1. Dizziness, lightheadedness and neck pain are not necessarily cervical spondylosis
There is a lot of confusion in the current understanding of cervical spondylosis. Patients who come to the clinic with dizziness and lightheadedness are often categorized as cervical spondylosis because no clear cause can be identified. What needs to be corrected is that such symptoms do not necessarily belong to cervical spondylosis, and the possible causes include hypertension, hyperlipidemia, cerebral insufficiency and other medical factors. Some other young people feel neck discomfort and pain and think they are suffering from cervical spondylosis, which is a misconception. Most of these cases are caused by factors such as long-term ambulatory work and excessive pillows, and are cervical muscle strain. We should also pay attention to this condition, indicating that the cervical spine has begun to degenerate, if not timely conditioning, may develop into cervical spondylosis. How to adjust for cervical muscle strain? It is recommended to put a low pillow, do not lower your head for a long time, change your posture frequently, do cervical spine exercises, traction, massage, massage should be moderate.
2, there are symptoms of nerve compression to be called a real cervical spondylosis
What is cervical spondylosis? Cervical spine degeneration with disc herniation or bone proliferation, followed by compression of the spinal cord or nerve roots, resulting in a series of neurological symptoms, that is, cervical spondylosis. In the past, cervical spondylosis was often divided into spinal cord type, nerve root type, vertebral artery type, sympathetic nerve type, and mixed type. With the deepening and development of the understanding of cervical spondylosis, coupled with the uncertainty of the vertebral artery type and sympathetic nerve type in clinical performance and diagnosis and treatment, these two subtypes gradually faded out. The symptoms of spinal cord type cervical spondylosis include numbness and weakness of the extremities, the feeling of walking on cotton, the feeling of thoracic and abdominal fasciculation, and physical examination reveals sensory and muscle weakness of the extremities, hyperactive tendon reflexes and positive pathological reflexes. The main symptom of neurogenic cervical spondylosis is radioactive pain and numbness in one or both upper extremities, and the effect of taking painkillers is poor, even affecting sleep, with few positive signs on physical examination. In patients with cervical spondylosis, degenerated and herniated cervical discs or bony bulges can be seen on magnetic resonance imaging (MRI) to compress the spinal cord or nerve roots, and some even have altered spinal cord signals. (Figures 1, 2, 3, and 4 in a and b) Patients with suspected cervical spondylosis should have a cervical MRI to confirm the diagnosis. (If no obvious nerve compression is seen on imaging, but there are symptoms, one has to rule out thoracic or peripheral neuropathy based on the associated symptoms, and also pay attention to whether the patient has psychological problems.)
3. Cervical spondylosis with severe nerve compression should be operated as soon as possible
Patients with cervical spondylosis with less severe nerve compression can try conservative treatment or radiofrequency ablation of the percutaneous perforated disc. Those with severe nerve compression should be operated as early as possible, the earlier the effect is done, the better the result. Prolonging the course of the disease will lead to nerve cell degeneration or even necrosis, which will affect the recovery of nerve function, for example, some patients have obvious relief of limb pain after surgery, but the numbness lasts longer.
Special reminder: patients with severe nerve compression should not perform traction, massage, massage and other treatments to avoid aggravating nerve damage.
4.Surgical treatment of cervical spondylosis is not terrible
Cervical spine surgery is not as scary and dangerous as the people think, the surgery only takes 1 to 2 hours, not much trauma, not much bleeding, you can sit up on the 2nd day after surgery, and you can get down on the 3rd day. Single-segment cervical spine surgery can be done under discoscopy, and cervical spondylosis with less than three segments is usually done through the anterior cervical approach, with bone graft fusion and internal fixation or artificial cervical disc replacement after decompression, and posterior cervical surgery is often performed for four or more segments, and the results are quite satisfactory. Since the technology has been developed very mature, older patients or patients with heart and lung diseases are not absolute contraindications to cervical spine surgery.
Matters needing attention before and after surgery: patients undergoing anterior cervical surgery should be trained to push the trachea before surgery by using the belly of one’s thumb to face the side of the trachea, slowly pushing the trachea to the opposite side with force and releasing it when there is discomfort, extending the time one by one to adapt to the intraoperative pulling. For posterior cervical surgery, shaved hair and prone position training should be performed for longer periods of time. If necessary, bedside continence training is also required. Cervical brace braking is required 2-3 months after cervical spine fixation, except for fixation during sleep, and the head is controlled by sandbags or rice bags on both sides. Patients who have artificial cervical disc replacement can move their necks freely after surgery.
