I. [Basic concept of cervical spondylosis
Cervical spondylosis is a lesion that produces pain in the neck and shoulders, or is accompanied by headache, limb paralysis and other symptoms due to degenerative changes in the cervical spine is called cervical spondylosis. The head is connected to the torso through the neck, and the cervical region has to bear a large amount of activity and support the weight of the head to maintain the balance of the head, so it is prone to strain, and degenerative changes occur with the increase of age, and the above symptoms appear. The fifth and sixth cervical vertebrae and the sixth and seventh cervical vertebrae are particularly common. Qing Maosheng, Department of Orthopedics and Traumatology, Shenzhen Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
II. [Etiology and pathology
(I) Pathology.
The normal cervical spine is to maintain its balance of internal and external forces. Internal force refers to the cervical spine
is the mechanical relationship between the opposing muscle groups in the cervical collar. When the balance of internal and external forces in the cervical spine is imbalanced by various factors (including internal and external factors), the cervical spine is mechanically compensated for by hyperplasia, degenerative changes occur and the disease develops.
(II) Etiology
The etiology is divided into endogenous and exogenous causes.
1. Exogenous causes –
Various acute and chronic trauma can cause different degrees of injury to the intervertebral disc, ligaments and posterior joint capsule, thus decreasing the stability of the spine and prompting compensatory hyperplasia of the cervical spine, which can directly or indirectly compress the nerves and blood vessels, thus providing symptoms.
2.Endogenous factors
Intervertebral disc degeneration is a common endogenous cause of this disease. Intervertebral disc degeneration starts from the cartilage plate: the cartilage plate gradually ossifies and permeability gradually decreases, thus causing gradual dehydration of the nucleus pulposus, resulting in fibrosis. The thickness of the intervertebral disc decreases, the intervertebral space narrows, and the stability of the spine decreases, which causes the posterior joint capsule to relax, the joint cavity becomes smaller, and the joint surface is prone to wear and tear, resulting in hyperplasia; at the same time, the joint surface of the hook vertebrae is also prone to wear and tear due to the narrowing of the gap, which promotes the generation of hyperplasia; due to the relaxation of the anterior and posterior longitudinal ligaments, the stability of the vertebral body decreases, which in turn promotes compensatory hyperplasia of the vertebral body; due to the decrease in the thickness of the intervertebral disc, the intervertebral Because the thickness of the intervertebral disc decreases, the upper and lower diameter of the intervertebral foramen becomes narrower, making it easier for each hyperplasia site to compress nerves and blood vessels and produce symptoms. Zheng Xianghong, Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University
C. [Clinical classification and clinical manifestations of cervical spondylosis
The symptoms of cervical spine due to degenerative changes are of two kinds: one is direct compression of nerves and blood vessels by hyperplasia; the other is indirect compression of nerves and blood vessels by hyperplasia. The latter category accounts for the majority of cervical spondylosis. It is mainly divided into four clinical types: nerve root type, vertebral artery type, spinal cord type and sympathetic nerve type.
(I) Nerve root type
Pain in the neck, radiating to the occiput or shoulder and upper limbs, accompanied by numbness, and symptoms such as skin sensory disorders in the occiput or upper limbs and muscle weakness may occur.
(II) Vertebral artery type
Pain in the neck, radiating to the occiput or shoulder and upper limbs, accompanied by numbness, and symptoms of cerebral ischemia, i.e., vertigo, nausea, vomiting, tinnitus, deafness, blurred vision, etc. The symptoms improve or worsen when the head position is changed. The spinal tract symptoms are sudden numbness of limbs, falling to the ground with objects, or sudden collapse due to autosensory impairment, which is not necessarily accompanied by impaired consciousness.
(C) Spinal cord type
The symptoms of neck pain and limitation of movement are mild or even absent, and the symptoms of spinal cord compression are mainly present. Unilateral compression is mainly manifested by increased muscle tone of the ipsilateral limb below the level of the lesion, reduced muscle strength, hyperactive tendon reflexes, and reduced superficial reflexes or pathological reflexes. In severe cases, patellar clonus or ankle clonus and sensory disturbance of the contralateral limb may occur. In the case of double compression, sensory or motor impairment appears in the early stage, and spastic paralysis of different degrees appears in the late stage.
(iv) Sympathetic nerve type
Ocular symptoms: eyelid weakness, blurred vision, swelling and pain in the eye sockets, tearing, and gold stars in the visual field; head symptoms: headache or migraine, dullness or dizziness, occipital pain or posterior neck pain, no obvious relationship between head position change and symptoms; cardiac symptoms: rapid heartbeat or bradycardia, pain in the precordial area; peripheral vascular symptoms: vasospasm, cold limbs, local skin temperature drop, or vasodilation, fingertip Redness, heat, pain or pain hypersensitivity; sweating disorder: local limb or half limb sweating or less sweating.
