be treated on an outpatient basis with.
Neck circumference protection, bed rest (special pillow), acupuncture and physiotherapy, application of blood-activating and pain-relieving anti-inflammatory drugs. Cervical spine traction and massage sometimes have immediate effect, but there is also a risk of aggravation or even paralysis, so it is necessary to be consulted and guided by a professional doctor. Long-term regular cervical spine exercises are sometimes necessary to maintain the effectiveness of treatment. Those with stubborn or recurrent symptoms can be hospitalized: choose acupoint closure, high epidural injection, and minimally invasive treatment with low-temperature plasma, together with oral Chinese medicine. Cervical spondylosis that does not heal for a long time, affects life, or even has incomplete paralysis requires surgery (more emphasis on early surgery for crestal cervical spondylosis), and the less severe the condition, the shorter the time, the better the effect.