I. Definition
Cervical spondylosis is defined as the irritation or compression of adjacent tissues by degeneration of the cervical disc itself and its secondary changes, which cause various symptoms and signs. Through the analysis and comprehensive observation of the whole process of cervical spondylosis, it has been shown that the disease mainly originates from degenerative changes of the cervical intervertebral disc.
II. Overview of the pathogenesis of cervical spondylosis
(I) Pathogenic factors (primary and secondary factors)
The occurrence and development of cervical spondylosis depends mainly on degenerative changes under the condition of congenital developmental spinal stenosis, while other factors including strain, deformity, trauma and inflammation can be regarded as predisposing factors or secondary factors.
(II) Pathogenesis
The main cause of this disease is degenerative disc degeneration. The pathogenesis can be divided into two stages according to the degenerative process of the intervertebral disc and its subsequent development.
(1) The formation of bone spurs is an inevitable product of disc degeneration to a certain extent, indicating that the degeneration of the cervical spine has reached a stage that is difficult to reverse. The characteristics of pathological changes in this stage are as follows: ligament-disc interstitial hematoma (subperiosteal hematoma) → mechanization, calcification, ossification → formation of bone superfluous (bone spur) on both sides of the barbels, the posterior upper edge of the vertebral body → causing a series of secondary changes
(2) The principles of treatment in this period are.
① asymptomatic people should pay attention to the prevention of various factors that can increase degeneration and induce disease.
(2) For those with symptoms, active treatment must be sought to stop the progression and eliminate the compression and irritation of adjacent tissues.
(3) Surgery can only remove bone spurs to promote the establishment of a new local equilibrium, but cannot completely change the pathological results caused by the degeneration of the affected joint.
C. Classification and treatment procedures of cervical spondylosis
(I) Cervical cervical spondylosis
1.Diagnostic criteria.
1. Clinical features: complaints of abnormal sensation such as pain in the neck, shoulder and occipital area, accompanied by corresponding pressure points and a stiff neck.
2. Imaging changes: straightening of cervical curvature or mild trapezoidal changes on X-ray lateral radiographs, and MR imaging showing disc degeneration or posterior synostosis.
3.Excluding other disorders: mainly excluding neck sprain, frozen shoulder, rheumatic myofibrositis and other non-cervical origin of neck and shoulder pain.
2.Treatment principles.
1.Avoid and eliminate all kinds of triggering factors: pay attention to sleep and working position, avoid long-term neck bending, head and neck trauma, strain and cold stimulation.
2.Non-surgical therapy is the main treatment, physical therapy, massage, external use of neck circumference, light weight (1-1.5kg) traction therapy, etc. can make the symptoms relieved. In the acute stage, interspinous and paraspinous nerve block therapy is more effective.
(B) Neurogenic cervical spondylosis
1. Overview: This type is second only to the former in incidence and is more common clinically, mainly manifesting as sensory, motor and reflex disorders consistent with the distribution area of spinal nerve roots.
2.Diagnostic criteria: mainly based on the following five points.
1, with more typical root symptoms (numbness, pain), and its scope and the cervical spinal nerve innervation of the region consistent.
2.The pressure neck test and upper limb pull test are mostly positive.
3.X-ray plain film can show abnormalities such as changes in cervical curvature, vertebral joint non-concealment and bone spur formation. MR imaging technology clearly shows the local pathological anatomy, including nucleus pulposus protrusion and prolapse, and the site and degree of spinal nerve root involvement.
4.The clinical manifestations are consistent with the abnormalities seen on imaging at the segmental level.
5. Substantial cervical skeletal lesions (tuberculosis, tumor, etc.), thoracic outlet syndrome, carpal tunnel syndrome, ulnar nerve, radial nerve and median nerve injury, periarthritis of the shoulder, tennis elbow and biceps tenosynovitis and other disorders with upper extremity pain should be excluded.
3.Treatment principles
1.Non-surgical treatment
Various targeted non-surgical therapies have obvious efficacy, among which continuous (or intermittent) traction of the head and neck, cervical braking and correction of poor posture have certain efficacy, and the application of nerve block therapy in the acute stage has obvious effect. In cases of nucleus pulposus protrusion and prolapse, the clinical manifestations are consistent with the imaging of the spinal nerve root involvement in the segment, and collagenase lysis therapy can be considered if the regular non-surgical therapy is ineffective for more than 3 months.
2.Surgical therapy
Surgery can be considered for anyone with progressive muscle atrophy and neurological dysfunction. The operation is preferable to the anterior cervical lateral anterior decompression, which is not only effective, but also has little effect on the stability of the cervical spine; for those with vertebral segment instability or root canal stenosis, internal fixation of the intervertebral segment interface can also be used at the same time, which will open up the vertebral segment and fix the fusion. Although the posterior cervical approach to decompression by cutting small joints is effective, it has been gradually abandoned because of the postoperative tendency to cause angular deformity of the cervical spine.
4.Prognosis
1, due to simple cervical nucleus pulposus protrusion, the prognosis is mostly good, and there are few recurrences after cure.
2, the nucleus pulposus prolapse has formed adhesions are prone to residual symptoms.
3.The prognosis is more satisfactory for those who are caused by the hyperplasia of the hook vertebral joint and are treated early and timely. If the disease is long and subarachnoid adhesions have formed at the root canal, the symptoms are easily prolonged and unsatisfactory.
4, patients with extensive bone hyperplasia, not only the treatment is complex, and the prognosis is poor.