I want to talk about the concept of “cervical spondylosis” versus “cervical spine disease”. This is a concept that is often confused and many people see them as the same disease, that is, they think that all cervical spine problems are cervical spondylosis, but they are not. Let’s talk about what cervical spondylosis is and how it is diagnosed. The concept of cervical spondylosis: the involvement of surrounding tissue structures (spinal cord, blood vessels, nerves and other tissues) due to degeneration of the cervical intervertebral disc and secondary pathological changes (including factors such as cervical disc bulging, protrusion, osteophytes, hypertrophy of the ligamentum flavum, ossification of the posterior longitudinal ligament), and causing clinical manifestations corresponding to them, is called cervical spondylosis. First, cervical spondylosis originates from the degeneration of the cervical intervertebral disc, which is simply called “aging” or “degeneration”, and is a kind of structural degeneration of the tissue. Eventually, it causes loss of function. Specifically for the cervical disc is the loss of water in the nucleus pulposus, the loss of elasticity of the annulus fibrosus, the early formation of the so-called disc bulge, and finally the rupture of the annulus fibrosus, the protrusion of the nucleus pulposus, compression of the nerve and cause symptoms; second, the degeneration of the disc secondary to the degeneration of the surrounding tissue structure, mainly including the following three aspects: 1, the cervical vertebrae or joint protrusion hyperplasia, hyperplasia is the so-called ” Bone spur”, hyperplasia is a normal response to the degeneration of the human body, is a protective change, hyperplasia and human degeneration is one of the specific performance. Here we need to emphasize a problem, bone spurs is only an imaging image called, in the human body there is no real “thorns” into the body and cause pain, so we do not need to specifically treat the bone spurs and make them disappear, no matter how to treat the bone spurs will not disappear naturally, unless surgically removed; 2, the yellow ligament hypertrophy, yellow The ligament is located in the back of the cervical spine between the ligaments, it forms the side and rear of the spinal canal together with the cervical spine plate, hypertrophy of the ligament will lead to narrowing of the spinal canal and compression of the spinal cord. The mechanism of hypertrophy of the ligamentum flavum is that the cervical degeneration causes relative instability between the cervical vertebrae, which makes the movement between the cervical vertebrae change, and the ligamentum flavum is stimulated by abnormal force and hypertrophy, which is also a protective reaction of the human body, and its important role is to increase the stability of the cervical vertebrae, but this thickening can narrow the cervical spinal canal and cause unfavorable side; 3, ossification of the posterior longitudinal ligament, posterior longitudinal ligament is a ligament connecting the posterior part of the spinal vertebral body from top to bottom in the longitudinal direction, located behind the intervertebral disc and vertebral body, which plays the role of stabilizing the cervical spine and forming the anterior part of the cervical spinal canal. Degeneration of the intervertebral disc causes chronic damage to the posterior longitudinal ligament, leading to tears, hyperplasia, and ossification. The result is also the occupation of part of the spinal canal, which in severe cases compresses the spinal cord and is one of the factors causing symptoms. Third, these changes all cause compression of the spinal cord and nerve roots to varying degrees; fourth, these changes on imaging all cause clinical symptoms corresponding to them. The last one is very important and will be introduced in detail as the focus below. So how to diagnose cervical spondylosis, is it through the photo sub or do MRI out a report, the doctor through these imaging information can diagnose cervical spondylosis? Of course not. In clinical work, we often encounter patients who take X-ray, CT or MRI reports and say I have cervical spondylosis, doctor, tell us how to treat it, and this situation is also a common phenomenon on the Internet. Even when I say: “You are not cervical spondylosis”, the patient will think I am irresponsible. That’s why I’ve been wanting to talk about how cervical spondylosis is diagnosed for your reference. There are three conditions for the diagnosis of cervical spondylosis: firstly, there must be clinical manifestations; secondly, there must be imaging manifestations; and thirdly, the imaging manifestations must correspond to the clinical manifestations. The third one, in particular, requires rich theoretical knowledge and certain clinical experience to master. The relationship between them is as follows: First, clinical manifestations are necessary. If the patient has no complaints, that is to say, if there is no discomfort, the diagnosis of cervical spondylosis cannot be established no matter how serious the imaging manifestations are. One may ask if this is still the case. The answer is yes, it does. For example, there was a woman, 46 years old, who went for an X-ray for other reasons, and unfortunately, the report concluded “cervical spondylosis”, and immediately underwent an MRI, and the result was “cervical spondylosis” very “severe”. Severe”, so they came to the