1.Cervical spondylosis is committed, neck pain
Modern people work busy, fast-paced life pressure, long-term ambulatory work, use of computers, do not pay attention to cervical spine health care, resulting in the incidence of cervical spondylosis is increasing year by year. Cervical spondylosis is mainly due to long-term strain and osteophytes of the cervical spine, or disc protrusion, ligament thickening, resulting in cervical spinal cord, nerve roots or vertebral artery compression, resulting in a series of functional disorders of the clinical syndrome. The cervical spine is located between the head, chest and upper limbs, and is the smallest of the spinal vertebrae, but the most flexible, most frequently active and heavily loaded segment. Long hours of neck in a posture, ambulatory work, operating a computer, looking down at the phone, high pillow, etc., easy to cause strain on the neck muscles, cervical degeneration. Patients with cervical spine disease often initially show neck and shoulder pain and numbness in the hands, and some show dizziness and even unstable walking. When the symptoms of pain at the back of the neck occur in daily life, you should be alert to the occurrence of cervical spondylosis, which is an early warning signal of the body to the disease, and what it wants to tell you is actually that it is time to let your cervical spine rest and rest. When there is just neck and shoulder discomfort, most of them are myofasciitis caused by strain, if not controlled at an early stage, it will form chronic pain, which will easily recur and leave “roots of the disease”.
2.What type of cervical spondylosis do I have?
The typing of cervical spondylosis is important because the treatment and prognosis of different types of cervical spondylosis are different. Cervical spondylosis is divided into four main types.
(1) Neurogenic cervical spondylosis
The incidence of this type is the highest, and the main lesion is the narrowing of the intervertebral foramen causing compression of the cervical spinal nerve, mostly seen in the 4-7 cervical vertebrae. High incidence age group: 30 to 50 years old. The main symptoms: early symptoms are neck pain and neck stiffness; radiating pain or numbness in the upper extremity, which radiates along the course of the compressed nerve root and the innervated area, and sometimes there is a clear relationship between the appearance and relief of symptoms and the position and posture of the patient’s neck; the affected upper extremity feels heavy and has reduced grip strength, and sometimes there is a fall of objects.
(2) Spinal cord type cervical spondylosis
This type is the most dangerous, and the main lesions are: cervical spine lesions leading to spinal cord compression, inflammation, edema, etc. High incidence age group: 40-60 years old. Main symptoms: numbness and heaviness of the lower limbs, difficulty in walking, and a feeling of stepping on cotton in both feet; numbness and pain in the upper limbs, weakness and inflexibility of the hands, difficulty in fine movements such as writing, fastening buttons, holding chopsticks, etc., and the tendency to drop objects; abnormal sensation in the trunk, and patients often feel a belt-like binding sensation in the chest, abdomen, or both lower limbs.
(3) Vertebral artery type cervical spondylosis
The main lesion is: insufficient blood supply due to bone spur, vascular variation or lesion. High incidence age group: 30-40 years old. Main symptoms: episodic vertigo, diplopia with nystagmus; sometimes accompanied by nausea, vomiting, tinnitus or hearing loss, which are related to the change of neck position; sudden weakness of lower limbs and sudden collapse, but consciousness, mostly occurs when the head and neck are in a certain position; occasional limb numbness and abnormal sensation.
(4) Sympathetic cervical spondylosis
The main lesion is that various cervical lesions provoke sympathetic nerve endings on the nerve roots, joint capsule or collateral ligament. High incidence age group: 30 to 45 years old. Main symptoms: dizziness, headache, poor sleep, memory loss, difficulty concentrating; eye swelling, blurred vision; tinnitus, ear blockage, hearing loss; nasal congestion, “allergic rhinitis”, foreign body sensation in the throat, dry mouth, vocal cord fatigue; nausea or even vomiting, abdominal distension, diarrhea, indigestion, belching, etc.; palpitations, chest tightness, changes in heart rate The patient’s heart rate may vary, such as palpitations, chest tightness, heart rate changes, arrhythmia, blood pressure changes, etc.; excessive sweating, no sweating, chills or fever on the face or a certain limb.
