Cervical spondylosis is a general term for a series of symptoms and signs caused by instability and compression of adjacent tissues due to degenerative degeneration of the cervical discs. The cervical spine is one of the parts of the body with high mobility and weight bearing, especially the cervical 4 and 5 and cervical 5 and 6 intervertebral discs are both the activity centers of the neck and the parts that are under the most pressure and concentration. With the growth of age and long-term strain, degeneration of the intervertebral disc as the precursor of the degeneration of the cervical spine, will produce a variety of clinical manifestations to form cervical spondylosis. Zheng Lin, Department of Traditional Chinese Medicine and Orthopedic Injury, Gucheng County People’s Hospital
Neck injury, chronic cumulative strain injury, especially poor posture and fatigue at work are important causes of cervical spine degeneration. Due to the degeneration of the intervertebral disc, the water content of the nucleus pulposus and annulus fibrosus decreases, and the resistance to compression and traction decreases. When subjected to the gravitational force of the head and the pulling force of the cephalothoracic muscles, the degenerated intervertebral disc can undergo limited or extensive bulging in all directions, resulting in narrowing of the intervertebral space, overlapping and misalignment of the articular processes, and smaller intervertebral foramina. When the cervical spine moves, intervertebral instability, increased intervertebral mobility and mild slipped vertebrae occur due to reduced stability between adjacent vertebrae, followed by small joint dysfunction, subluxation or dislocation, hypertrophy of the ligamentum flavum due to stimulation, and osteophytes at the small joints, hook and cone joints, vertebral plates and ligamentous attachments. Bone spurs on the lateral posterior edge of the vertebral body, as well as spurs in the hook and cone joints and small joints, together with the posterior lateral bulging disc, can crush nerve roots or vertebral arteries. The posterior spurs of the vertebral body together with the discs protruding into the spinal canal and the edematous posterior longitudinal ligament are the main causes of spinal cord compression. Developmental cervical spinal stenosis with posterior protrusion of cervical discs or posterior cervical vertebral body bone spurs is very likely to cause spinal cord compression symptoms. In addition, the degeneration of cervical intervertebral discs and small joints and ligaments can cause damage to the muscles, fascia and ligaments of the neck due to the imbalance of the internal and external balance of the vertebral body.
The disease occurs in middle-aged and elderly people, with cervical 4 and 5 and cervical 5 and 6 areas being the most common. It is clinically divided into cervical, radicular, vertebral artery, sympathetic, spinal cord, etc., and there is a mixture of each syndrome type.
Diagnostic points]
I. Cervical type (simple type)
There is a history of neck strain. The patient feels neck pain and the pain spreads to the back of the shoulder. The cervical spine movement is impaired, especially the restriction of movement in a certain direction is especially obvious. Individual muscle spasms in the neck, and “pillow” like symptoms are common. There is pressure pain at the spinous process or paravertebral region of the cervical spine, but no radiating pain in the upper extremities. X-ray film shows the loss of lateral physiological curvature of cervical spine and double shadowing of articular prominence.
Nerve root type
There is paroxysmal or persistent vague or severe pain in the cervical-occipital region or the back of the neck and shoulder. Burning or cutting pain in the direction of the cervical spinal nerve segment, accompanied by pins and needles or electric-like numbness. The symptoms worsen when the neck is moved or when the abdominal pressure increases. At the same time, the upper extremities feel sunken or weak phenomenon. The neck has varying degrees of stiffness or painful oblique neck deformity, muscle tension, and restricted movement. The affected spinal nerve has pressure pain next to the corresponding spinous process. Positive brachial plexus nerve pull test. Intervertebral foraminal crush test is positive. In addition, there is sensory impairment in the skin of the affected innervation area, muscle atrophy and tendon reflex changes.
Third, spinal cord type
There are many symptoms of cervical spondylosis of spinal cord type because the site and degree of stimulation or compression of spinal cord are different. The main symptoms are numbness, soreness, burning sensation, stiffness and weakness, which mostly occur in the lower extremities and then develop into the upper extremities; there are also cases that occur in one upper extremity or lower extremity, bilateral upper extremity or bilateral lower extremity first. In addition, there are also symptoms such as headache, dizziness or abnormal urination and defecation.
IV. Vertebral artery type
Episodes of cerebral dizziness, nausea and vomiting occur when the head is extended or turned to a certain position, and the symptoms disappear when the head is turned away from that position. When the head is turned, the patient suddenly feels weakness in the limbs and falls down. When falling, the patient is mostly conscious and may have brainstem symptoms, including numbness of the limbs, abnormal sensation, and falling of objects held on the ground in mild cases, and paralysis of the contralateral limbs in severe cases. In addition, there are also signs of brainstem ischemia such as hoarseness, loss of voice, nasal eating, dysphagia, ocular muscle paralysis, blurred vision, emphasis, Horner’s syndrome, etc. X-rays can show hyperplasia of the hook and cone joints, and vertebral arteriograms can show tortuosity, thinning and compression of the vertebral arteries.
V. Sympathetic nerve type
Dizziness, dizziness or migraine, blurred vision, swelling and pain in the eye sockets, gold stars in the visual field, arrhythmia, cold and swollen limbs, and abnormal sweating. X-rays may show typical cervical spondylosis changes.
[Differential diagnosis
I. Neurogenic cervical spondylosis
Anyone with symptoms of numbness and pain in the neck, shoulder and upper limbs or signs of cervical spinal nerve damage should be differentiated from neurogenic cervical spondylosis. Some diseases, such as cervical sprain, fasciitis, frozen shoulder, tennis elbow, diaphragm irritation, carpal tunnel syndrome, thoracic outlet syndrome, etc., can be easily excluded simply by considering their possibilities. Some diseases, such as cervical spine tuberculosis, cervical spine tumor, cervical spine fracture and dislocation, mediastinal tumor, cervical ribs, etc., can be identified by x-ray. In addition, attention should be paid to differentiate it from supraclavicular swelling, progressive myasthenia, coronary heart disease, angina pectoris and other diseases.
