Overview
Cervical spondylosis is a condition in which degenerative changes of the cervical disc itself and its secondary changes irritate or compress adjacent tissues and cause various symptoms and/or signs.
As can be seen from the definition of cervical spondylosis, the disease is primarily a degenerative disease, but is closely related to a variety of factors. It originates from degeneration of the cervical disc, which itself can present many symptoms and signs, and in combination with spinal stenosis, symptoms may appear early or may be temporarily asymptomatic, but symptoms appear when a trigger is encountered.
Most patients develop a series of secondary changes based on the primary degeneration of the cervical spine. These secondary changes include both organic changes and dynamic abnormalities. The organic changes include herniated and prolapsed nucleus pulposus, subperiosteal hematoma of the ligament, bone spur formation, and secondary spinal stenosis. Dynamic changes include cervical instability, such as intervertebral loosening, misalignment, and increased curvature. These pathophysiological and pathological anatomical changes constitute the essence of cervical spondylosis.
Clinical manifestations
(I) Cervical cervical spondylosis
1. The symptoms are mostly in young and middle-aged people with discomfort such as soreness, pain and swelling in the neck. This soreness and swelling is mainly in the back of the neck. Female patients often complain of discomfort in the scapula and shoulder. Patients often complain that they do not know what position to put their head and neck comfortably. Some patients have limited neck movement, and a few may have transient upper limb numbness, but no muscle strength loss and walking impairment.
2. Physical signs The patient’s neck is usually not crooked. The physiological curvature is reduced or disappeared, and the fingers are often used to pinch the neck collar. There may be pressure pain between the spinous process and the paraspinal process.
(II) Neurogenic cervical spondylosis
1. radicular pain Radicular pain is the most common symptom, and the pain range is consistent with the spinal nerve distribution area of the involved vertebral segment. Accompanying with radicular pain are other sensory disorders in this nerve distribution area, among which numbness, hypersensitivity and sensory diminution are common.
2.Radicular dystonia may appear in the early stage, but soon it will be weakened and muscle weakness and myasthenia gravis will appear. In the hand, atrophy of the interosseous muscle and interosseous muscle is most obvious.
3, tendon reflex abnormal early appear tendon reflex active, later reflex gradually weakened, serious reflex disappeared. However, pathological reflexes do not appear when there is a simple radicular compression, but if there are pathological reflexes, it means that the spinal cord itself is also damaged.
4. Neck symptoms include neck pain and discomfort, and there may be pressure pain at the side of the neck. There may be pain when compressing the top of the head, and there may also be pressure pain in the spinous process.
5.Special test When there is a cervical disc herniation, there is a positive pressure neck test. The spinal nerve pull test is positive.
(C) Spinal cord type cervical spondylosis
1. Symptoms Patients first experience symptoms of bilateral or unilateral lower limb sinking and numbness, followed by difficulty walking, tightening of lower limb muscles, slow walking, unable to walk fast, and in heavy cases, obvious gait staggering, and even unable to run. Poor coordination of both lower limbs and inability to cross obstacles. Both feet have a cotton-like feeling. Self-reported stiffness in the neck and numbness in the extremities when the neck is extended.
Generally, the symptoms of the lower extremities may appear before the symptoms of the upper extremities, and numbness and pain may appear on one or both sides of the upper extremities. Some patients have sphincter dysfunction and urinary retention. In addition to the symptoms of the extremities, there is often decreased sensation of the skin below the chest1 plane and tightness of the chest and abdomen, i.e. the feeling of girdling.
The most obvious sign is elevated muscle tone in the extremities. In severe cases, a slight movement of the extremities can induce muscle spasm, and the lower extremities are often more pronounced than the upper extremities. The symptoms of the lower limbs are mostly bilateral, and the severity can vary.
The typical symptoms of the upper extremity are muscle weakness and myasthenia with neurogenic hyperalgesia, while the lower extremity myasthenia is not obvious and mainly manifests as myospasm, hyperreflexia, ankle clonus and patellar clonus. Hoffmann’s sign is positive, as are Babinski’s, Oppenheim’s, Chaddock’s, and Gordon’s signs. The abdominal wall reflex and testicular reflex may be diminished or even absent.
