Definition of cervical spondylosis.
Cervical intervertebral joint degeneration, involving the spinal cord, nerve roots, blood vessels and other surrounding tissues, resulting in the corresponding clinical manifestations (including symptoms and physical manifestations) is called cervical spondylosis, also known as cervical degenerative lesions. The national prevalence rate is about 10%.
1.Cervical cervical spondylosis.
The neck pain, stiffness and discomfort produced by the cervical degeneration itself is called simple cervical spondylosis.
Clinical manifestations: morning stiffness of the neck, pain at rest, relieved after activity, and pain aggravated after neck strain. The examination: spasm of the collar muscles, restricted movement of all sides of the cervical spine, especially difficult to tilt back, and pressure pain points next to the cervical spine. x-ray shows poor curvature of the cervical spine, straightening or retroflexion, and different degrees of hyperplasia at the edge of the vertebral body. ct or mri: no manifestation of spinal cord and nerve root compression. Differential diagnosis: rheumatoid arthritis. This type of cervical spondylosis does not require surgery.
2. neurogenic cervical spondylosis.
Clinical manifestations: head, neck, shoulder, upper thoracic back and arm pain or numbness and movement disorders in the area of innervation of the compressed nerve roots; cervical stiffness, restricted movement, positive head back pressure neck test and positive intervertebral foramen compression test. In some patients, the brachial plexus pull test was positive, and cystic changes could be palpated in the collateral ligament of the corresponding segment of the lesion when the head was tilted back.
X-rays: nerve root stenosis may be present in oblique phase, CT & MRI: compression of the corresponding nerve root is seen. It should be differentiated from cervical and dorsal fasciitis, frozen shoulder, humeral epicondylitis, cervical tuberculosis, carpal tunnel syndrome, and tumor. This treatment effect type of disease requires regular conservative treatment, and conservative treatment is ineffective and requires surgery.
3.Spinal cord type cervical spondylosis.
The most serious type of cervical spondylosis, and the type most suitable for surgical treatment; clinical manifestations: early performance of limb heaviness and weakness, unstable walking, inactivity, sometimes they feel a burning sensation and numbness in the lower limbs. In the late stage, monoplegia, hemiplegia, paraplegia, quadriplegia, urinary and fecal incontinence, and sexual dysfunction appear.
There is increased muscle tone, decreased muscle strength, hyperactive tendon reflexes, and decreased superficial sensation in the limbs below the lesion plane. Hoffman’s sign, Babinski’s sign and other pathological reflexes appear. x-rays mostly show osteophytes at the posterior edge of the vertebral body and possible spinal stenosis, CT and MRI can clarify the diagnosis. Differential diagnosis: atlantoaxial dislocation, tumor, cavity, spinal vascular disease, myelitis, etc. Once this type of cervical spondylosis is diagnosed, surgery should be performed as soon as possible.
4. Vertebral artery type cervical spondylosis.
Vertigo is position-related, mostly occurs suddenly when getting up, lying down, turning over, or turning the head, and lasts for a few seconds to tens of seconds in short cases, or a few hours to one or two days in long cases, and can occur repeatedly. Sometimes it can cause symptoms such as vomiting, sudden fall, and falling of objects. This type of cervical spondylosis is often associated with arteriosclerosis, so pay attention to the presence of a history of hypertension and coronary heart disease.
Special examination of the neck: positive head tilt and neck rotation test. Blood pressure, blood lipids, cholesterol, fundus of the eye for atherosclerosis and electrocardiogram should also be checked. x-ray film can be seen as hyperplasia of the hook vertebral joint and narrowing of the vertebral space. Digital subtraction, auditory brainstem evoked potentials, vertebral arteriography, and B-mode ultrasound for dynamic vertebral arteriography can be done when available. It should be differentiated from the following diseases: Meniere’s disease, otolith disease, and intracranial tumors. If the symptoms are severe, but caused by hyperplasia of the hook vertebral joint, surgical decompression treatment is feasible.
5. Sympathetic cervical spondylosis.
The symptoms are diverse, often including dizziness (independent of body position, often light in the morning and heavy in the afternoon), eyelids not opening, eye swelling, blurred vision, tinnitus, abnormal pharyngeal sensation, neck discomfort and easy fatigue, insomnia and dreaminess, easy sweating, emotional excitement, panic and chest tightness. If it is manifested in the upper extremities, the arms are swollen and cold, numb, shoulder and arm pain, and movement is limited. The head back pressure neck test is often positive, neck movement is not restricted, and the rotational neck test is negative.
X-ray examination may have osteophytes on the anterior and posterior edges of the vertebral body and cervical spine slippage (cervical 5 is more common), CT & MRI mostly show spinal cord or nerve root compression is not obvious. This type should be differentiated from coronary artery disease, Meniere’s disease, and neuropathy. This type generally does not require surgical treatment.
6. Mixed type of cervical spondylosis.
A mixture of spinal cord type and nerve root type is common.
7.Esophageal type.
It manifests as dysphagia, which is caused by hyperplasia of the anterior edge of the vertebral body stimulating or compressing the esophagus.
Surgical treatment: Simply speaking, for cervical spondylosis involving two segments, anterior cervical discectomy + vertebral body fusion is feasible under the microscope. For more than two segments, posterior cervical spinal canal enlargement is considered. The key to surgery is to apply microscopic techniques to decompress adequately, remove herniated or prolapsed discs, and return the compressed dura mater to minimize compression of the spinal cord.
Some patients ask about the difference between doing this type of surgery under a microscope and doing it under the traditional naked eye, and we answer this question with an analogy: “One is embroidery, and the other is shoe-making”. The microscopic technique is to remove the lesion under a microscope with a magnified surgical field, which is called embroidery; traditional surgery is performed under the naked eye, which is relatively rough, and the degree of surgical refinement can be imagined”.