I. Definition of cervical spondylosis
Cervical spondylosis is a syndrome of a series of clinical symptoms caused by degenerative degeneration of the cervical disc and osteophytes of the cervical spine. Cervical spondylosis can be divided into cervical type, nerve root type, spinal cord type, vertebral artery type, sympathetic nerve type and other types. Cervical spondylosis often manifests clinically as pain in the neck, shoulder arm, upper back of scapula and anterior thoracic region, arm and hand numbness, muscle atrophy, and even tetraplegia. It can occur at any age, with more middle-aged and elderly people over 40 years old. Cervical spondylosis is characterized by high incidence, long treatment time and easy recurrence after treatment.
Second, the causes and mechanisms of cervical spondylosis
Cervical spondylosis is mainly caused by degenerative changes in the cervical intervertebral discs and cervical spine and its accessory structures.
Cause 1. Intervertebral disc
Degenerative changes of the cervical intervertebral discs usually begin after the age of 30. The nucleus pulposus becomes thin and the intervertebral space becomes narrow, so that the fibrous ring and surrounding ligaments become relaxed and the stability of the cervical spine is weakened, which makes it easier to further strain and degenerative changes. Degeneration of the fibrous ring and narrowing of the intervertebral space make it easy for the disc to protrude posteriorly and laterally. Cervical 4, 5, cervical 5, 6 intervertebral mobility is the largest, stress is also the most concentrated, the most vulnerable to injury.
Cause 2, vertebral body and its accessory structures
When cervical instability is caused by thinning of the intervertebral disc, the surrounding ligaments are often strained by abnormal stresses, resulting in damage to their attachment points and causing osteophytes. The narrowing of the vertebral space also increases the stress on the posterior joint and the hook joint, causing damage and hyperplasia. The segments prone to hyperplasia are cervical 5, cervical 6, cervical 4 and cervical 7 in that order.
Cause 3, disc herniation, vertebral body posterior margin hyperplasia, yellow ligament hypertrophy, etc. can cause spinal canal stenosis, resulting in spinal cord type cervical spondylosis. Hook vertebral joint, posterior joint hyperplasia, and disc protrusion to the lateral posterior can compress or stimulate the nerve root, vertebral artery and sympathetic nerve, causing corresponding symptoms.
Cause 4, vascular factors and chemical factors
The pathogenesis of cervical spondylosis, like lumbar disc herniation, cannot be explained by mechanical compression factors alone, but also by vascular and chemical factors at work, thus causing edema and inflammation that trigger or aggravate neurological symptoms.
Third, the treatment method of cervical spondylosis
(A) Cervical spondylosis traction treatment
1. Indications Cervical traction is often used as the first choice of treatment for cervical spondylosis of neurogenic, cervical and sympathetic types. However, spinal cord type cervical spondylosis with more obvious spinal cord compression and obvious cervical segmental instability should not be used.
2. The method of cervical traction Generally, the cervical pillow traction belt is used for cervical traction.
(1) posture: the position can be taken sitting or lying, for convenience, more stable sitting position, so that the neck from the longitudinal axis of the trunk forward about 10 °-3O °, to avoid over-extension. The patient is required to fully relax the neck, shoulder and the whole torso muscles. The traction position should be comfortable for the patient, and should be adjusted as appropriate if there is discomfort. In patients with vertebral artery type, the anterior tilt angle should be small, and in patients with spinal cord type cervical spondylosis, the posture should be nearly vertical, avoiding forward flexion traction.
(2) Traction weight and duration: the commonly used traction weight varies greatly, from 1/10 to 1/5 of the patient’s own body weight, mostly with 6-7 kg, starting with a smaller weight to facilitate patient adaptation. At the end of each traction, the patient should have an obvious feeling of neck stretching, but no special discomfort, if this feeling is not obvious, the weight should be increased as appropriate. The duration of each traction is usually 20-30 minutes. Traction weight and duration can be made in different combinations, generally the duration is shorter when the traction weight is larger and longer when the traction weight is smaller.
