Cervical spondylosis, also known as cervical spine syndrome, neck and shoulder syndrome, neck and shoulder hand syndrome. Cervical spondylosis is mainly a complex series of symptoms caused by degeneration of the intervertebral discs leading to the formation of osteophytes at the margins of the upper and lower vertebral bodies, which stimulate the cervical spinal nerve roots, spinal cord, vertebral artery, posterior pharyngeal wall, and soft tissues around the esophagus. If the cervical spine only has osteophytes and narrowing of the vertebral space without symptoms of pressure on soft tissues such as nerves and vertebral arteries, it is not called cervical spondylosis, but only cervical degenerative arthritis or osteoarthritis. Cervical spondylosis is a common disease in older people, accounting for 80% of people over 40 years old. The ratio of men to women is 3:1.
Due to the specificity of the anatomical structure of the cervical spine, pathological changes are also characteristic: simple disc herniation is rare, accounting for only about 5%; the most common change is osteophytes, especially the formation of bone spurs in the hook spine joint. The latter is often the main cause of cervical nerve root and vertebral artery compression. Sometimes the posterior border of the vertebral body forms and protrudes into the spinal canal and can compress the spinal cord. In addition, some degree of developmental spinal stenosis (anterior-posterior diameter <12-14 mm) has a greater impact on the development of cervical spondylosis. In recent years, it has been found that such abnormalities are not uncommon. On this basis, once cervical degeneration occurs, it can cause serious clinical symptoms even if the degree is mild.
I. Clinical manifestations
Cervical spondylosis can be divided into the following six types according to the differences in the site of compression, tissue and clinical symptoms exhibited.
(A) Cervical cervical spondylosis (muscle ligament joint capsule type) This type is the most common
1. Symptoms: pain in the neck is often the first symptom of cervical spondylosis, and those with longer disease duration may have stiff neck and abnormal ringing. Due to the degeneration of the cervical spine, the nerve endings of the intervertebral disc fiber ring, ligament, joint capsule and periosteum are stimulated, resulting in neck pain and reflex neck muscle spasm. The pain is mostly induced by improper position of the head and neck during sleep, cold or sudden twisting of the neck during physical activity. Therefore, the pain often appears in the early morning after sleep, and it is usually persistent soreness or drilling pain, which is aggravated when the head and neck are active.
2.Signs: Physical examination shows head tilt to the affected side, straightening of the neck physiological foreshortening, neck muscle tension and restricted movement. There are often obvious pressure points in the affected area, such as tendon attachment points, fascia, ligaments and cervical spinous process. There is usually no manifestation of neurological dysfunction.
3.X-ray examination shows mild or moderate cervical degeneration.
(II) Nerve root type cervical spondylosis
1. Symptoms: It mostly develops after middle age and has an intermittent course. The prominent symptom is nerve root pain or cutting pain in the neck, which can be radiated from the cervical nerve root to the shoulder, upper arm and forearm and even the hand in an electric shock-like manner, and its location is mostly limited to a single root or a few nerve roots in the distribution area of one side.
2.Signs: During the attack, it is common that the patient has neck straightness, restricted movement, and small physiological anterior convexity of the cervical spine, and in severe cases, the head is in a forced position.
3.Auxiliary examination: X-ray examination shows that the physiological anterior convexity of the cervical spine becomes shallow, disappears or even reverts, the lesioned vertebral space becomes narrow, the hook vertebral joint spur forms, the intervertebral foramen becomes smaller, and there are occasional changes such as slippage of the vertebral body.
(C) cervical spondylosis
1, symptoms: this type is less common, the onset is often chronic, but sometimes can also be acute attacks. The main symptoms are slowly progressive numbness of both lower limbs, chills, pain, unstable walking, stepping on cotton, trembling and muscle weakness. The preferred site of the lesion is the lower cervical spinal cord, which corresponds to the level of the cervical 5-6 and cervical 6-7 intervertebral spaces, accounting for about 90% of the lesions, and mainly damages the ventral side of the spinal cord on one side.
2.Signs: cervical spine movement is limited, and there are often pressure points in the cervical spinal space, paraspinal and transverse process apices.
3, imaging: most of the cervical spine plain films have characteristic changes of cervical spondylosis, CT or MRI: can clearly show the situation and location of cervical marrow compression.
(IV) Vertebral artery type cervical spondylosis
The most important cause of vertebral artery type cervical spondylosis, also known as vertebral sign, is degenerative changes of the cervical spine.
