Cervical spondylosis, also known as cervical spine syndrome, is a general term for cervical osteoarthritis, proliferative cervicitis, cervical nerve root syndrome and cervical disc prolapse, which is a disorder based on degenerative pathological changes. It is a clinical syndrome with a series of dysfunctions mainly due to long-term cervical spine strain, osteophytes, or disc prolapse and ligament thickening, resulting in compression of the cervical spinal cord, nerve roots or vertebral artery. It manifests as a series of pathological changes of cervical disc degeneration itself and its secondary pathology, such as destabilization and loosening of vertebral joints; herniated or prolapsed nucleus pulposus; bone spur formation; ligamentous hypertrophy and secondary spinal stenosis, etc., which stimulate or compress the adjacent nerve roots, spinal cord, vertebral artery and cervical sympathetic nerve and other tissues, causing a series of symptoms and signs.
Cervical spondylosis can be divided into: cervical cervical spondylosis, neurogenic cervical spondylosis, spinal cord cervical spondylosis, vertebral artery cervical spondylosis, sympathetic cervical spondylosis, and esophageal compression cervical spondylosis.
I. Pathogenic factors of cervical spondylosis
1.Degenerative changes of the cervical spine
Degenerative changes of the cervical spine are the main cause of the pathogenesis of cervical spondylosis, among 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) Disc degeneration When disc degeneration begins to occur, normal function is lost 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, degeneration of the cervical intervertebral disc becomes a major factor in the occurrence and development of cervical spondylosis.
(2) Emergence of the ligament-disc gap and hematoma formation This process is critical to the occurrence and pathogenesis of cervical spondylosis and is the pathological anatomical basis for its progression from cervical disc disease to osteopathic cervical spondylosis. In fact, in the early stages of cervical spondylosis, the degeneration of the intervertebral disc not only causes the displacement of the dehydrated and sclerotic nucleus pulposus to the posterior or anterior part of the vertebral joint and finally to the lower part of the ligament, thus increasing the local pressure and causing the separation of the ligament and periosteum from the peripheral cortical bone of the vertebral body, but also the degeneration of the disc itself can cause the loosening and abnormal movement of the intervertebral joints, which further increases the tearing of the ligament and periosteum. Tearing of the ligament and periosteum is exacerbated and the formation of the ligament-disc gap is accelerated.
Ligamentous-disc interstitial hematomas are formed after subligamentous separation of the posterior aspect of the intervertebral space, which is often accompanied by local microvascular tears and hemorrhage.
(3) Bone spur formation at the vertebral body margin With the formation of a hematoma in the subligamentous space, fibroblasts become active and gradually grow into the hematoma, gradually replacing it with granulation tissue. As the hematoma mechanizes, ossifies, and deposits calcium salts, it eventually forms a bone flab that protrudes into the vertebral canal or into the anterior edge of the vertebral body.
(4) Degeneration of other parts of the cervical spine Degeneration of the cervical spine is not limited to the intervertebral discs and the adjacent vertebral body edges and hook vertebral joints, but should also include: ① small joints Most of the intervertebral joints become degenerated after disc degeneration resulting in instability and abnormal activity of the intervertebral body. The ligamentum flavum mostly begins to degenerate on the basis of the degeneration of the first two. In the early stage, the ligament is lax and gradually becomes hypertrophic and thickens and protrudes into the spinal canal. In later stages, calcification or ossification may occur. (3) The degeneration of the anterior longitudinal ligament and posterior longitudinal ligament is mainly manifested by fibrous hyperplasia and sclerosis of the ligament itself, and later calcification or ossification is formed and is consistent with the diseased vertebral segment.
(5) Reduction in the sagittal diameter and volume of the spinal canal Due to the aforementioned causes, the internal volume of the spinal canal is reduced, mainly due to the posterior nucleus pulposus, invagination of the posterior longitudinal ligament and ligamentum flavum, and loosening and hyperplasia of the hook vertebral joint and small joints. At this time, if there are other limited pathogenic factors. For example, nucleus pulposus prolapse, traumatic displacement of vertebral segments, bone spur formation and other occupational factors can cause or aggravate the symptoms of neurological involvement.
2. Developmental cervical spinal stenosis
In recent years, it has become clear that the internal diameter of the cervical spinal canal, especially the sagittal diameter, has a very close relationship not only to the occurrence and development of cervical spondylosis, but also to the diagnosis, treatment, selection of surgical methods and prognosis of cervical spondylosis. Some people have severe cervical degeneration and significant bone growth, but do not develop the disease, mainly because the sagittal diameter of the cervical spinal canal is wide and there is a large compensatory gap in the spinal canal. While some patients are not very serious cervical degeneration, but the symptoms appear early and more serious.