IV. [Clinical diagnosis
(A) Nerve root type Nerve root type symptoms and the following signs are present
(1) Tension in the neck muscles and reduced physiological pronation. 2) Pressure pain: pressure pain in the lesioned segment next to the spinous process and in the nerve distribution area. 3) Positive brachial plexus nerve pull test. 4) Positive intervertebral foraminal squeeze test. 5) Sensory changes: sensory hypersensitivity in the body distribution area if the nerve root is lightly stimulated and for a short period of time; hyperalgesia if the nerve root is heavily compressed or for a longer period of time. 6) X-rays are consistent with clinical manifestations.
(B) Vertebral artery type Clinical manifestations of vertebral artery type and the following signs appear
1, when the head is turned to a certain party, the symptoms can appear, change the orientation, the symptoms will be relieved; 2, X-ray orthopantomolemia can be seen lateral to the hook vertebral joint, oblique position can be seen intervertebral foramen become smaller. 3, special examination: vertebral artery angiography or transcranial vascular Doppler.
(C) Spinal cord type The presence of spinal cord type symptoms and the following signs
1. increased muscle tone and decreased muscle strength; 2. hyperactive biceps, triceps, and Achilles tendon reflexes; 3. decreased abdominal wall reflexes and levator reflexes; 4. positive Hoffman’s sign and Babinski’s sign for pathological reflexes; 5. special tests
Myelogram or subarachnoid angiography
(iv) Sympathetic type Sympathetic type symptoms without special signs
V. Treatment
Chinese medicine treatment for cervical spondylosis mainly adopts internal and external application of Chinese medicine, massage and acupuncture.
(I) Chinese medicine treatment.
The formation of cervical spondylosis is mainly caused by degenerative changes of the vertebrae and neck, and the degeneration occurs in the soft tissues of the neck and the cervical vertebrae, and the theory of Chinese medicine is that “the liver is the master of tendons and the kidney is the master of bones”, so cervical spondylosis occurs due to deficiency of the liver and kidney and stagnation of blood. Chinese medicine treatment is used to nourish the liver and kidney, benefit the qi and blood, dispel the wind and open the ligament. The formula is Ge Gen Sang Zhi Tang: Ge Gen 30 g Mulberry Branch 15 g Fenfeng 15 g Chuanxiong 10 g Radix Codonopsis 15 g Peony 30 g Atractylodes Macrocephalae 15 g Mulberry 30 g Ocimum sanctum 15 g Allium 10 g Ling Xian 15 g Licorice 10 g.
1, nerve root type plus Wu Ling Li 10 grams of Guiweiwei 10 grams of Kuanzhu Vine 30 grams of Yuanhu 10 grams.
2, vertebral artery type add Tianma 10 grams Angelica 10 grams Qiangwu 15 grams.
3, spinal cord type add Dilong 15 grams of bone marrow 15 grams of wolfberry 15 grams.
4, sympathetic nerve type add Chai Hu 10 grams, Fuxia 10 grams, ginger 10 grams.
5, with Chinese medicine to identify the evidence to add or subtract: wind and Yang on the disturbance, dizziness, dizziness, red tongue, thin coating yellow pulse string add tianma 10 grams, mother of pearl 30 grams, turtle plate 30 grams; kidney yin deficiency, five heart bothered heat, red tongue, less moss pulse thin number add wolfberry 15 grams, taro meat 15 grams; qi and blood deficiency, fatigue, less breath, thin tongue, thin coating white pulse weak add astragalus 15 grams, ginseng 15 grams, white atractylodes 15 grams; wind-cold damp paralysis, head and neck sleepiness If the tongue is light with white greasy pulse, add Gui Zhi 10 grams, Chuan Pu 10 grams, Coix Seed 20 grams; damp-heat burning pain, annoyance and anxiety, red tongue with yellow greasy pulse, add Silphium 20 grams, Yin Hua Vine 15 grams, Jiang Huang 10 grams.
(B) massage therapy
Treatment principle: relax the tendons and channels, invigorate blood circulation and remove blood stasis, and regulate the tendons.
Treatment methods.
1.Tendon relaxation and enlightenment
Patient sitting, with gentle rolling, pressing, taking, one finger Zen pushing and other techniques on both sides of the cervical vertebrae and shoulder treatment, so that the tension and spasm of the muscles relax, thereby strengthening the local qi and blood flow, promote the absorption of edema, to create conditions for the next step of manipulative treatment; at the same time, can reduce the pulling force on the cervical vertebrae caused by muscle tension.
