First of all, let’s understand what is called neurogenic cervical spondylosis: numbness, pain, weakness and other symptoms of unilateral or bilateral upper limbs caused by unilateral or bilateral spinal nerve root irritation or compression, which is manifested by sensory, motor and reflex disorders consistent with the distribution area of the spinal nerve root, this disease is more common, various targeted non-surgical treatments have obvious efficacy, especially continuous (or intermittent) traction of the head and neck The prognosis is mostly good with continuous (or intermittent) traction on the head and neck, massage, heat therapy, and appropriate exercise. III
Second, let us understand the causes of cervical spondylosis: protrusion or prolapse of the nucleus pulposus, osteophytes or traumatic arthritis of the posterior small joints, bone spur formation of the hook joint, and loosening and displacement of the three adjacent joints (intervertebral joint, hook joint and posterior small joint) can cause irritation and compression of the spinal nerve roots. In addition, narrowing of the root canal, adhesive arachnoiditis in the root cuff, and inflammation and tumors in the surrounding area can also cause symptoms similar to this disease.
Third, let us understand the clinical manifestations of cervical spondylosis.
1, cervical symptoms: vary in severity depending on the cause of radicular compression. If it is mainly due to the herniated nucleus pulposus, it is mostly accompanied by obvious neck pain, paravertebral muscle pressure pain and formal cervical posture due to the direct stimulation of local sinus vertebral nerve, and direct pressure pain or percussion pain between the spinous process or spinous process of cervical spine is mostly positive, and these manifestations are especially obvious in the acute stage. If it is caused by simple degeneration and osteophytes of the hook vertebrae joint, the cervical symptoms are milder, and there may not even be any special findings.
2. Radicular pain: It is the most common, and its extent corresponds to the distribution area of the spinal nerve roots of the affected vertebral segment. Patients often lift the upper limb to relieve pain, so the affected limb is often placed above the shoulder to relieve pain.
3. Radicular dystonia: It is obvious in those who are first compressed by the anterior root, and the muscle tone is increased in the early stage, but it is soon weakened and muscle atrophy appears. The involvement is also limited to the muscle group innervated by the spinal nerve root. In the hand, the large and small interosseous muscles and interosseous muscles are obvious.
4.Tendon reflex changes: the reflex arc involved in the affected spinal nerve roots appears abnormal. The reflexes are active in the early stage, but diminish or disappear in the middle and late stages, and should be compared with the contralateral side during the examination. There should be no pathological reflexes in purely radicular involvement, but if there are pathological reflexes, it means that the spinal cord is involved at the same time.
5. Signs: cervical compression test, intervertebral foramen squeeze test and brachial plexus nerve pull test are helpful for diagnosis. Most of the pull tests that increase the tension of spinal nerve roots are positive, especially in the acute phase and in those with posterior root compression. Positive cervical compression test is mostly seen in cases with nucleus pulposus herniation, nucleus pulposus prolapse and vertebral segment instability, while most of them are weakly positive due to hooked vertebral hyperplasia, and most of them are negative due to occupying lesions in the spinal canal.
Fourth. Examination methods
Generally speaking, the diagnosis can be made by frontal and lateral, double oblique, and lateral hyperextension and hyperflexion X-ray and MRI examination of the cervical spine, and if surgery is needed, CT examination of the cervical spine segment should be performed at the same time to understand whether there is ossification of the posterior longitudinal ligament. intervertebral disc degeneration and posterior protrusion of the nucleus pulposus, and the nucleus pulposus may even protrude into the root canal and the spinal canal, and most of them are biased to the affected side.
Fifth, diagnosis.
1, with more typical radicular symptoms: including numbness and pain, and its scope is consistent with the area innervated by the cervical spinal nerve.
2, pressure neck test and upper limb pulling test: mostly positive, painful point closure without significant effect, but the diagnosis is clear do not need to do this test.
3, imaging: X-ray plain film can show abnormalities such as changes in cervical curvature, vertebral joint instability and bone spur formation, etc. MRI examination can clearly show the local pathological anatomy, including the protrusion and prolapse of the nucleus pulposus, the site and extent of spinal nerve root involvement, etc.
Sixth, differential diagnosis.
There are 8 pairs of cervical spinal nerves and they are innervated at different sites, so when they are involved, the distribution and variation of symptoms vary greatly depending on the site of involvement. Clinically, the cervical 5-8 spinal nerve roots are more frequently involved, so this is the focus of differentiation of easily confused diseases.
The disease should be differentiated from substantial cervical skeletal lesions (tuberculosis, tumors, etc.), thoracic outlet syndrome, carpal tunnel syndrome, ulnar, radial and median nerve injuries, periarthritis of the shoulder, tennis elbow and biceps tendinitis, and other disorders that are mainly painful in the upper extremities.
The radicular pain of this disease must be distinguished from the dry pain (mainly radial nerve trunk, ulnar nerve trunk and median nerve trunk) and plexus pain (mainly cervical plexus, brachial plexus and axillary plexus).
It is also necessary to differentiate the radicular muscle strength disorder from the dry and plexiform muscle atrophy and from the muscle strength changes caused by spinal cord lesions. If necessary, electromyography or cortical evoked potentials can be performed to differentiate.
Seventh, treatment
1.Conservative treatment: mainly cervical spine (continuous or intermittent) traction, manipulation and massage, at the same time can be given intravenously hormone, mannitol and other drugs, heat therapy and appropriate exercise will also have a certain effect.
2.Surgical treatment.
Surgery can be considered for anyone with the following conditions.
(1) After regular non-surgical treatment for more than 3 months is ineffective, clinical manifestations, imaging and neurological localization are consistent.
(2) With progressive muscle atrophy and severe pain.
(3) Although the non-surgical treatment is effective, the recurrent symptoms affect work, study and life.
(3) Although non-surgical treatment is effective, work and study are affected by recurrent symptoms. The operation is preferable to lateral anterior decompression of the anterior cervical approach, which is not only effective but also has little impact on the stability of the cervical spine. For those with vertebral segment instability or root canal stenosis, internal fixation of the intervertebral interface can also be used at the same time to open up the vertebral segment and fix the fusion. The posterior cervical approach of decompression through incision of small joints is effective, but has been gradually abandoned because of the postoperative tendency to cause angular deformity of the cervical spine. A few experts have also adopted posterior intervertebral discoscopic nucleus pulposus removal for treatment, which is less invasive and has good short-term results, but remains to be observed in the long term.
Eighth, prognosis
1, due to simple cervical nucleus pulposus herniation, the prognosis is mostly good, and there are few recurrences after cure.
2, those whose nucleus pulposus has formed adhesions are prone to cerebrospinal fluid leakage, operate with a little care and caution, generally no residual symptoms.
3, caused by the hook joint hyperplasia, early and timely treatment prognosis is more satisfactory. If the disease is longer and subarachnoid space adhesions have formed at the root canal, the outcome is less satisfactory due to prolonged symptoms.
4.The treatment of radicular pain caused by extensive bone proliferation is complicated, but as long as the operation is meticulous, patient and thorough decompression, the prognosis is very good.
Attachment case: female, 53 years old, left upper extremity numbness and pain for more than two years, aggravated with left shoulder pain for one month left dorsal forearm and left dorsal hand skin sensation loss, positive left intervertebral foramen extrusion test, remaining negative. After conservative treatment without significant improvement of symptoms, the patient requested surgical treatment. The patient was treated with anterior cervical ACDF surgery under general anesthesia, and the patient’s symptoms were relieved immediately after surgery.
Preoperative X-ray Preoperative MRI Preoperative MRI Postoperative X-ray
Postoperative wound healing