hospital. After careful questioning of the patient and physical examination, the woman only had some neck discomfort and no signs of nerve compression. The reason for this is that the cervical spinal canal is wide, and although there is an obvious protrusion of the disc, the spinal cord avoids compression as a result of avoidance, that is, moving backwards, and there are no symptoms corresponding to the protrusion of the disc on the film, so the diagnosis of cervical spondylosis in this person cannot be established. However, if this patient has a narrowing of the cervical spinal canal, it will cause the spinal cord to be compressed and produce the corresponding symptoms, and then the diagnosis of cervical spondylosis can be established. This is like a family living in a large house, very spacious, if you buy a large cabinet to put in the house will not feel particularly crowded. The other family, although the population is as large as the previous family, lives in a small house, and if they buy another cabinet, they will not be able to put it in, or there will be crowding, and some problems such as crowding and discomfort will occur due to the addition of another cabinet. Secondly, although the patient has obvious symptoms similar to cervical spondylosis, if no cervical disc herniation, hyperplasia and other degenerative manifestations can be found in the imaging, the diagnosis of cervical spondylosis cannot be established. It is well understood that another cause should be found. One has to ask why this is? We will talk about it further below. Thirdly, with complaints of discomfort, abnormal signs on physical examination, and signs of cervical degeneration on imaging, is the diagnosis of cervical spondylosis certain? The answer is: “Not necessarily”. Why is that? Here we must emphasize the combination of clinical manifestations and imaging, that is, the clinical manifestations that “correspond” to the imaging manifestations. So what is the clinical manifestation corresponding to imaging? Well, the cervical spine corresponds to the spinal cord and sends out nerves to innervate a certain part of the body, which is fixed (except for special variants), that is, the same for everyone. For example, if the middle finger is innervated by the cervical 7 nerve root, which is the same in almost all people, then pressure on the cervical 7 nerve must manifest as numbness in the middle finger. Conversely, if the middle finger is numb and no cervical 7 nerve root compression is seen on the image, then the diagnosis of cervical radiculopathy cannot be made and there must be another cause. This also explains what was said earlier that although there are clinical manifestations, the cervical spine does not necessarily have the imaging manifestations of nerve compression, which is the scope of differential diagnosis, and this differential diagnosis must be made by a professional clinician, so that one must not rely on the imaging report to give the patient a final diagnosis. It is important to emphasize that the most important imaging manifestations of cervical spondylosis are plain X-rays and MRI. MRI can distinguish the intervertebral disc, dura, spinal cord, nerve roots, blood vessels and many tissue structures around the cervical spine. As far as possible, CT is not used to diagnose cervical spondylosis. Since CT has limited ability to distinguish soft tissues, but has a strong ability to distinguish bones, 3D CT scan is performed only when surgery is needed, mainly to understand whether there are bone spurs at the posterior edge of each cervical vertebra, the width of the spinal canal and so on. X-rays are often necessary to see the general structure of the cervical spine, especially the physiological curvature, the width of the bony spinal canal, the hyperplasia of the posterior border of the vertebral body, etc., which is very helpful for diagnosis. It is often the case that some patients come in for an MRI only, and when they hear that they need another X-ray, they say, “I’ve had the MRI done why do I need a photograph?” Very skeptical of my advice, to the point that some people think I am intentionally spending more of his money. That’s why it’s important to improve the patient’s trust in the doctor, which of course requires a two-pronged effort. Cervical spine disease, as described earlier, is a unique concept that refers exclusively to a series of clinical symptoms caused by nerve or blood vessel compression due to cervical spine degeneration, rather than all cervical spine-related diseases, which means that not all cervical spine problems are called cervical spine disease. The following are some of the common “cervical spine diseases”. Loss of cervical spine physiological curvature Strictly speaking, loss of cervical spine physiological curvature is not a “disease”, but only a pathological manifestation. As many people know, the normal cervical spine structure has a certain curvature, convex forward or backward curvature. The curvature of the curve is the angle between the posterior border of the cervical 2 vertebrae and the posterior border of the cervical 7 vertebrae, and the average angle for normal people is 14 degrees. Near zero degrees is the loss of physiological curvature. Why does the human cervical spine maintain such an angle? This is explained by the structure and physiological function of the cervical spine. The main function of the cervical spine is to connect the head to the torso (or trunk) and to