Cervical spondylosis is also known as cervical spine syndrome. It is a common and frequent disease among middle-aged and elderly people. It refers to a series of neurological symptoms and changes in the cervical spine and its joints caused by degenerative changes in the bones, joints and nearby soft tissues of the cervical spine, resulting in pressure on the nerve roots, spinal cord and vertebral artery.
Clinical manifestations of cervical spondylosis
1, cervical spondylosis performance of the lighter head, neck, shoulder and arm numbness and pain, the heavier can lead to limb soreness and weakness, and even urinary and fecal incontinence, paralysis. If the lesion involves the vertebral artery and sympathetic nerve, corresponding clinical manifestations such as dizziness and panic may appear.
2, simple classification as cervical, nerve root, spinal cord, vertebral artery, sympathetic type, is a common clinical disease.
3.There is a trend of rejuvenation. It used to be common in people over 40 years old, but now cervical spondylosis can occur in people in their 30s.
Etiology of cervical spondylosis
1.Degenerative changes of the cervical spine
Degenerative changes of the cervical spine are the main cause of the development of cervical spondylosis, of which the degeneration of the intervertebral disc is particularly important and is the first factor in the degeneration of the structures of the cervical spine, from which a series of pathological anatomy and pathophysiological changes of cervical spondylosis evolve.
(1) Deformation of the intervertebral disc
When degeneration of the intervertebral disc begins to occur, it loses its normal function due to morphological changes, which in turn affects or disrupts the biomechanical balance of the cervical spine motion segments and produces a series of changes in the associated structures. Therefore, we regard degeneration of the cervical intervertebral disc as a major factor in the occurrence and development of cervical spondylosis.
(2) Emergence of ligament-disc gap and hematoma formation
The degeneration of the intervertebral disc causes loosening and abnormal activity of the intervertebral joints, and local microvascular tearing and bleeding result in the formation of a ligament-disc interstitial hematoma. This hematoma can directly stimulate the sinuso-vertebral nerve endings distributed on the posterior longitudinal ligament and cause various symptoms, and it also raises the subligamentous pressure, thus causing a series of symptoms such as neck discomfort, soreness, and a feeling of heaviness in the head and neck.
(3) Bone spur formation at the vertebral body edge
With the mechanization of the hematoma, ossification and deposition of calcium salts, a bone flab that protrudes toward the vertebral canal or toward the anterior edge of the vertebral body is finally formed. This bone superfluous can be due to repeated local trauma, continuous stretching of the surrounding ligaments and other factors, and gradually increase in size through bleeding, mechanization, ossification or calcification, and the texture becomes harder and harder
(4) Degeneration of other parts of the cervical spine: the small joint, the yellow ligament, the anterior longitudinal ligament and the posterior longitudinal ligament.
The degeneration of the anterior longitudinal ligament and posterior longitudinal ligament is mainly manifested by the fibrous hyperplasia and sclerosis of the ligament itself, and at a later stage, calcification or ossification is formed, which may be regarded as the natural protective effect of the human body. Since the ligament hardening and calcification can directly play a local braking effect, thus increasing the stability of the cervical spine, slowing down the further development and deterioration of cervical spondylosis
2.Developmental cervical spinal stenosis
It is often seen clinically that some people have serious cervical spine degeneration and obvious osteophytes, but they do not develop.
The main reason is that the sagittal diameter of the cervical spinal canal is wide and there is a large compensatory gap in the spinal canal. In some patients, the cervical degeneration is not very serious, but the symptoms appear early and are more serious. It can be seen from the imaging data that the size of the actual diameter of the cervical spinal canal is the main factor that determines the appearance of neurological symptoms early or late or whether they appear.
3.Chronic strain injury
Chronic strain injury refers to a variety of activities that exceed the maximum normal physiological range of activity or the local tolerable time value. Because it is different from obvious trauma or accidents in life and work, it is easy to be ignored, but it has a direct relationship to the occurrence, development, treatment and prognosis of cervical spondylosis, such strain injury and cause mainly from the following three situations.
(1) poor sleep position
About 1/3 to 1/4 of a person’s life is spent in bed. Therefore, poor sleep position, which lasts for a long time and cannot be adjusted in time when the brain is at rest, is bound to cause imbalance of the paravertebral muscles, ligaments and joints. The side with high tension is prone to different degrees of strain due to fatigue, and the imbalance outside the spinal canal and the spinal canal tissue, thus accelerating the degeneration process of the cervical spine. Therefore, it is often found in clinical practice that the first symptoms of many cases appear after waking up.
