The concept of cervical spondylosis was only introduced in the 1950s and became widely recognized in the mid-1960s. In the late 1970s, the emergence and continuous improvement of CT and MRI diagnostic technologies provided clear imaging images for the diagnosis of cervical spondylosis, especially the emergence of MRI technology, which can clearly display lesions in front of physicians and patients like a living human anatomy atlas, and people’s understanding of cervical spondylosis became more and more profound, and the pathological changes and clinical features of cervical spondylosis became more profound. Early diagnosis of cervical spondylosis and proper scientific timing of surgical intervention and selection of a reasonable surgical approach have significantly improved the long-term treatment outcome of cervical spondylosis and significantly reduced surgical risks and complications. Today, the scope of surgical intervention for cervical spondylosis is limited to patients with intractable pain and progressive worsening of neurological symptoms. However, clinical work has revealed an increasing tendency to confuse the basic concepts of cervical spondylosis diagnosis, to blindly and unfoundedly expand the indications for surgery and to misuse endosurgery, resulting in increasing theoretical confusion and errors in work, which must be a cause for concern and a long-lasting accumulation. Recently, I have read a lot of relevant literature, and combined with my clinical practice in spine surgery for more than 20 years, I would like to discuss the issues related to the diagnosis and treatment of cervical spondylosis. The concept of cervical spondylosis In the book Modern Cervical Spondylology, there is a passage that the concept of cervical spondylosis is more ambiguous internationally, often mixing multiple cervical spine disorders together, such as cervical disc disease, cervical disc prolapse, and vertebral segment hypertrophy, but in fact the conditions described are basically similar. According to most of the literature, therefore, the author also chooses this term to represent cervical spondylosis. In clinical work, it is also true that many colleagues describe some cervical disc herniation and cervical spinal stenosis as cervical spondylosis, which I believe can be called cervical spondylosis in a broad sense. In the book, the author does not mention cervical disc herniation, but divides cervical spondylosis into 3 stages: cervical disc disease stage, osteogenic cervical spondylosis stage and spinal cord degeneration stage. From his discussion, it is clear that the so-called cervical intervertebral disc disease stage is now recognized as cervical disc herniation. Cervical spondylosis is a term that is conventionally used in China. It is defined as the irritation or compression of adjacent tissues by the cervical disc degeneration itself and its secondary changes, and causes various symptoms and/or signs. The basic modern concept of cervical spondylosis is based on the degeneration of the cervical disc as the main lesion, including secondary changes in the muscles and joints around the neck and the adjacent vertebral body degeneration and hyperplasia up to compression of the neurovascular, and induces clinical symptoms and signs associated with it. Although this conceptual category basically expresses the pathological and clinical features of cervical spondylosis, this name is currently debated because it does not reflect well the cervical spine biomechanics and spinal cord function. The literature has also questioned the term “pinched cervical spondylosis”: the so-called “pinched cervical spondylosis” or “pinched cervical spondylosis” is only a common and more severe pathology of CSM. The so-called “entrapment cervical disease” or “clamping cervical disease” is only a common and more severe pathology of CSM. Clinical studies have shown that the basic pathology of cervical spondylosis should not be arbitrarily named as another type, otherwise it will easily cause confusion in the understanding of cervical spine pathology; “entrapment” is only an imaging manifestation of cervical spondylosis on MRI, which only serves to describe in detail the degree and extent of spinal cord compression in cervical spondylosis, not a specific category of cervical spondylosis. It is not a specific type of cervical spine disease. From the perspective of disease science, we do not agree with the terms “inlay cervical spondylosis” and “clamped cervical spondylosis”. The 2nd National Symposium on Cervical Spondylosis held in 1992 held that “the term cervical spondylosis has a clear meaning, and the degenerative changes of cervical disc tissue and its secondary pathological changes involve the surrounding tissue structures (nerve roots, spinal cord, vertebral artery, sympathetic nerve, etc.), and the corresponding clinical manifestations appear as cervical spondylosis. Those who only have degenerative changes of cervical thrust without corresponding clinical