3.Chronic strain injury
Chronic strain injury refers to a variety of overlimiting activities that exceed the maximum normal physiological range of activity or the local tolerable hourly 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 with the occurrence, development, treatment and prognosis of cervical spondylosis, etc. The causes of such strain injury are mainly from the following three situations.
(1) poor sleep position poor sleep position because of its long duration and in the brain at rest can not be adjusted in time, is bound to cause the paravertebral muscles, ligaments and joints of the balance disorders.
(2) Improper work posture A large amount of statistical material shows that the incidence of cervical spondylosis is particularly high in certain workloads, not high intensity, but in a sitting position, especially in low head workers, including domestic workers, embroidery workers, office workers, typing scribes, assembly workers on the instrument assembly line, etc.
(3) Inappropriate physical exercise Normal physical exercise contributes to health, but activities or exercises that exceed the endurance of the neck, 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.
4.Congenital deformity of the cervical spine
In the health examination or comparative study film of the normal human cervical spine, it is often found that the cervical spine segment can have various abnormalities, of which about 5% are obvious skeletal deformities. However, when compared with patients with cervical spondylosis, the number of deformities in the cervical spine of the latter is about double that of normal people.
Second, cervical spondylosis clinical manifestations
The clinical symptoms of cervical spondylosis are more complicated. There are mainly neck and back pain, upper limb weakness, finger numbness, lower limb weakness, walking difficulties, dizziness, nausea, vomiting, and even blurred vision, tachycardia and swallowing difficulties. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.
1.Nerve root type cervical spondylosis
(1) It has more typical radicular symptoms (numbness and pain) and the scope is consistent with the area innervated by the cervical spinal nerve.
(2) Positive head compression test or brachial plexus pulling test.
(3) Imaging findings are consistent with the clinical presentation.
(4) No significant effect of painful point closure.
(5) Excluding extra-cervical spine lesions such as thoracic outlet syndrome, carpal tunnel syndrome, elbow tunnel syndrome, periarthritis and other disorders causing mainly upper limb pain.
2.Spinal cord type cervical spondylosis
(1) Clinical manifestation of cervical spinal cord damage.
(2) X-ray film shows osteophytes at the posterior edge of the vertebral body and spinal stenosis. Imaging confirms the presence of spinal cord compression.
(3) Excluding amyotrophic lateral sclerosis, spinal cord tumor, spinal cord injury, multiple peripheral neuritis, etc.
3.Vertebral artery type cervical spondylosis
(1)There was a sudden collapse attack. And accompanied by cervical vertigo.
(2) Positive spin neck test.
(3) X-ray shows segmental instability or osteophytes of the cardinal joints.
(4) Most of them are accompanied by sympathetic symptoms.
(5) Exclude ophthalmogenic and otogenic vertigo.
(6) Exclude insufficiency of basilar artery supply caused by compression of vertebral artery segment I (the segment of vertebral artery before entering the transverse foramen of cervical 6) and vertebral artery segment III (the segment of vertebral artery before exiting the cervical spine into the skull).
(7) Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) is required before surgery.
4.Sympathetic cervical spondylosis
Clinical manifestations include a series of sympathetic symptoms such as dizziness, blurred vision, tinnitus, hand numbness, tachycardia, precordial pain, etc. There is instability or degeneration of the cervical spine on X-ray. Vertebral arteriogram is negative.
5.Esophageal compression type cervical spondylosis
Cervical vertebrae with anterior bird’s beak-like hyperplasia compressing the esophagus causing dysphagia (confirmed by barium examination of the esophagus), etc.
6.Cervical cervical spondylosis
Cervical cervical spondylosis, also called localized cervical spondylosis, refers to pain and corresponding pressure points in the head, shoulder, neck and arm, and there are no obvious degenerative changes such as narrowing of the intervertebral space on X-ray, but there can be changes in the physiological curve of the cervical spine, intervertebral instability and mild osteophytes, etc.
Third, the complications of cervical spondylosis
1.Swallowing disorder
There is a feeling of obstruction when swallowing, a foreign body feeling in the esophagus, and a few people have nausea, vomiting, hoarseness, dry cough, chest tightness and other symptoms. This is caused by direct compression of the posterior wall of the esophagus by the anterior edge of the cervical spine and esophageal stenosis, or it may be caused by irritation of the soft tissues around the esophagus due to excessive formation of bone spurs.
2.Visual impairment
It is manifested as vision loss, eye swelling and pain, photophobia, lacrimation, pupil size, and even visual field reduction and sharp vision loss, and blindness may occur in individual patients. This is related to the ischemic lesion of the visual center of the occipital lobe of the brain caused by autonomic nerve disorder and insufficient blood supply to the vertebrobasilar artery due to cervical spondylosis.