(2) Improper working posture
A large number of statistics show that the incidence of cervical spondylosis is particularly high among certain workers with low workload and low intensity but in a seated position, especially those who work with their heads down, including domestic workers, embroidery workers, office workers, typing and transcribers, assembly workers on instrument assembly lines, etc. In addition to the strain on the muscles and ligaments at the back of the neck caused by long-term head down, the internal pressure of the intervertebral discs is also much higher than in the normal position in the flexed neck, and can even be more than double. In addition, for the same reason, certain occupations where the head and neck often turn in one direction, such as operating room nurses, traffic police and teachers, are also prone to neck strain injury.
(3) Inappropriate physical exercise
Normal physical exercise can contribute to health, but activities or exercises that exceed the neck’s endurance, such as inversions or somersaults with the head and neck as weight-bearing support points, can increase the load on the cervical spine, especially in the absence of proper guidance. Those who have degeneration of the cervical spine should avoid exercise activities that increase the amount and frequency of head and neck activities in order to delay degenerative changes in the cervical spine.
Symptoms of cervical spondylosis
1.Cervical type
Complaints of abnormal sensations such as head, neck and shoulder pain, accompanied by corresponding pressure pain points. Characterized by stiffness, discomfort and pain in the neck, as well as inflexibility of movement, this is also the most common type.
2.Nerve root type
The patient’s palm or arm is numb, painful, and the grip strength is weakened, sometimes even holding a cup feels powerless, and when the condition is severe, it is difficult to sleep with pain throughout the night. On examination, the neck is stiff and movement is limited, and the upper limbs have dull superficial sensation, reduced muscle strength and weak reflexes.
3.Vertebral artery type
Headache, dizziness and other symptoms of cerebral vascular spasm and cerebral ischemia symptoms such as vertigo, nausea, otorrhea and blurred vision. Each vertigo attack is related to neck rotation.
4.Sympathetic nerve type
Clinical manifestation is a series of sympathetic symptoms such as dizziness, dizziness, tinnitus, hand numbness, tachycardia, anterior heart pain, etc.
5.Spinal cord type cervical spondylosis
The manifestation is weakness, stiffness, high muscle tone and hyperactive tendon reflexes of the limbs, which may lead to pathological reflexes.
6.Mixed type cervical spondylosis
There are clinical manifestations of more than two of the above.
Treatment of cervical spondylosis
There are many ways to treat cervical spondylosis, which can be divided into two categories: non-surgical treatment and surgery.
1.Non-surgical therapy includes manipulation, Chinese and Western medicine, neck collar, neck pillow, cervical traction, local closure, physiotherapy, acupuncture and functional exercise, etc. Most patients can get better results through non-surgical therapy, and it is very popular because it costs less money and is less painful.
2.Surgical treatment includes posterior laminectomy and decompression, anterior discectomy, intervertebral implantation, bone spur resection, vertebral artery decompression and so on. Only in a very small number of cases, nerve, blood vessel, spinal cord compression symptoms progressive aggravation, or recurrent, seriously affect work and life, surgery is required.
3.Integrated therapy combining Chinese and Western medicine. It is the most basic therapy for cervical spondylosis. It includes cervical spine traction, physical therapy, massage, acupuncture, medicine, collar, neck support and medical sports and self-therapy. Non-surgical treatment can reduce the symptoms of cervical spondylosis, improve significantly, and even cure it. It is especially beneficial to patients with early cervical spondylosis. In addition, non-surgical treatment can lay a good foundation for surgical treatment. This is because cervical spondylosis is accelerated by various additional factors on top of the degeneration of the body. Therefore, in order to stop, slow down or reverse this process, a series of preventive and therapeutic measures must be taken, which are the most basic and effective measures for cervical spondylosis, and thus, non-surgical therapy is the basic therapy for this disease.
Indications for non-surgical treatment.
(1) Cervical disc herniation.
(2) Nerve root type, sympathetic nerve type and vertebral artery type cervical spondylosis.
(3) Early spinal cord cervical spondylosis.
(4) Aged and frail or with poor heart, liver or kidney function, unable to tolerate surgery.
(5) people with severe neurological disorders or mental disorders with cervical spondylosis
(6) Those whose diagnosis of cervical spondylosis is not completely certain and needs to be observed during treatment
(7) Patients who are recovering from surgery.
Cervical spine traction therapy
The mechanism of action of cervical traction is.
1.Restrict the activity of cervical spine, which is conducive to tissue congestion and the decreasing of edema.
2.Relieve the muscle spasm of the neck, thus reducing the pressure on the intervertebral disc.
3.Increase the vertebral space and intervertebral foramen, so that the irritation and compression of the nerve roots can be eased, and the adhesions between the nerve roots and the surrounding tissues may be loosened.
4.Cushion the pressure of intervertebral disc tissue to the periphery, and force the decompression of the already outwardly protruding fibrous ring tissue.