In addition to the above four types, it is common for different symptoms of the above four types to occur at the same time in clinical practice, which is called mixed type. At present, the clinical manifestations of neurogenic cervical spondylosis and spinal cord cervical spondylosis are more typical, so the diagnosis and treatment are less controversial, while the clinical manifestations of vertebral artery cervical spondylosis and sympathetic cervical spondylosis are more similar to neurological diseases and otorhinolaryngological diseases, etc., and there are still more controversies in diagnosis and treatment.
3.Patients with cervical spondylosis should have those examinations
Special examinations should be selected according to the patient’s different conditions, mainly according to the patient’s different medical history and physical examination characteristics, combined with the doctor’s judgment. Different special examinations have their own advantages and disadvantages, and therefore have different scope of application.
There are more auxiliary examinations that can be done for cervical spondylosis, and the most used and popular one in clinical practice is cervical spine X-ray. Cervical spine X-ray is clinically important and is the most routine and basic special examination in the diagnosis of cervical spondylosis. It is also simple, convenient, inexpensive and easily accepted by the majority of patients, and can clarify the presence of bone destruction and deformity of the cervical spine, and observe the presence of bone spurs, narrowing of the spinal space and ossification of the posterior longitudinal ligament of the cervical spine. More importantly, radiographs are an essential basis for positioning during surgery. In addition to cervical spine X-ray, there are many special imaging methods, such as magnetic resonance imaging (MRI), CT, myelography, body layer photography, etc., as well as other functional tests such as electromyography, evoked potentials, cerebral hemogram, etc. The specific auxiliary tests to be used clinically should be applied by the specialist according to the needs of the condition.
It should be noted that many patients have a wrong view that MRI and CT are more advanced and more advanced than X-ray plain film technology and therefore can also see more clearly and can replace X-ray plain film examination completely. Therefore, many patients, especially those who have been to many hospitals, come to the hospital with a large number of MRI and CT films in their hands, but not the most basic X-ray plain films, which is a bit of putting the cart before the horse.
4, high pillow really worry-free?
As the saying goes, “no worries about your pillow”, is that really true? In fact, it is not. From a medical point of view, the long-term use of too high pillow, prone to induce cervical spondylosis. Why is this? From the side, the normal human cervical spine is not straight, but there is a forward projection of the physiological curvature. The pillow is too high will make the cervical vertebrae excessive forward flexion, the cervical spine rear muscles and ligaments in this state for a long time prone to strain, the front of the disc pressure and cause aging disc degeneration. In the long run, the degeneration of the structure of the spinal cord, nerves, blood vessels, compression, neck and shoulder pain, upper limb numbness, dizziness or walking instability and other symptoms of cervical spondylosis. The length of the pillow is generally more than their shoulder width when lying down 10-16 cm is appropriate, the height of the head and neck is usually equal to the height of their fist or slightly lower as the standard. For people who are used to lying on their side, the height of the pillow should be the same height as their side of the shoulder after compression. Therefore, the high pillow is not worry-free. Whether cervical spondylosis patients or healthy people, sleep should not use a high pillow, a reasonable choice of pillow to maintain the physiological convexity of the cervical spine, so as to prevent the occurrence of cervical spondylosis.
5, cervical spondylosis prevention from the side to do
(1) change the habits of life, avoid long hours of work, avoid maintaining the cervical spine in a posture for a long time, and keep the spine straight.
(2) strengthen the neck and shoulder muscle strength exercise, swimming is a better way to exercise the neck, shoulder and waist back muscle exercise. Normally, you can do forward flexion, back extension and rotation of the head and upper limbs, which can relieve fatigue and exercise muscle strength, and help maintain the stability of the cervical vertebrae and protect the cervical intervertebral discs and small joints.
(3) Pay attention to the warmth of the neck and shoulders, avoid prolonged blowing of air conditioning or air conditioning temperature is too low.
(4) scientific and reasonable choice of pillow, avoid the bad habit of high pillow sleep, avoid the head and neck in a state of flexion for a long time.
(5) Do not doze off when sitting in a car and avoid sudden head shaking.
(6) Early and thorough treatment of soft tissue strain in the neck and shoulder to avoid its development into cervical spondylosis.
(7) Optimistic attitude towards life, healthy lifestyle, let the cervical spine relax outside of 8 hours, and participate in exercises such as swimming and badminton appropriately.
(8) labor or walking to prevent flash and contusion.