5. Introduction of typical cervical spondylosis cases
Case 1: A case of neurogenic cervical spondylosis was admitted in March 2007. A 43-year-old male patient with radiating pain in the left upper extremity for 2 months, accompanied by numbness and weakness, with no obvious effect of anti-inflammatory and analgesic drugs, the pain was more severe at night, with severe insomnia. Nerve roots”. The patient was treated with an anterior cervical decompression graft fusion with internal fixation (cage + titanium mesh + plate) using an anterior approach to the left sternocleidomastoid muscle, and the pain in the left upper limb disappeared after the operation, and the quality of life improved significantly. (Figure 1)a
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Figure 1 (Case 1), 43-year-old male patient with neurogenic cervical spondylosis. a, b: MRI of the cervical spine showed “straightening of the physiological curvature of the cervical spine, herniated discs in cervical 5/6, 6/7, and cervical 7/thoracic 1 with left-sided compression of nerve roots”. c, d: anterior cervical decompression graft fusion internal fixation (cage + titanium mesh + plate) was performed. After the operation, the pain in the left upper limb disappeared and the quality of life was significantly improved.
Case 2: In April 2007, a 59-year-old male patient with cervical spondylosis, from Yuelai Town, Haimen, Nantong City, Jiangsu Province, began to experience weakness in both hands and unstable walking without any clear history of trauma or other causative factors, which developed into wheelchair use within a month; physical examination revealed decreased sensation and muscle strength in the extremities, marked hyperactivity of tendon reflexes in the upper and lower extremities, and severe spinal ataxia; cervical spine X-ray and MRI indicated that cervical 5/6 and 6/7 discs were herniated. The cervical spine X-ray and MRI showed that the cervical 5/6 and 6/7 discs were herniated, and the spinal cord was significantly compressed and had signal changes. The diagnosis of spinal cord cervical spondylosis with tetraplegia was confirmed. An anterior cervical decompression graft fusion internal fixation (titanium mesh + plate) was performed, and the patient recovered well and was able to walk on the ground after 3 weeks and ride a bicycle at 2 months postoperatively. (Figure 2)
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Figure 2 (Case 2), 59-year-old male patient with spinal cervical spondylosis with quadriplegia. a, b: MRI of cervical spine showed “cervical 5/6 and 6/7 disc protrusion with significant spinal cord compression and signal changes”; c, d: anterior cervical decompression graft fusion internal fixation (titanium mesh + plate) was performed, and the postoperative recovery was good, and he was able to walk after 3 weeks. He was able to walk on the ground after 3 weeks, and was able to ride a bicycle at 2 months after surgery.
Case 3: In January 2011, there was a case of spinal cervical spondylosis in a 56-year-old male with numbness and weakness of both upper limbs for 5 years, aggravated by unsteadiness in walking for 3 months. An anterior cervical decompression graft fusion internal fixation (insert cage) was performed, and the symptoms were significantly relieved after the operation, and the patient was able to walk on the ground three days later. (Figure 3)
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Figure 3 (Case 3), 56-year-old male with spinal cervical spondylosis. a, b: MRI of the cervical spine showed “herniated discs in cervical 4/5 and 5/6, especially in cervical 4/5, with significant nerve compression and spinal cord signal changes”; c, d: anterior cervical decompression graft fusion internal fixation (inserted cage) was performed, and postoperative symptoms The symptoms were significantly relieved and he was able to walk on the ground 3 days later.
Case 4: In February 2011, a 51-year-old male with spinal cord cervical spondylosis was admitted with numbness, weakness and unstable walking for 2 months, especially in the left limb. The anterior cervical decompression + artificial cervical disc replacement was performed, and the symptoms were significantly relieved after the operation, and the patient was able to walk on the second day and move his neck freely. (Figure 4) a
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Figure 4 (Case 4), 51-year-old male with spinal cord cervical spondylosis. a, b: MRI showed “cervical 4/5 disc protrusion with significant spinal cord compression and signal changes”; c, d: anterior cervical decompression + artificial cervical disc replacement was performed, and the symptoms were significantly relieved after the operation, and he was able to walk on the ground and move his neck freely on the second day.