(D) Vertebral artery type cervical spondylosis
1. Vertigo is the most important feature of this disease when the head rotates and causes vertigo attacks. Under normal circumstances, the head rotates mainly between the neck 1 – 2. The vertebral artery is squeezed here. If the head rotates to the right, the blood flow of the right vertebral artery decreases and the blood flow of the left vertebral artery increases to compensate for the blood supply. If one side of the vertebral artery is already compressed and has no compensatory capacity, when the head is turned to the healthy side, it can cause vertigo due to insufficient blood supply to the brain. Generally, the head is turned to the healthy side, while the lesion is on the opposite side.
2.Headache is caused by insufficient blood supply to the vertebral basilar artery, resulting in the expansion of blood vessels in the lateral branch circulation. The headache is mainly in the occipital and parieto-occipital areas, with throbbing and swelling pains, often accompanied by nausea, vomiting, sweating and other symptoms of autonomic disorders.
3.Sudden collapse is a special symptom of this disease. There is no warning before the onset of the disease, and it mostly occurs when walking or standing, and can be triggered when the head and neck are overly rotated or extended and flexed, and the symptoms disappear after the reverse activity. This situation is mostly due to vasospasm of the vertebral artery after stimulation and reduced blood flow.
4.Patients with visual impairment have sudden amblyopia or blindness that lasts for several minutes and then gradually regains vision, which is caused by bilateral posterior cerebral artery ischemia. In addition, there may be diplopia, eye flash, gold star, black howl, phantom vision and other phenomena.
5, sensory disorders facial sensory abnormalities, numbness around the mouth or tongue, occasional phantom hearing or phantom smell.
Diagnostic points
(A) Cervical cervical spondylosis
1. Pain in the neck, shoulder and occipital area, and head and neck movement is restricted due to pain. Because it often develops in the morning when waking up, it is called drop pillow.
2. Tension in the cervical muscles with pressure points and limited head movement.
3, X-rays show changes in cervical curvature, and power radiographs may show instability and loosening of the intervertebral joints. Due to myospasm, the head is tilted, and a part of the posterior edge of the vertebral body is overshadowed on the lateral X-ray, and the small joints are also partially overshadowed.
(B) Neurogenic cervical spondylosis
1. It has typical radicular symptoms, and its scope is consistent with the involved vertebral segments. There is pain in the neck and shoulder, the back of the neck, and radiates downward to the forearm and fingers along the nerve root distribution area. Sometimes there is skin hypersensitivity, touching with electric sensation, numbness and obvious hyperalgesia in the area innervated by the nerve roots.
2. The spinal nerve root pull test is mostly positive, and the pain point injection therapy is not effective for upper extremity radiating pain.
3. X-ray orthopantomographs show hyperplasia of the hook vertebral joint. The physiological anterior arc disappears or straightens, the vertebral space narrows, and bone spurs form in the lateral radiograph. Extension and flexion power film shows cervical instability.
(C) Spinal cord type cervical spondylosis
1. There is no discomfort in the neck, but the hand movements are clumsy, small movements are out of order, and coordination is poor. There may be a feeling of banding in the chest.
2. Unstable gait, easy to fall, unable to cross obstacles.
3.Tendon reflexes of upper and lower limbs are hyperactive, tension is elevated, Hoffmann’s sign is positive, ankle clonus and patellar clonus may appear, and Babins ki sign may be positive in severe cases. Early sensory deficits are mild, but in severe cases, irregular hyperalgesia may be present. The area of sensory loss or hyperalgesia is lamellar or striated.
4, X-rays show lesional disc stenosis and osteophytes at the posterior edge of the vertebral body.
5, M R I examination shows that the spinal cord is compressed in a wave-like indentation, and in severe cases, the spinal cord may become thin or bead-like. MRI can also show disc herniation, and there can be signal changes in the spinal cord of the compressed segment.
(D) Vertebral artery type cervical spondylosis
1. History of cervical vertigo (i.e., vertebral basilar artery ischemia) and sudden collapse, with the exception of ophthalmogenic and otogenic vertigo.
2. Some patients have autonomic symptoms.
3. Positive neck rotation provocation test.
4.X-ray shows vertebral instability and crooked vertebral joint hyperplasia.
5.Vertebral arteriogram and vertebral artery flow test can assist in localization but cannot be used as a basis for diagnosis.