5.To stretch the vertebral artery that is twisted between the transverse foramen.
6.Traction on the embedded synovial membrane of the small joint.
Traction method: usually using the occipito-mandibular cloth belt traction method. Mild patients use intermittent traction, 1~3 times a day, 1/2~1 hour each time; severe cases can be continuous traction, traction 6~8 hours a day. The traction weight can start from 3~4 kg, and the traction weight and traction time can be increased appropriately according to the age, physical strength, neck muscle development and the patient’s response to traction treatment. Course of treatment: 30 times of traction with small weight is a course of treatment. If it is effective, traction can be continued for 1~2 sessions or longer. Rest 7~10 days between treatments. Traction treatment can improve the efficacy if it is combined with other treatment measures.
Physiotherapy for cervical spondylosis
Mechanism of action of physiotherapy.
1.Elimination of nerve roots and surrounding soft tissues as inflammatory edema.
2.Improve the blood supply and nutritional status of the spinal cord, nerve roots and the neck.
3.Ease the muscle spasm of the neck, enhance the effect of cervical traction, and improve the blood circulation of soft tissues in the neck.
4.Delay or reduce the process of calcification and ossification of intervertebral joints, joint capsule and ligaments.
5.Enhance muscle tone and improve the function of small joints.
6.Improve the whole body calcium and phosphorus metabolism and the function of the vegetative nervous system.
Massage and massage therapy for cervical spondylosis
Massage and massage therapy is a more effective treatment measure for cervical spondylosis. Its therapeutic effects on cervical spondylosis are.
1, dredge the veins and channels, stop pain and numbness.
2, widen the vertebral space, expand the intervertebral foramen, rectify the slipped vertebral body, and release the nerve compression.
3.Relax nerve roots and soft tissue adhesions to relieve symptoms.
4.Ease muscle tension and restore cervical spine activities.
5.Massaging the paralyzed limb can reduce muscle atrophy and prevent joint stiffness and joint deformity.
Drug treatment of cervical spondylosis
Drugs can play an auxiliary symptomatic treatment role in the treatment of cervical spondylosis, and the commonly used drugs are
1.Antipyretic and analgesic agents: Fotarine, Fenbid, etc.
2, vasodilator drugs: Dibazol, Mazeline, etc., can dilate blood vessels and improve the blood supply to the spinal cord.
3, antispasmodic drugs: such as pivot Fen, clozoxazone and other drugs, can release muscle spasm, suitable for those with increased muscle tone and severe clonus.
4.Drugs for nutrition and regulation of the nervous system: commonly used are glutamate, methylcobalamin, etc., which can regulate the function of the nervous system and the recovery of neurodegeneration.
Local application drugs for cervical spondylosis
1, topical pain relieving application: local application of this kind of drugs has good effect on reducing pain caused by myofasciitis and muscle strain. Qingpeng cream and orthopedic water, etc. When applied, the affected area will be washed and first hot compress, and then rub the affected area with fingers dipped in a small amount of liquid or ointment, with pain relief, numbness and a feeling of ease.
2, external medicine and fumigation medicine: this method also has a certain effect on the elimination of muscle pain.
Collar and neck brace
Collar and neck brace can play a brake to protect the cervical spine, reduce the wear and tear of nerves, reduce the traumatic reaction of intervertebral joints, and help the tissue edema to subside and consolidate the effect of treatment and prevent recurrence.
The collar and cervical brace can be applied to patients with all types of cervical spondylosis, and are more suitable for patients with acute attacks, especially for patients with cervical disc herniation, sympathetic nerve type and vertebral artery type cervical spondylosis. It is worn during the day and can be removed at rest.
Long-term application of neck brace and collar can cause muscle atrophy of the neck and back, stiff joints, but not beneficial, but harmful, so the wearing time should not be too long, and during the application of regular medical physical exercise. After the symptoms are gradually reduced, the collar and neck brace should be removed in time to strengthen the muscle exercise.
Acupuncture
Acupuncture therapy is a valuable heritage of Chinese medicine. It can play a role in dredging meridians, regulating qi and blood, dredging tendons and relieving pain, etc. The treatment of cervical spondylosis can achieve obvious results, and the equipment is simple and easy to implement.
Wax therapy
Wax therapy is to apply heated paraffin wax to the affected area, so that local tissues are heated, blood vessels expand, circulation is accelerated, and cell permeability increases, which is conducive to the dissipation of edema, anti-inflammation and analgesia in deep tissues due to the long duration of heat. This method is simple and easy to implement, and can be used at home.
Surgical treatment
1. Indications
(1) Cervical disc herniation is not relieved or the radicular pain continues to worsen after non-surgical treatment, seriously affecting life and workers.