manifestations should not be diagnosed as cervical thrust disease. This concept has been widely recognized by professional scholars and applied in textbooks and professional literature since its establishment, from which it can be seen that it is clearly different from cervical disc herniation and cervical spinal stenosis, etc. Through the analysis and comprehensive observation of the whole process of cervical spondylosis, it can be convinced that cervical spondylosis mainly originates from degenerative changes of the cervical intervertebral disc. Simple degeneration itself may result in various symptoms and signs due to loss of water, degeneration and instability of the vertebral segments, more often seen in those with cervical spinal stenosis. In a sense, cervical spondylosis and cervical spinal stenosis are, in essence, twins. In recent years, it has been recognized that cervical disc herniation and cervical spinal stenosis with clinical symptoms are separate disorders. The concepts of cervical spondylosis and cervical disc herniation are clearly described in the book Modern Spine Surgery. Cervical disc herniation is a pathologic process of disc degeneration, and the onset of degeneration predicts further loss of stability of the segment. Degeneration does not necessarily lead to disc herniation, and disc herniation does not represent clinical pathogenesis, but only suggests the presence of a pathologic basis for spinal cord or nerve root compression. Studies have shown that cervical disc degeneration is followed by changes in the stability of adjacent vertebral segments, resulting in abnormal proliferation of subchondral bone, i.e., disc degeneration and herniation along with bone redundancy. Within certain limits, a relatively stable state is maintained, and once the spinal cord or nerve roots are compressed, it leads to clinical pathogenesis, which is usually called cervical spondylosis. Cervical disc herniation is one of the pathological changes in the pathogenesis of cervical spondylosis, and it is not appropriate to consider cervical disc herniation and cervical spondylosis as the same kind of disease. A herniated disc is a nucleus pulposus and a ruptured annulus fibrosus that is not accompanied or mildly accompanied by the formation of subchondral bone hyperplasia in that segment of the vertebral body, but does not lead to clinical morbidity once the rupture of the annulus fibrosus of the disc and the protrusion of the degenerated nucleus pulposus cause compression of the spinal cord or nerve roots and morbidity. It is only when the compressor is pure disc tissue that it is called cervical disc herniation. It is also pointed out in Practical Cervical Surgery that cervical disc herniation refers to a series of clinical manifestations of cervical disc herniation alone, which can cause rupture of the annulus fibrosus and posterior longitudinal ligament and protrusion of the nucleus pulposus causing pressure on the cervical cord or nerve roots, and cervical spondylosis are two cervical spine disorders with different pathological changes. According to the course of the disease, it is divided into: acute cervical disc herniation and chronic cervical disc herniation. It is sometimes difficult to distinguish strictly between cervical spondylosis and cervical disc herniation clinically, but the following aspects can be distinguished: ① There is a significant difference in the age of onset of the two. The age of onset of cervical spondylosis is more than 50 years old, and it is more common between 50 and 60 years old; while the age of onset of cervical disc herniation is low, and most of it occurs between 40 and 50 years old. ②Cervical disc herniation often has a history of trauma, sudden onset, faster development of the disease, timely treatment and recovery is also fast; cervical spondylosis is mostly gradually aggravated and deteriorated, and treatment and recovery is slow. In cervical disc herniation, the degenerative changes of the disc are light, the segments are few, mostly one segment, the narrowing of the intervertebral space is not obvious, and there is no proliferation of bone superfluous; in cervical spondylosis, the degenerative changes are obvious, the segments are many, and the narrowing of the intervertebral space is accompanied by the formation of bone superfluous. Although cervical spondylosis is often associated with cervical spinal stenosis clinically, and even more than 80% of cervical spondylosis is based on the pathology of spinal stenosis, solitary cervical spinal stenosis is not uncommon. Although the diagnosis and treatment of cervical spinal stenosis has its similarities with cervical spondylosis, it is not identical in substance. Modern Cervical Spondylology lists the key points of differentiation between developmental cervical spinal stenosis and spinal cord cervical spondylosis. However, it is difficult to define multisegmental cervical spondylosis and degenerative cervical spinal stenosis in clinical practice up to now.