support the head, with the cervical intervertebral discs accounting for 80% of the total force; and the small articular processes at the back accounting for 20% of the total force;. The cervical spine is made up of seven freely movable cervical vertebrae connected together. The cervical spine has to produce random movements while maintaining the weight of the head, and its power system is the muscles. There are muscles all around the cervical spine, but the posterior side is the main muscle group, the anterior side is relatively less, and the left and right are symmetrically distributed. Biomechanically, this structural feature is the most energy-efficient posture for the strong posterior muscles in the cervical spine only in normal physiological curvature, and the least stressful physiological position for the cervical discs. However, modern technological advances make many of us work in a long-term seated position. Long-term low head position makes the muscles on the back side of the neck to maintain normal posture in a fatigued state, people have to relax the muscles and let the ligamentous structures at the back of the cervical spine in a highly tense state to maintain the position of the head, the result of long-term repeated is that the muscles are increasingly weak, another result is that the cervical intervertebral discs completely bear all the force from the head, not only that, when the head is low due to the forward shift of the head’s center of gravity, the back of the Not only that, but the forward shift of the head’s center of gravity and the stretching of the ligaments at the back when the head is lowered makes the actual force of the cervical disc 3 to 5 times the weight of the head. This is like the relationship between a street light standing on the side of the road and a power pole or a “scaffold” used by a builder, which is the simplest mechanical load distribution problem. The result of such a long-term change in the mechanical load of the cervical disc is a “degenerative change” in the cervical disc, which is one of the bases of cervical degeneration, and the consequences are very serious. However, the loss of cervical physiological curvature does not immediately lead to clinical symptoms, as we have described earlier, without clinical symptoms, the disease cannot be diagnosed, so that the loss of cervical physiological curvature is not a disease, but a pathological phenomenon with more serious consequences, which can be called “disease” when the symptoms of nerve compression continue to develop. “It is not a disease. Of course, recently there is a new view that the loss of cervical physiological curvature is called “cervical cervical spondylosis” when symptoms of neck pain occur at the same time, but this view has not been widely recognized. This view has not been widely accepted because it does not fully fit the concept of cervical spondylosis that we introduced above. Cervicodorsal strain and cervicodorsal fasciitis Cervicodorsal strain and cervicodorsal fasciitis are essentially terms for different pathological changes of the same disease, both of which are chronic damage to the muscles at the back of the neck and the cervicodorsal fascia caused by prolonged head down or improper sitting posture. As mentioned above, the main role of the muscles of the back of the neck is to elevate and extend the neck and maintain head extension. Chronic damage to the muscles of the back of the neck is caused by prolonged low head position or improper sitting posture, which results in clinical manifestations such as straightening of the muscles of the back of the neck, pain, inability to move, accompanied by muscle soreness and swelling, and in severe cases, sympathetic nerve disorders such as dizziness, nausea, and rapid heartbeat, which are generally more likely to occur when cold. Cervical supraspinous ligamentitis The supraspinous ligament is a ligamentous structure in the superficial part of the spinous process of the spine from the cervical 2 to the sacrum, existing between the two adjacent spinous processes, whose function is mainly to limit the excessive curvature of the spine, relaxing when the spine is straight and straining when it is excessively curved. In life, the muscles in the back of the neck relax due to prolonged head down, and the muscle power in the back of the cervical spine is transferred to the tensile stress of the interspinous ligament. If this tensile stress is uniformly distributed in the supraspinous ligament, the damage caused will not be immediately apparent, but if it is not uniformly distributed, stress concentration will occur, making the supraspinous ligament at the point of stress concentration obviously damaged and clinical symptoms appear. The main pain is interspinous (between the highest points palpated at the back of the neck), and the diagnosis can be made clinically if significant pressure pain can be palpated. In fact, supraspinous ligamentitis best occurs near the junction of the cervical, thoracic and thoracic and lumbar segments. There are many other diseases of the cervical spine that cannot be described here, but in short, I would like to say that cervical spondylosis is a specific diagnosis and does not include all diseases of the cervical spine, just as we do not diagnose “lumbar spondylosis”. There are many people on the Internet who confuse them, and some businesses even use them for profiteering, so I hope my account can provide some help to you.