Test examination of the cervical spine
The test examination of cervical spondylosis is a physical examination without the use of instruments, which includes.
1. Forward flexion and rotation test: the patient is made to flex the neck forward and asked to rotate to the left and right. If there is pain in the cervical spine, it indicates degenerative changes in the small joints of the cervical spine.
2, intervertebral foramen squeeze test (pressure top test): make the patient’s head tilted to the affected side, the examiner’s left palm placed on the top of the patient’s head, the right hand clenched fist tapping the back of the left hand, then there is radiological pain or numbness in the limbs, indicating that the force downward transmission to the intervertebral foramen becomes smaller, there is radicular damage; for radicular pain is very strong, the examiner with both hands overlapping on the top of the head, between the pressure, can induce or intensify the symptoms. A positive pressure test when the patient’s head is in a neutral or posterior extension position is called a positive Jackson head press test.
3, brachial plexus pull test: the patient lowers his head, the examiner holds the patient’s head and neck with one hand and the wrist of the affected limb with the other hand, pushing and pulling in the opposite direction to see if the patient feels radiating pain or numbness, which is called the Eaten test. If pulling and then forcing the affected limb for internal rotation, it is called the Eaten strengthening test.
4.Extension test of upper limb: The examiner places one hand on the shoulder of the healthy side to play a fixed role, and holds the other hand on the patient’s wrist, and makes it gradually stretch backward and outward to increase the pulling on the cervical nerve root.
II. X-ray examination of cervical spondylosis
About 90% of normal men over 50 years old and women over 60 years old have bone spurs of cervical vertebrae. Therefore, there are changes in X-ray plain film, not necessarily clinical symptoms. X-rays related to cervical spondylosis are described as follows.
3. Orthostatic position: observe whether there is dislocation of the pivot joint, fracture or absence of the dentate process. The seventh cervical vertebra has no overgrowth of the transverse process, and there are no cervical ribs. The hook and cone joint and the vertebral space are not widened or narrowed.
2. Lateral position.
(i) Changes in curvature: straightening of the cervical spine, loss of physiological protrusion or reverse curvature.
(ii) abnormal mobility: in the lateral X-ray of the cervical spine in hyperextension and extension and flexion, changes in the elasticity of the intervertebral disc can be seen.
(iii) Bone redundancy: Bone redundancy and ligamentous calcification can be produced in the anterior and posterior parts of the vertebral body close to the intervertebral disc.
(iv) Narrowing of the intervertebral space: The intervertebral disc can be thinned due to herniation of the nucleus pulposus and fibrous degeneration of the intervertebral disc with reduced water content, which is manifested as narrowing of the intervertebral space on the X-ray.
(e) Subluxation and small intervertebral foramen: After disc degeneration, the stability of the intervertebral body is low, and the vertebral body tends to subluxation, or slipped vertebrae.
(vi) calcification of the collar ligament: calcification of the collar ligament is one of the typical lesions of cervical spondylosis.
(3) Oblique position: the left and right oblique films of the spine are taken, which are mainly used to observe the size of the intervertebral foramen and the osteophytes of the hook vertebral joint.
3.Electromyography examination of cervical spondylosis
The electromyography of cervical spondylosis and cervical disc herniation is due to the fact that both cervical spondylosis and cervical disc herniation can cause the nerve roots to degenerate due to long-term compression, thus losing the inhibitory effect on the innervated muscles. Thus, the muscle fibers that are denervated can produce spontaneous contractions due to the stimulation of small amounts of acetylcholine in the body. As a result, fiber potentials appear in one or both upper extremity muscles, and occasionally a few fascicular fibrillation sites. During small forceful contractions, the multiphase potentials are normal and no giant potentials appear. During large force contractions, the phase is completely disturbed. The average time frame and average potential of motor unit potentials were normal. The amplitude was 1 to 2 mV. Cervical spondylosis is caused by extensive degeneration of the intervertebral discs, resulting in osteophytes. The damage to the nerve roots is more extensive and more muscles appear to be denervated. In patients with advanced lesions and longer disease duration, a decrease in wave number and amplitude can occur during active self-induced contractions. In contrast, cervical disc herniation is often a single disc herniation, and the changes are mostly in one upper extremity, and the range of innervated muscles is clearly segmental.
IV. CT examination of cervical spondylosis
CT has been used to diagnose insufficiency of arch closure, osteophytes, vertebral body fracture, posterior longitudinal ligament ossification, spinal stenosis, spinal canal enlargement or bone destruction due to spinal cord tumor, and to measure bone density to estimate the degree of osteoporosis. In addition, the soft tissues inside and outside the dural sheath and the subarachnoid space can be clearly seen on cross-sectional images. Therefore, it can correctly diagnose herniated discs and neurofibromas. The cavitation of the spinal cord or medulla oblongata is of certain value for the diagnosis and differential diagnosis of cervical spondylosis.
V. Diagnostic criteria of cervical spondylosis
There are two diagnostic criteria for cervical spondylosis.
(1) The diagnosis can be confirmed if the clinical manifestations and X-ray findings are consistent with cervical spondylosis.
(2) Those with typical clinical manifestations of cervical spondylosis and no abnormalities on X-ray.
The diagnosis of cervical spondylosis should be made on the premise of excluding other disorders.
However, for those who have no clinical complaints and signs but have abnormalities on X-ray, cervical spondylosis should not be diagnosed. The positive findings on the radiographs can be described.