Cervical spondylosis is a clinical syndrome caused by degenerative degeneration of cervical discs, hypertrophy and hyperplasia of cervical vertebrae, as well as cervical injury, resulting in osteophytes of cervical vertebrae, or prolapsed discs and thickened ligaments, which stimulate or compress the cervical spinal cord, cervical nerves and blood vessels and produce a series of symptoms. The main manifestations are neck and shoulder pain, dizziness and headache, numbness of upper limbs, muscle atrophy, spasm of both lower limbs in severe cases, difficulty in walking, and even paralysis of all four limbs, urinary and fecal disorders, and paralysis. It mostly occurs in middle-aged and elderly people, with a higher incidence in men than in women.
Disease classification
(1) Nerve root type: The stimulation of degenerative changes of cervical discs or osteophytes compresses the spinal nerve roots, causing sensory and motor dysfunction of the upper limbs, often manifesting as motor impairment or sensory numbness of one upper limb segment.
(2) Spinal cord type: cervical disc herniation, ligamentous hypertrophy and ossification or other causes of cervical spinal stenosis, spinal cord compression and ischemia, resulting in spinal cord conduction dysfunction. In some cases, the disease starts in the upper limbs and progresses to the lower limbs; in others, the disease starts in the lower limbs and progresses to the upper limbs. The main manifestations are unstable walking, numbness of the limbs, and difficulty in urination and defecation.
(3) Vertebral artery type: Due to the stimulation of degenerative changes of the hook vertebral joint, compression of the vertebral artery, resulting in inadequate blood supply to the vertebral basilar artery, often accompanied by dizziness, black haze and other symptoms, related to the rotation of the neck.
(4) Sympathetic nerve type: stimulation of degenerative changes of the cervical disc, compression of sympathetic nerve fibers in the neck, causing a series of reflex symptoms, is clinically rare, and is often mixed with cardiovascular disease and endocrine disease, making it difficult to distinguish.
(5) Other types: It refers to the esophageal compression type with foreign body sensation in swallowing, which is very rare clinically.
Causes of morbidity
Cervical spondylosis is one of the common and frequent diseases in middle and old people. According to statistics, its incidence increases with age. Chronic strain is the primary culprit in the development of cervical spondylosis. Long-term injury to local muscles, ligaments and joint capsule can cause local hemorrhage and edema, inflammatory changes, gradual inflammatory mechanization in the lesioned area, and formation of osteophytes, which affect local nerves and blood vessels. Trauma is a direct factor in the occurrence of cervical spondylosis. Often, people already have varying degrees of pathology prior to trauma, putting the cervical spine at high risk, and trauma directly induces the onset of symptoms. Poor posture is another major cause of cervical spine injury. Long hours of low work, lying in bed watching TV, reading books, like high pillows, long hours of computer operation, violent rotation of the neck or head, sleeping in a moving car, all these bad posture will make the neck muscles in a long-term fatigue state, prone to injury. Cervical dysplasia or defects are also one of the causes of cervical spondylosis that cannot be ignored. Asian races have a smaller spinal canal volume compared to Europeans and Americans, which makes them more prone to spinal cord compression and symptoms. In patients with unilateral vertebral artery agenesis, the incidence of vertebral artery type cervical spondylosis is almost 100%, and the difference is only a matter of time. In addition, skull base depression, congenital fused spine, root canal stenosis, small spinal canal, etc. are all congenital developmental abnormalities that are also important causes of this disease.
Clinical manifestations
Prevalent groups
1, prolonged head down reading, sitting office personnel: long-term head and neck in a single position, resulting in local over-activity, damage to local intervertebral discs, ligaments, etc., prone to cervical spondylosis.
2, head and neck trauma personnel: head and neck trauma does not directly cause cervical spondylosis, but is often an aggravating factor for cervical spondylosis symptoms, some patients due to cervical spine osteophytes, cervical disc bulge, soft tissue lesions in the spinal canal caused by cervical spinal canal in a narrow critical state, plus cervical trauma often induced symptoms, and even paralysis occurs. Inadequate neck massage is also often reported in the occurrence of paralysis.
3, bad posture: such as lying in bed watching TV, reading books, high pillow, sleeping in a sitting position, etc.; sleeping on a sleeper car, poor muscle protection when sleeping, easy to have neck injury when braking.
4, cervical spine structure dysplasia: congenital small spinal canal is also the basis for the development. The incidence of cervical spondylosis is one times higher than normal in people with a narrow central spinal canal and nerve root canal.
Disease symptoms
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients start with mild symptoms and gradually worsen them later, while some have more severe symptoms. One type is often combined with several other types, which is called mixed cervical spondylosis.
The main symptoms are:
1. neck and shoulder pain that can radiate to the head and occipital region and upper limbs.