6.How to maintain a good working posture
Posture in line with physiology is good posture, cervical spine normal existence of physiological foreshortening. In the case of neck flexion, the pressure within the cervical disc is greater than the natural supination and extension position, thus easy to aggravate the cervical disc degeneration. Although you can not work, but you can work through the regulation of the state to achieve the purpose of preventing neck discomfort. First of all, the height and tilt of the desktop should be adjusted, in principle, the head, neck and chest to maintain the normal physiological curve, the line of sight flat in front or slightly tilted 5 ° -10 °, to avoid the head and neck for a long time in the supination or flexion state. Secondly, at any time should not be fixed in a certain posture for a long time, at least no 1-2 hours to be able to move the whole body for about 5 minutes, to eliminate the fatigue of the neck and then continue to work, which is conducive to alleviating chronic strain injury of the cervical spine.
7.How to do neck exercise for middle-aged and elderly people
Many people think that yoga, backward walking and other exercises can relieve the condition, in fact, sometimes it may not. Both the cervical spine and other organs of the body have undergone a series of irreversible aging degeneration. Therefore, the elderly in the neck exercise must pay attention to the intensity and amount of exercise, yoga in many movements if you can not control the strength of the cervical spine will be damaged. Older people’s balance decreases, backward walking increases the risk of inadvertent falls and cervical spine injury, and therefore is not suitable for the elderly. The specific methods of moving the neck are.
(1) cross your fingers to hold the back of the head slowly backward, so that the head to maintain the supine position, maintain about 10 seconds, repeat 6-8 times.
(2) Slowly rotate the head and neck from side to side, maintaining it for about 10 seconds each time, alternating between left and right and repeating 3-6 times each.
In addition, middle-aged and elderly people have relatively weak neck muscle strength, often accompanied by chronic strain on the neck muscles, and the imbalance of neck muscle strength is not conducive to maintaining the stability of the cervical spine. Therefore, middle-aged and elderly people should properly exercise the strength of the neck muscles by the following methods.
Try to contract both shoulders, insist on about 10 seconds, repeat 6-10 times. Cross the fingers of both hands to hold the forehead, give some resistance, resistance under the forward flexion of the neck, adhere to about 10 seconds, repeat 3-5 times. One hand to hold the side of the head, give a certain resistance, resistance under the lateral flexion of the neck, adhere to about 10 seconds, alternating left and right, repeat 3-5 times. Cross your head with both hands, give some resistance, make your head tilt backward under resistance, insist on about 10 seconds, repeat 3-5 times.
8, dizziness should see what department
Dizziness is a complex condition. Sympathetic cervical spondylosis can cause dizziness, but its clinical manifestations are the most complex, with variable symptoms and no specific signs, making it difficult to confirm the diagnosis. Sympathetic cervical spondylosis can occur in people of all ages from young adults to the elderly, but of course it is more common in middle-aged and elderly people. Sympathetic cervical spondylosis has the following characteristics: the patient feels that the symptoms are aggravated when the head is pressed downward, and the patient feels that the symptoms can be slightly reduced when the head is pulled upward; the patient’s symptoms can be reduced after resting in bed, and aggravated after getting cold, exertion or poor rest; moreover, the patient can have the characteristics that the symptoms are light in the morning, aggravated in the afternoon or evening, and can be reduced in the morning after getting up or after taking a nap. In other words, the patient’s symptoms can be alleviated after rest and aggravated after exertion. But is dizziness necessarily caused by cervical spondylosis? Not necessarily. Diseases in neurology, otolaryngology, ophthalmology, cardiology and other related departments may also cause dizziness, such as otoliths, hypertension, hypotension, cerebral arteriosclerosis, cerebral vascular spasm or thrombosis, Meniere’s disease (Meniere’s), vaginitis, vestibular dysfunction, autonomic dysfunction and so on. Sympathetic cervical spondylosis is an exclusion diagnosis, and the symptoms are subjective to the patient’s perception. Imaging examinations such as X-ray plain film, MRI and CT of the cervical spine do not have special significance for the diagnosis of this disease, but only suggest the existence of lesions in the cervical spine. Therefore, when there are symptoms of dizziness, the dizziness caused by the above-mentioned related diseases should be excluded first, so as not to delay the disease and delay treatment, resulting in serious consequences.
9.Does cervical spondylosis require an operation?