2.Widening the intervertebral space Cervical traction with manipulation or instruments widens the intervertebral space to enlarge the intervertebral foramen; at the same time, it creates conditions for correcting the mechanical balance of the cervical spine. This method is mainly used for nerve root type.
3.Realization of physical injury
(1) The patient sits with the head bent forward to an appropriate angle. The doctor presses the spine of the affected vertebra with one thumb, holds the patient’s chin with the other elbow, and pulls forward and upward, while rotating the head to the affected side, at which time the elastic sound of rectification can often be heard.
(2) The patient lies on his back with a pillow behind the shoulder, the doctor stands at the head of the bed, holds the patient’s occiput with his right hand, holds the chin with his left hand, pulls the patient’s head up from the occiput so that the neck is at an angle of 45° with the horizontal plane, and the traction lasts for 1 – 2 minutes. Then the head is gently rotated to the left and right and swung back and forth by mistake. At this point, a popping sound can often be heard during rectification.
Activate blood circulation and remove blood stasis Push or press and knead both sides of the cervical spine with a gentle one-finger bullet, and treat up and down back and forth. Then use the straight rubbing method to treat both sides of the cervical vertebrae, in order to penetrate the heat. It can be combined with hot compress on the neck.
(C) Acupuncture treatment
1, milli-needle treatment Points: corresponding lesions of the cervical spine pinch points, the large vertebrae, Fengchi, shoulder well, Wai Guan. Method: use medium stimulation, stay for 20 – 30 minutes, once a day or every other day, 10 times for a course of treatment.
2.Trigeminal acupuncture points: Dazhi, Waiyue, Fengmen. Method: Choose 1 – 2 points each time, after routine skin disinfection, align the acupuncture points, use the trigeminal needle to quickly pierce about half a minute to 1 minute, and then quickly withdraw to bleed. Then cupping and rotational movement of the head after removal of the can. Every 3 – 5 days 1 time, the general treatment 3 times preferably not more than 10 times.
3.Water acupuncture
Acupuncture points: Da Loom, Shoulder Middle Yu, Shoulder Outer Yu, Tian Zong. Method: Choose 2 points each time, sterilize the local skin, use the fast needle method, enter the needle and slowly and accurately pierce the acupuncture point, after “getting gas”, draw back no blood, then push in the medicine solution (Angelica 2ml Dan Shen 2ml) and inject 1-1.5ml into each point. 1 time per day or every other day, 10 times for a course of treatment, the interval of treatment is 3 – 5 days.
4.Electro-acupuncture
Acupuncture points: Lin spine, Fengchi, cervical pinch points, shoulder middle Yu, Da loom, Tianzong. Method: select 2—4 points each time, after routine sterilization, first stab the milli-needle into the acupuncture point with the speed method to achieve the required induction (i.e., get gas), and then connect the two output wires of the electro-acupuncture to the two needle bodies that have been stabbed. Turn on the power switch, adjust the electric flow to the patient’s tolerance, and stimulate with pulse current for 20 minutes.
5.Mild moxibustion
Acupuncture points: main acupuncture point: the lesion of the spine point, the large vertebrae, Quchi, the foot three li, the absolute bone. Supporting points: body pillar, kidney, ring jump, Yanglingquan, shoulder well, Tianzong, Yangchi, Zhongzhu. Method: Choose 4–6 points each time, ignite one end of the moxa stick, first close to the skin, then slowly raise it until the patient feels comfortable and fix it in this position (usually half an inch from the skin), and smoke it for 5–10 minutes continuously until the bureau is red. Moxibustion treatment 1-2 times a day, daily or every other day moxibustion treatment, 10 times for a course of treatment, the course of treatment interval for 3 – 5 days.
Six, [prevention of cervical spondylosis].
1, the formation of cervical spondylosis is mostly due to the head in a long time low position, resulting in a long-term chronic process of neck strain, so in the prevention of cervical spondylosis should pay attention to make the neck get proper rest and avoid the head in the same position for a long time.
2, pay attention to the posture of sleep: the pillow should not be too high or too low, too high will change the physiological bending of the cervical vertebrae anterior convexity, so that the anterior convexity physiological bending straight; too low will make the neck in an excessive posterior posture, resulting in an increase in the physiological bending of the neck; this will cause cervical muscle strain and degenerative changes in the cervical vertebrae.
3, pay attention to avoid wind and cold: be sure to keep your hair dry before going to bed, do not wash your hair before going to bed; sleep to avoid cold neck; pay attention to avoid the cold wind in the air-conditioned environment directly blowing on the neck.