3.Cervical heart syndrome
It is easily misdiagnosed as coronary artery disease and is characterized by pain in the precordial region, chest tightness, arrhythmia (such as premature beats) and ST-segment changes in the electrocardiogram. This is caused by the stimulation and compression of the nerve roots in the back of the neck by the cervical spine spurs.
4. Hypertensive cervical spondylosis
It can cause an increase or decrease in blood pressure, of which the increase in blood pressure is the most common, called “cervical hypertension”. Since cervical spondylosis and hypertension are both common diseases of middle-aged and elderly people, they often coexist.
5. Chest pain
The pain is slow-onset and persistent unilateral pain in the pectoralis major muscle and breast, with pressure pain in the pectoralis major muscle during examination. This is related to the compression of the cervical 6 and 7 nerve roots by the cervical spine spurs.
6.Lower limb paralysis
Early manifestation is numbness, pain and limp in the lower limbs, and some patients have a feeling like stepping on cotton when walking. Individual patients may also have defecation and urination disorders, such as frequent urination, urgent urination, poor urination or incontinence. This is because the lateral bundle of vertebrae is stimulated or compressed by the cervical spur, resulting in lower limb movement and sensory impairment.
7.Sudden collapse
Sudden collapse often occurs when the body loses support due to sudden head twisting while standing or walking, and the patient can wake up soon after collapse, without any impairment of consciousness or sequelae. Such patients can be accompanied by dizziness, nausea, vomiting, sweating and other symptoms of plant nerve dysfunction. This is due to the disorder of blood supply to the basilar artery caused by the proliferative changes of the cervical spine compressing the vertebral artery, resulting in a temporary lack of blood supply to the brain.
IV. Conservative treatment of cervical spondylosis
1.Medication
Pain relievers, sedatives and vitamins (such as B1 and B12) can be applied selectively, which have certain effect on the relief of symptoms.
2.Exercise therapy
When the symptoms of each type of cervical spondylosis are basically relieved or in a chronic state, medical gymnastics can be started to promote the further elimination of symptoms and consolidate the therapeutic effect. During the acute attack of symptoms, local rest is recommended, and it is not advisable to increase the stimulation of movement. Exercise is contraindicated when there are more obvious or progressive spinal cord compression symptoms, especially cervical backward movement should be contraindicated. In the case of vertebral artery cervical spondylosis, gentle and slow rotation of the neck is recommended, and the amplitude should be controlled appropriately.
3.Traction treatment
Traction” was one of the preferred methods for treating cervical spondylosis in the past, but in recent years, it has been found that many patients with cervical spondylosis, especially those who have used “traction” for a long time, suffer from cervical spondylosis after using “traction”. However, in recent years, it has been found that many patients with cervical spondylosis, especially those who have been using “traction” for a long time, not only do not reduce their cervical spondylosis, but also aggravate it.
Traction not only can not promote the recovery of the cervical spine physiological curvature, on the contrary, traction straightened the cervical spine, but also weakened the cervical spine physiological curvature, so cervical spondylosis should be used with caution traction therapy.
4.Massage and massage therapy
It is a more effective treatment measure for cervical spondylosis. Its therapeutic effect is to relieve the tension and spasm of the neck and shoulder muscles, restore the cervical spine activities, release the nerve roots and soft tissue adhesions to relieve symptoms, spinal cord type cervical spondylosis generally prohibit gravity massage and reset, otherwise it is very easy to aggravate the symptoms, and may even lead to paraplegia, even if the early symptoms are not obvious, surgery is generally recommended.
5.Physiotherapy
In the treatment of cervical spondylosis, physiotherapy can play a variety of roles. It is generally believed that iontophoresis, ultrasound, ultraviolet light or intermittent current are feasible in the acute stage; ultrasound, iodine iontophoresis, induction electricity or other heat therapy are used after the pain is reduced.
6.Warm compress
This treatment can improve blood circulation, relieve muscle spasm, eliminate swelling to reduce symptoms, and help stabilize the affected vertebrae after manipulative treatment. This method can be used hot towel and hot water bag local external compresses, acute patients with heavy pain symptoms should not be warm compress treatment.
V. Prevention of cervical spondylosis
1, pay attention to the combination of work and rest;
2, head down and work for an hour to rest and raise the head for five minutes, self-massage the neck for two minutes;
3, the appropriate pillow height; it is recommended that people with cervical spondylosis tendency to use the length of 50-60cm, 12cm diameter cylindrical buckwheat pillow;
4, avoid leaning on the bed screen to read or watch TV.