(2) Cervical spondylosis with symptoms of spinal cord involvement and partial or complete obstruction caused by spinal cord iodine oil.
(3) Patients with cervical spondylosis who suffer from sudden cervical trauma or acute spastic paralysis of limbs without obvious trauma.
(4) Cervical spondylosis causing repeated cervical vertigo, dizziness or sudden collapse, which is ineffective after non-surgical treatment.
(5) Cervical spondylosis with clear sympathetic nerve symptoms, which is ineffective by non-surgical treatment and seriously affects workers.
(6) Cervical spondylosis with osteophytes in front of the vertebrae causing symptoms of esophageal or laryngeal recurrent nerve compression.
2.Contraindications to surgical treatment.
(1) Serious cardiovascular disease or liver and kidney dysfunction.
(2) Aged and physically weak.
(3) Those with severe neurosis.
(4) People with mental illness
How to prevent cervical spondylosis
Cervical spondylosis-prone people: long-term accounting, writing, typing, office and other occupational staff, due to long-term low desk work, so that the cervical spine for a long time in a flexion position or some specific position, not only to increase the pressure within the cervical disc, but also to make the neck muscles in a long-term non-coordinated stress state, the back of the neck muscles and ligaments are susceptible to strain strain, the front edge of the vertebral body, mutual wear, hyperplasia, coupled with torsion, lateral flexion, further leading to injury. Lateral flexion is excessive, further leading to injury, easy to occur cervical spondylosis.
1, sitting correctly: to prevent the occurrence of cervical spondylosis, the most important thing is to sit correctly, so that the neck and shoulders relax and maintain the most comfortable and natural posture. Office workers should also stand up and walk around from time to time to move the neck and shoulders, so that the neck and shoulder muscles are relaxed.
2.Activate your neck: you should work for about 1 to 2 hours and let your head and neck rotate to the front and back several times, gently and slowly to achieve the maximum range of motion in each direction. So that the cervical joint fatigue is relieved.
3, look up: when a long time to see things at close range, especially in a low state, both affect the cervical spine, but also easy to cause vision fatigue, and even induce refractive error. Therefore, whenever a long time after ambulation, should look up into the distance for about half a minute. This can eliminate fatigue, but also conducive to the health care of the cervical spine.
4, the way to sleep: sleep not to sleep on top, the pillow can not be too high, too hard or too low. Pillow: the center should be slightly concave, the neck should be in full contact with the pillow and keep slightly backward, do not hang. Those who are used to lying on their sides should make the pillow as high as the shoulder. When sleeping, do not lie down and read a book. Do not blow cold wind to the head and neck.
5, avoid injury: avoid and reduce acute cervical spine injury, such as avoid lifting heavy objects, emergency brakes, etc.
6.Prevent cold and humidity: prevent wind and cold, humidity, avoid wind and cold attack at midnight and early morning bathing. Cervical spondylosis patients are often closely related to the wind and cold, humidity and other seasonal climate change. Wind chill causes local vasoconstriction and reduced blood flow rate, which hinders the metabolism and blood circulation of tissues. In winter, you should wear a scarf or a high-collared sweater to prevent the neck from being exposed to wind and cold.
7.Prevent infection: actively treat neck infection and other neck diseases.
Rehabilitation exercise: It can improve the blood circulation of the patient’s neck and loosen the adhesions and spastic soft tissues. Those without cervical spondylosis can play a preventive role.
Posture: feet apart and shoulder width, arms naturally hanging, the whole body relaxed, eyes flat, even breathing, standing and sitting can be.
1, look left and right: head first to the left and then to the right, the amplitude should be large, in order to feel sore, 30 times.
2, before and after nodding: head before and then after, when the front stoop neck as far forward as possible to lengthen, 30 times.
3.Spin your shoulders and neck: place your hands on both sides of your shoulders, palms down, and rotate your arms 20-30 times from back to front, and then 20-30 times from front to back.
4.Shake your head: rotate your head to the left a front, a right and a back 5 times, then rotate in the opposite direction 5 times.
5, head and hands against each other: hands crossed close to the back of the neck, force the top of the head and neck, the head and neck backward force, mutual resistance 5 times.
6, hands to the sky: hands up over the head, palms up, look up at the back of the hands for 5 seconds.
Precautions
1, it is appropriate to use a neck brace during the attack of this disease.
2. Patients should prevent the head from being lowered for too long and avoid working in an improper position, avoid carrying heavy objects on the shoulders and hands.
3, the patient should sleep with a pillow of moderate height, the pillow should not be too hard, should be padded in the occipital area.
4, the local should be warm, to avoid the back of the neck by wind and cold.