2.Heavy feeling in the back of one shoulder, weakness in the upper limbs, numbness of the fingers, loss of sensation in the skin of the limbs, weakness in holding things in the hands, and sometimes unconscious gripping of things to the ground.
3, its serious typical performance is: lower limb weakness, unstable walking, two feet numbness, walking like stepping on cotton feeling.
4. In the most serious cases, there is even loss of control of bowel movements and urination, sexual dysfunction, and even tetraplegia.
5, often accompanied by head, neck, shoulder, back and arm pain, neck and neck stiffness, limited movement.
6.Some of them are accompanied by dizziness, house rotation, heavy cases are accompanied by nausea and vomiting, bedridden, a few may have vertigo and sudden collapse.
7.When cervical spondylosis involves sympathetic nerve, dizziness, headache, blurred vision, swelling of the second eye, dryness, inability to open the second eye, tinnitus, ear blockage, loss of balance, tachycardia, panic, tight c feeling in the chest, and some even have symptoms such as gastrointestinal distension. There are also symptoms such as dysphagia and dysphonia.
Most of the symptoms are mild at the onset and are not taken seriously, most of them can recover on their own, sometimes light and sometimes heavy, and only when the symptoms continue to worsen and cannot be reversed and affect work and life do they get attention. If the disease remains untreated for a long time, it can cause psychological damage and produce symptoms such as insomnia, irritability, anger, anxiety and depression.
Auxiliary examination
1.Cervical spine X-ray film: cervical spine disease X-ray film often shows the loss of the normal physiological curvature of the cervical spine or reversion, spinal space narrowing, spinal canal stenosis, vertebral body posterior edge bone superfluous formation, in the cervical spine hyperextension hyperflexion position film can also be observed in the cervical spine segmental instability.
2.CT of cervical spine: the hyperplastic calcification of cervical spine can be observed more clearly, and it has a clear diagnostic value for spinal stenosis and vertebral body posterior edge bone superfluous formation.
3, cervical MRI: can clearly observe the herniated disc compressing the spinal cord, and is routinely used as evidence of preoperative imaging to clarify the segment and resection range of surgery.
4.Vertebral-basilar artery Doppler: It is used to detect the blood flow of vertebral artery and can also observe the travel of vertebral artery, and it has a high value for the identification of patients with vertigo as the main symptom.
5.Electromyography: It is suitable for patients with muscle weakness as the main manifestation, and its main purpose is to clarify the localization of the diseased nerve and to differentiate it from neurological diseases such as lateral sclerosis and neurodegeneration, but it requires more demanding examination conditions and often has false positive results.
Differential diagnosis
Clinical symptoms of cervical spondylosis are present, but they should also be distinguished from symptoms not caused by cervical spondylosis. If vertigo is also present, otogenic vertigo, vestibular dysfunction, auditory neuroma, etc. should be ruled out first. There are also vertigo of cerebral origin and vertigo of ocular origin. In addition, the same neck and shoulder upper extremity pain should also be differentiated from such as drop pillow, frozen shoulder, thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome. Rheumatic muscle and arthritis, spondylitis tumor, etc. should be differentiated.
Conservative treatment
1, oral medication: mainly used for pain relief, local anti-inflammatory, relaxation muscle treatment, for cervical instability and other secondary local soft tissue strain and other efficacy is clear, but can not treat cervical spondylosis at the root. For patients with weakness or numbness of the limbs, neurotrophic drugs can also be used to assist rehabilitation and promote recovery of the compressed nerves.
2.Traction method: Through the mutual balance between traction force and anti-traction force, the head and neck are relatively fixed in the physiological curve state, so that the cervical spine curve is gradually changed, but its efficacy is limited and only suitable for patients with mild neurogenic cervical spondylosis; and traction is prohibited in the acute period to prevent local inflammation and edema from aggravating.
3, physiotherapy: physiotherapy is the abbreviation of physical therapy. It is the application of natural and artificial physical factors, such as sound, light, electricity, heat, magnetism and other effects on the human body, in order to achieve the purpose of treatment and prevention of disease. However, its effect is also weak and cannot be treated at the root. And often physical therapy is easy to produce burns on the skin.
4, Chinese medicine is profound, the efficacy but with the doctor’s personal experience has a lot to do with, need to be carefully selected.
Surgical treatment
For patients with cervical spondylosis with clear diagnosis, serious symptoms of nerve root compression and no significant improvement in symptoms after conservative treatment, surgery should be adopted, while for patients with spinal cord type cervical spondylosis, i.e. patients who mainly show symptoms such as weakness in walking and unstable walking of both lower limbs, surgery should be implemented as early as possible to obtain good recovery effect, because the treatment effect of such patients is closely related to the length of nerve compression. For patients with vertebral artery and sympathetic nerve excitation, the effect of surgery is relatively less certain.