1.Symptoms
(1) Headache: it occurs in episodes and lasts for several minutes, hours or even longer, or occasionally it can be persistent pain with paroxysmal intensification. The pain is mainly located in the top of the cervical occipital area on one side, and is mostly of the nature of throbbing pain (fluctuating pain), burning pain, or often accompanied by unusual sensations such as soreness and swelling in the affected area. The attack often starts at the back of the neck and rapidly spreads to the posterior ear and occipital region, and sometimes radiates to the orbital region and the root of the nose. Sometimes the attack may be accompanied by aura such as blackness or flashing light in front of the eyes, and symptoms of autonomic dysfunction such as nausea, vomiting, sweating, salivation, panic, chest tightness and change in blood pressure when the pain is severe. In individual cases, the headache may be accompanied by pain, numbness, tingling or foreign body sensation in the face, hard palate, tongue or throat, etc. Therefore, this kind of headache is quite similar to migraine, so it is called cervical migraine.
② Vertigo: The most common symptom of this syndrome. Its nature may be rotational or general vertigo.
③Tinnitus and hearing loss
④Visual symptoms: mainly due to posterior cerebral artery ischemia. The manifestation is often episodic vision loss, dark spots and flashes in the eyes, visual field defects, occasional diplopia and hallucinations.
⑤ Other symptoms: A few patients may have episodes of impaired consciousness. Other individual cases may have sudden onset of numbness and weakness of limbs and fall down, but the mind is clear and can quickly get up and continue activities.
2. Physical signs.
① pressure pain at the projection of the traveling vertebral artery.
②Signs similar to those of cervical cervical spondylosis.
3.Auxiliary examination.
X-ray examination commonly shows obvious hyperplasia of the cervical spine, especially at the transverse foramen; MRA shows narrowing or deformation of the vertebral artery on one or both sides; CT often has no positive findings.
(E) Sympathetic cervical spondylosis
This type of cervical spondylosis is caused by direct or reflex stimulation of sympathetic nerves in the neck due to degeneration of the cervical spine. Its symptoms are extremely complex and the scope of involvement is particularly wide, including the upper part of the trunk, head and upper limbs of the affected side, which is the so-called “upper quadrant” of sympathetic nerve distribution.
Symptoms: Common symptoms include pain and sensory abnormalities, altered glandular secretion and nutritional disorders, and visceral dysfunction, etc., and these symptoms often intermingle with each other.
2.Signs: Same as cervical cervical spondylosis, but there are often signs of circulatory system such as increased heart rate and premature beats.
3, auxiliary examination: ECG examination is generally normal. Spinal X-ray examination often shows degenerative changes in the cervical spine or upper thoracic spine.
(F) Mixed cervical spondylosis
Mixed cervical spondylosis can be diagnosed when the above two types or more than two types of symptoms and signs coexist.
II. Diagnosis and differential diagnosis
It is generally not difficult to diagnose based on symptoms, signs and auxiliary examination, but it needs to be differentiated from occipital neuralgia, Meniere’s disease, subclavian artery reflux syndrome and frozen shoulder.
III. Treatment
The treatment of cervical spondylosis is currently based on conservative therapy. The main measures include.
1.Analgesic fluid injection: according to different types of cervical spondylosis, analgesic fluid is injected into the epidural cavity, hook joint, transverse process, joint capsule, yellow ligament, interspinous ligament, collateral ligament and lesioned muscles of the lesion; stellate ganglion block can be added for combined autonomic nerve dysfunction; collagenase lysis is feasible for those with obvious disc protrusion.
2.Manipulation: On the basis of the above two steps, gentle and safe manipulation is implemented for those with positive cervical induction test.
3.Physiotherapy or apparatus treatment: according to the need, appropriate local physiotherapy and cervical traction and fixation, 30 minutes each time, 1~2 times a day, as long as the patient feels comfortable.
4.Medication: During the whole treatment period, apply Chinese and Western drugs that relax the tendons and activate blood, improve microcirculation and anti-inflammatory and pain relief, such as Danshen injection, 654-2 injection given intravenously, cervical rejuvenation or non-steroidal anti-inflammatory and analgesic drugs taken orally, and local anti-inflammatory rubs can also be applied.
5.Small needle knife therapy: under the condition of local painlessness after injection, use needle knife to shred the painful hard nodes, cut the hypertrophic yellow ligament to expand the vertebral canal, cut the joint capsule to decompress the joint cavity, expand the intervertebral foramen and release the adherent nerve roots. It should be emphasized that the surgeon performing the operation must be familiar with the anatomy and must know the front end of the needle knife and what tissues and structures are around it to ensure accurate positioning or it will have serious consequences. Arterial compression syndrome is the same syndrome that results from damage to the vertebral artery and the sympathetic plexus of the vertebral artery (vertebral nerve).