Second, spinal cord cervical spondylosis
Anyone with symptoms of spinal cord damage must be distinguished from spinal cord cervical spondylosis. Those who can be distinguished from ordinary X-ray include cervical fracture and dislocation, spontaneous circumflex joint dislocation, congenital malformation of cervical spine, chronic infection or tumor of cervical spine. In addition, attention should be paid to differentiate from spinal cord tumors, adhesive arachnoiditis, spinal cord cavitation, primary lateral sclerosis, amyotrophic lateral sclerosis, and ossification of the posterior longitudinal ligament.
Vertebral artery type cervical spondylosis
It should be distinguished from Meniere’s syndrome. The latter is a disorder of the vegetative nervous system with unknown origin in the middle ear and characterized by sympathetic hyperexcitability. Symptoms include headache, vertigo, nausea, vomiting, tinnitus, deafness, nystagmus, slowed pulse and decreased blood pressure. The attacks are related to cortical dysfunction, excessive fatigue, lack of sleep, and mood swings, rather than being triggered by the activities of the neck.
IV. Sympathetic cervical spondylosis
1. Insufficient coronary artery blood supply: These patients have episodes of severe pain in the precordial region, accompanied by chest tightness and shortness of breath, and only reflex pain on the ulnar side of one or both upper limbs without other signs of cervical spinal nerve root stimulation in the upper limbs. The electrocardiogram may have abnormal changes. The symptoms can be reduced or relieved when taking nitroglycerin-like drugs.
2, neurosis: no X-ray changes of cervical spondylosis or other manifestations of nerve root and spinal cord involvement, and the application of drug therapy has certain effect. Long-term observation and repeated examination are needed to identify it.
Diagnostic hints]
I. Nerve root type
The patient has neck and shoulder pain, radiating to the upper extremities and accompanied by string numbness. The symptoms are aggravated by neck activity or increased abdominal pressure. If the examination reveals signs of nerve root involvement, such as straightening of the neck, restriction of movement, a certain range of pressure pain, sensory impairment, muscle weakness and change in reflexes, the disease should be considered.
Second, spinal cord type
The disease should be suspected if the patient has numbness, weakness and upper motor neuron damage in the limbs or trunk in middle age or above, and the symptoms are sometimes good and sometimes bad, with a wave-like progressive aggravation. If a patient has neurogenic cervical spondylosis and later develops symptoms and signs of spinal cord bundle involvement, the possibility of this disease should be considered.
Vertebral artery type
The diagnosis of this type should grasp the characteristics of cervical vertigo. In other words, brainstem ischemia such as vertigo, sudden fall, falling on the ground, nausea and vomiting are often triggered or aggravated by turning or bending the head sideways. It also has the manifestation of cervical spondylosis and arteriosclerosis, and the hook and cone joint hyperplasia is seen on X-ray.
IV. Sympathetic nerve type
This disease can be considered when the above symptoms of sympathetic nerve are combined with clinical manifestations of nerve root type or spinal cord type cervical spondylosis, or when there are typical cervical spondylosis changes on cervical spine X-ray.
【Treatment methods
I. Non-surgical treatment
Non-surgical treatment is applicable to most cases of cervical spondylosis, and it is very effective in early cases and should generally be used first. Non-surgical treatment of cervical spondylosis is a comprehensive therapy combining Chinese and Western medicine, which includes cervical traction, physiotherapy, massage, massage, acupuncture, medication, rest, collar or neck brace and medical sports, etc. One or several of these methods can be used according to different situations and applied simultaneously or alternately.
(A) Cervical spine traction
Cervical spine traction therapy is a more effective and widely used therapy for cervical spondylosis. It is applicable to all types of cervical spondylosis and is more effective for early cases. When traction is applied to the spinal cord type cervical spondylosis with a long period of illness, sometimes the symptoms can be aggravated, so it is used sparingly.
The effect of cervical traction can brake and release the cervical muscle spasm, increase the vertebral space and intervertebral foramen, relieve the bulging force of the intervertebral disc, pull open the embedded small joint synovial membrane, and straighten the twisted vertebral artery. Occipital M-belt traction is usually used.
(ii) Physiotherapy
Physiotherapy can eliminate the inflammatory edema of nerve roots and surrounding tissues, improve the blood supply and nutritional status of nerves, relieve the spasm of neck muscles, and improve the blood supply of soft tissues in the neck.
(C) Massage and tui-na therapy
The technique should be light and steady, avoid using violence, pay attention to avoid damaging the cervical spinal cord and causing paralysis, this method is not suitable for spinal cord type.
Surgical treatment
(A) Indications
1, cervical disc herniation by non-surgical treatment after the radicular pain is not relieved or continue to aggravate, seriously affect the life and workers.
2, cervical spondylosis with spinal cord involvement, partial or complete obstruction by myelography.
3.Patients with cervical spondylosis who have sudden cervical trauma or acute spastic paralysis of limbs without obvious trauma.
4.Cervical spondylosis causes repeated cervical vertigo, syncope or sudden collapse, and the non-surgical treatment is ineffective.
5.Cervical spondylosis with clear sympathetic nerve symptoms, which is ineffective by non-surgical treatment and seriously affects workers.
6.Cervical spondylosis with osteophytes in front of the vertebrae causing symptoms of esophageal or laryngeal recurrent nerve compression.
(B) Contraindications
1, serious cardiovascular disease or liver and kidney dysfunction.
2.The elderly and physically weak.
3.Serious neurosis.
4.Persons with mental illness.