Due to cervical disc degeneration or trauma, resulting in disc protrusion or rupture, the symptoms of nerve root or spinal cord damage are called cervical disc prolapse.
I. Diagnostic basis.
1, mostly seen in young adults, with obvious history of cervical trauma or occupational history of prolonged low head position work.
2. In cases of nerve root compression, severe pain in the neck, shoulder and upper back with radiating neuralgia in the upper extremities; the pain is aggravated during neck movement and sleep. The muscle strength decreases, the tendon reflex is weakened or disappears, and the brachial plexus nerve pull test is positive. 3. In patients with cervical medullary compression, incomplete paralysis of the limbs, motor sensory disorders, hyperactive tendon reflexes, knee and ankle clonus, positive pathological reflexes, and dysfunction of the second stool are observed.
4.Some patients have symptoms such as vertigo and headache.
5.X-ray examination excludes other lesions such as fracture and dislocation, and can find some non-specific signs of instability, such as angulation of the anterior and posterior edges of the cervical vertebrae, anterior or posterior tilt of the vertebral body, cervical slippage, narrowing of the lesioned vertebral space or narrowing of the anterior and posterior width, etc., but the vertebral body bones are not necessarily obvious.
6, CT scan is helpful for the diagnosis of this disease; MRI examination can show that the intervertebral disc tissue protrudes into the spinal canal and compresses the cervical nerve root, dural sac or spinal cord.
Second, the classification of Chinese medical evidence.
1. Qi stagnation and blood stasis: the symptoms show sudden onset or sudden aggravation, with a history of trauma before the onset; stiffness in the neck, severe pain and radiation to the back and arm fingers. The tongue is dark, or there are petechiae or petechiae, and the pulse is astringent.
2.Phlegm and stasis in each other: severe pain in the neck, back, shoulder and arm, weakness in the upper limbs, dizziness, heaviness like a wrap; palpitation, nausea, tiredness and drowsiness; choking in the throat, chest tightness and distension, distention and fullness in the stomach and epigastrium, and unpleasant complexion. The tongue is purple and dark, the coating is white and greasy, and the pulse is stringent and astringent.
3.Liver and kidney deficiency: slow onset, pain in neck and arm, soreness and weakness in lower limbs, constriction of tendons and veins, staggering gait, or even bedridden; soreness and weakness in waist and knees, difficulty in passing stool, sexual dysfunction. The tongue is fat, with teeth marks on the side, and the pulse is sunken and weak.
MRI examination can show that the intervertebral disc protrudes posteriorly in the form of block or fragment, compressing the lateral side of the cervical spinal cord and the nerve root on one side, and the anterolateral side of the cervical spinal cord is deformed and displaced to the posterior side or the healthy side, and the nerve root is displaced to the posterior side or the image disappears.
2. Central type: The main clinical manifestation is cervical spinal cord compression, MRI shows that the intervertebral disc protrudes in a mass, compressing the anterior central part of the cervical spinal cord, and the compressed spinal cord can be locally bent, flattened or sunken and displaced to the posterior side with abnormal signal performance.
IV. Treatment options.
1. Qi stagnation and blood stasis evidence: activate blood circulation, remove blood stasis, move Qi and relieve pain. Rolling, pressing and kneading or one-finger meditation pushing method is operated on the back of the neck, shoulder and upper limb of the affected side, and gentle and light pulling and stretching method is applied to the neck. Those who have cervical spine reversion can reasonably apply cervical spine adjustment techniques to restore normal curvature and reduce spinal cord and nerve root tension.
2.Phlegm and stasis mutual knot evidence: dispel phlegm and remove stasis, promote paralysis and open the ligament. On the basis of cervical manipulation, the patient’s head and face can be gently manipulated with one-finger meditation pushing method and fish interval kneading method to eliminate the symptoms of vertigo. For those who have cervical vertebrae reversion, cervical spine adjustment techniques can be reasonably applied to restore the normal curvature and reduce the tension of the spinal cord and nerve roots.
3, liver and kidney deficiency evidence: nourish liver and kidney, strengthen tendons and bones. On the basis of cervical manipulation, then roll and knead the thoracic spine, lumbar spine and lower limbs to improve the spinal curve, reduce spinal cord tension and reduce muscle spasm.
4, other therapies a, acupuncture: can use Fengchi, Tianzhu, cervical pinch spine and other points.
b, drugs: can be used to invigorate blood circulation and remove blood stasis class of Chinese medicine for internal or external application, and can use antipyretic and analgesic drugs, mannitol or sodium heptaerythroside static dehydration, applicable to the acute phase.
c. Closure: cervical nerve root closure or sacral canal drip, applicable to the acute stage.
V. Complication management After the appearance of severe spinal cord compression symptoms, the patient should be promptly recommended for surgery.
VI. Precautions.
1, to pay attention to the safety of the force of manipulation, cervical spine adjustment techniques should not be rough, it is recommended to inform the patient of the possible hazards of manipulation before treatment.
2.The acute period should be protected by cervical brace.
3.Pay attention to the position and time of work and study, the reasonableness of the pillow and the warmth of the back of the neck and shoulder.
4.After the symptoms are relieved, the functional exercise of neck muscles should be insisted.
7.Efficacy assessment 1.Cure: the pain and numbness, nerve root and cervical medullary compression disappears, and the ability to work and live before the onset of the disease is restored.
2.Improved: the pain and numbness are reduced, and the quality of life and labor ability are improved.
3.Not healed: no improvement of symptoms and signs.