(3) Traction frequency and duration: generally traction 1-2 times a day, there are also 3 times a day, 10-20 days for a course of treatment, can continue for several courses until the basic elimination of symptoms.
(4) If traction in sitting position is not effective, or if the patient has heavy symptoms or is too weak to sit, traction in supine position can be used. Use pillow cushion to maintain proper posture, traction weight is generally 2-3kg. rest 15 minutes after 2 hours of continuous traction, then traction again, the total time of traction can be 10-14 hours per day.
(5) Intermittent traction can be performed using electric traction apparatus, which is considered to be beneficial for relaxing muscles and improving local blood circulation. Generally, traction for 2 minutes, relax or reduce the traction weight for 1 minute, repeatedly for about half an hour.
(B) Cervical spondylosis tui-na
Chinese medicine believes that cervical spondylosis is caused by long-term strain on the neck, loss of harmony of qi and blood, combined with external wind and cold, blocking the meridians.
For spinal cord cervical spondylosis, massage therapy is not traditionally advocated because it may aggravate the damage to the spinal cord, but there are reports of safe and effective traction and massage therapy in China, therefore, massage therapy is not necessarily contraindicated for light spinal cord cervical spondylosis, only that the technique should be gentle and exempt from the spinning technique.
(C) Physiotherapy for cervical spondylosis
Physiotherapy can improve local blood circulation, relax spastic muscles and relieve symptoms. High frequency (microwave, ultra-short wave), low and medium frequency electrotherapy (such as TENS, intermittent electrotherapy, computerized medium frequency), ultrasound, magnetic therapy, etc. can be used.
(D) Cervical spondylosis exercise therapy
1.The role of exercise therapy
Exercise therapy for cervical spondylosis is mainly to do medical gymnastics exercises, the purpose and role of medical gymnastics for cervical spondylosis are mainly twofold.
(1) Through the relaxation movement of the neck in all directions, active blood circulation in the cervical spine area, eliminate bruising and edema, while stretching the neck ligaments and relaxing the spastic muscles, so as to reduce the symptoms;
(2) Strengthen the neck muscles, enhance their ability to tolerate fatigue and improve the stability of the cervical spine, thus consolidating the treatment effect and preventing recurrent attacks.
2.Indications and contraindications
When the symptoms of each type of cervical spondylosis are basically relieved or in a chronic state, medical gymnastics can be started to promote the further elimination of symptoms and consolidate the therapeutic effect. Local rest is recommended during the acute attack of symptoms, and it is not advisable to increase the stimulation of movement. Exercise is contraindicated when there are more obvious or progressive spinal cord compression symptoms, especially cervical backward movement should be contraindicated. In the case of vertebral artery cervical spondylosis, gentle and slow rotation of the neck is recommended, and the amplitude should be controlled appropriately.
(E) Nerve block therapy for cervical spondylosis
The most commonly used nerve block methods are intervertebral foraminal block and cervical epidural block. The corresponding intervertebral foramen plus soft tissue pain point block for the treatment of cervical radiculopathy has the characteristics of high efficacy, simplicity, safety, and can be treated in an outpatient clinic. Cervical epidural block can be performed by either single or indwelling catheter continuous epidural cavity drug injection. Most of the drugs used are mixed solutions, and the current formulas differ slightly from each other, so it is difficult to select the best formula. However, the basic drugs in the mixture are recognized as local anesthetics and vitamin B12, with the difference being the type and concentration of local anesthetics. Hormonal preparations (flumethasone or prednisolone) can be added to the mixture in the first course of treatment for patients in the acute phase. The pain relief time is gradually prolonged with the number of treatments, and generally it takes 4 courses on average to receive satisfactory results.
(F) Surgical treatment
For cervical spondylosis with no obvious effect of the above conservative treatment, or cervical spondylosis with significant compression of the spinal cord and typical limb symptoms, surgical treatment is required. Surgical methods include anterior surgery, posterior surgery and combined anterior and posterior surgery.