Cervical spondylosis is not terrible, and most of them do not require surgery. Most of the early cervical spondylosis choose conservative treatment methods, but the course of treatment is long, the recurrence rate is high, and most patients still have some symptoms later, so non-surgical treatment needs to be long-term or repeated. Conservative treatment is relative to surgical treatment, that is, it is a non-surgical treatment method, so clinicians often refer to it as “conservative treatment”. Since the dictionary interpretation of the word “conservative” has the meaning of “being old-fashioned, not innovative, backward, not seeking advancement, sticking to the old rules, not being able to accept new things”, some people often think that “conservative therapy” means “being old-fashioned”. Therefore, some people often think that “conservative therapy” means “old-fashioned, not advanced, stereotypical, conservative thinking”, which is actually a misunderstanding of the term “conservative therapy” by these patients. In the use of non-surgical conservative therapy is, should be used in combination with a variety of treatment methods, so as to improve the effectiveness, as soon as possible to alleviate the disease, shorten the course of treatment; at the same time can also reduce the adverse effects of various non-surgical treatments, such as reducing the amount of oral anti-inflammatory painkillers, thereby reducing its gastrointestinal adverse reactions and renal adverse reactions, but also reduce some physical therapy caused by skin pigmentation and other adverse reactions. Conservative treatment methods for cervical spine include the following components.
Oral medication: For patients with mainly neck and shoulder pain, oral anti-inflammatory and analgesic drugs can be taken, supplemented by muscarinic and nerve-nourishing drugs.
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 incorrect phenomenon is gradually changed, but its efficacy is limited and only suitable for mild patients; and traction is prohibited in the acute period to prevent local inflammation and edema from aggravating.
Physical therapy: Physical therapy 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.
Tui Na method: Tui Na method is an important part of Chinese medicine. With only the hands and simple instruments of the tui-na practitioner, different techniques are applied to certain parts of the body or acupuncture points along the route of meridians and the direction of the flow of qi and blood to achieve therapeutic purposes. However, it is forbidden to massage during the acute period or acute attack, otherwise it will aggravate the inflammation and edema of the nerve root and increase the pain. This method is also not recommended for spinal cord type cervical spondylosis.
Acupuncture method: According to the basic theory of Chinese medicine, the occurrence of cervical spondylosis is mostly due to the invasion of wind and cold, disharmony of qi and blood, and inaccessibility of meridians, so the main role of acupuncture in treating cervical spondylosis is to achieve the purpose of relaxing tendons and activating blood through acupuncture. Acupuncture is painful for patients, and some patients even suffer from dizziness and fear of needles; moreover, acupuncture can lead to some complications.
Intervertebral foraminal block (epidural block) and paravertebral sympathetic nerve block: are effective treatment methods, repeated single block or continuous drug injection can receive good results. However, they are not effective for a long period of time, so they must be repeatedly performed to consolidate the effect, and at least 2 to 4 consecutive courses of treatment are required.
Most patients can be relieved after conservative treatment, but if conservative treatment is ineffective, for example, in neurogenic cervical spondylosis, the patient has severe muscle atrophy, which means that the nerves are greatly damaged, and surgery must be performed at this time.
In spinal cord cervical spondylosis, according to the current understanding of this disease, once the diagnosis is confirmed, whether it is mild or severe, early surgery is advocated. If the spinal cord is compressed for a long time, then surgery will affect the efficacy of surgery and cannot be improved effectively.
Surgery for cervical spondylosis includes anterior and posterior decompression surgery, and patients can go down to normal activities the day after surgery.
10.Under what circumstances can a patient with cervical spondylosis not receive surgical treatment
As the old saying goes, “People are sick with many diseases; and doctors are sick with few paths.” Surgery is a double-edged sword, under what circumstances can patients not receive surgical treatment?
(1) The symptoms of cervical spondylosis are mild and do not affect normal life and workers.
(2) Those whose symptoms have disappeared or have been significantly relieved after conservative treatment.
(3) Those who are in poor general condition, have serious metabolic diseases or have obvious organic lesions of major organs and cannot tolerate surgery and anesthesia.
(4) Those with severe disease, more than 2 years of disease duration, severe extremity extensive muscle atrophy, or complete spinal cord dysfunction, MRI shows that the spinal cord has atrophy, cavities and softening foci, and the estimated postoperative efficacy is not good.
(5) Those who have severe neurosis.
(6) Those who have mental illness and cannot actively cooperate with treatment before, during and after surgery.