Cervical spondylosis (cervical spondylosis)
Cervical spondylosis is a condition in which symptoms or signs are caused by the degeneration of the cervical disc and its secondary changes that irritate or compress adjacent tissues such as the spinal cord, nerves, blood vessels and esophagus.
The functional unit of the cervical spine consists of two adjacent vertebral bodies, two synovial joints, two hook joints (also called Luschka joints or hooks) and intervertebral discs. Upper cervical vertebrae C1, C2; lower cervical vertebrae C3-7
Early stage: cervical disc degeneration → loss of proteoglycans and water → degeneration of the annulus fibrosus → herniation of the nucleus pulposus (mostly posteriorly)
Also leads to reactive repair of vertebral body and end plate → subchondral osteosclerosis and osteophytes; disc height ↓ → cervical instability → fibroblasts ↑ → mechanization and ossification → osteophytes of the hook joint (more common in C5-6, C4-5, C6-7); abnormal loading of the synovial joint → cartilage degeneration → traumatic arthritis → cervical pain and limited motion; ligamentous laxity → cervical instability → ligamentous hyperplasia and hypertrophy → spinal canal and intervertebral Foraminal volume ↓
Imaging examination: Although important, it must be combined with clinical, otherwise it cannot be used as a basis for diagnosis alone
Cervical spine X-ray plain film: cervical spine front and side; anterior flexion and posterior extension; double oblique film; cervical spine open mouth position.
MRI or CT plain scan + 3D reconstruction
Classification of cervical spondylosis: nerve root type, spinal cord type, sympathetic type, vertebral artery type and mixed type, etc.
1. Nerve root type: 60-70%, C5/6 and C6/7 are common
Due to cervical degeneration, compression of spinal nerve roots or passive pulling produces neurogenic symptoms; cervical pain occurs due to stimulation of sinus nerve endings; cervical 4 and 5, cervical 5 and 6, and cervical 6 and 7 are the most common; brachial plexus pulling and pressure neck test appears positive, which is manifested as induced radicular pain.
Differentiation from peripheral nerve impingement syndrome: local bony and fibrous impingement nerve factors, while the pressure-causing factors of neurogenic cervical spondylosis are cervical disc herniation, cervical hook joint hyperplasia, etc., which can be identified by imaging analysis and EMG.
2, spinal cord type: accounting for 10% to 15% of cervical spondylosis, the most serious type of cervical spondylosis among all types of symptoms. The arrangement of the pyramidal tract in the spinal cord is from the inside to the outside, in order of nerve fibers to the cervical, upper extremity, thoracic, lumbar, lower extremity and sacral areas. The symptoms vary depending on the location of spinal cord compression. Usually, there are three types.
Central type (upper extremity symptom-based type): The deep part of the pyramidal fasciculus adjacent to the central canal is involved first.
Peripheral type (lower extremity symptom-based type): the conus pallidus is involved first
Anterior central vascular type (extremity symptomatic type): the anterior central artery of the spinal cord is involved
Clinical manifestations include numbness and weakness of the upper or lower extremities, stiffness, and a feeling of stepping on cotton in both feet, etc. Later on, there are frequent urination or difficulty in urination and defecation, etc. On examination, there are planes of sensory impairment, decreased muscle strength, active or hyperactive tendon reflexes of the extremities, and weakened or absent abdominal wall reflexes, testicular reflexes and anal reflexes. Pathological reflexes were positive.
Differential diagnosis.
Amyotrophic lateral sclerosis: the age of onset is mostly around 40 years old, while the age of onset of spinal cord type cervical spondylosis is mostly above 50 years old; the onset is sudden and the disease progresses rapidly, often with muscle weakness changes as the main symptom, usually without sensory impairment; myasthenia gravis is obvious with intrinsic hand muscles, and shoulder and neck muscle atrophy develops from distal to proximal, while shoulder muscle atrophy is rare in cervical spondylosis; sternocleidomastoid and lingual muscles characteristically Sternocleidomastoid and lingual muscles are characteristic, and EMG shows spontaneous potentials in the sternocleidomastoid and lingual muscles
Syringomyelia: chronic degeneration of the spinal cord, with cavity formation, white matter reduction and gliosis in the spinal cord; most often seen in young adults; sensory dissociation often occurs, with loss of pain and temperature sensation and presence of tactile and deep sensation; no pain sensation due to neurotropic disorders in the joints; neurological and traumatic arthritis, called Charcot, with joint bone fragmentation and dislodgmentation, enlarged joint range of motion or abnormal motion. Traumatic arthritis is called Charcot joint; MRI shows the same abnormal signal area in the spinal cord as in the cerebrospinal fluid.
Vertebral body tumor
3. Vertebral artery type: characterized by vertigo attacks caused by cranial rotation
Mechanical compression or segmental → compression or irritation of vertebral artery → narrowing, folding or spasm of vertebral artery → inadequate blood supply to vertebrobasilar artery
Clinical manifestations: migraine, tinnitus, hearing loss or deafness, visual impairment, dysphonia, sudden vertigo, sudden collapse; large number of postganglionic fibers of sympathetic nerves around the vertebral artery → vegetative symptoms, panic, palpitations, cardiac rhythm disturbance, gastrointestinal dysfunction
Differential diagnosis: exclude Meniere’s syndrome, eye muscle disorders with similar symptoms
4, sympathetic type: middle-aged women are more often associated with long-term head down and desk work. More symptoms, less objective signs
Clinical manifestations: neck pain, headache and dizziness; numbness and coldness of the face or trunk, dullness of pain perception; easy sweating or no sweating, palpitations, tachycardia, bradycardia, arrhythmia; tinnitus, hearing ↓ vision ↓ or eye swelling and pain, dryness or lacrimation; memory loss, insomnia and other symptoms
Differentiation: except cardiovascular disease
5.Esophageal compression type: hyperplastic bones compressing the esophagus
6.Mixed type: more than two kinds of compression exist at the same time
Treatment of cervical spondylosis
1.Nerve root type, sympathetic type and vertebral artery type mostly adopt conservative treatment: local braking, traction, physical therapy, blood circulation, etc. to improve circulation, reduce edema and eliminate inflammation.
2, the spinal cord type mostly adopts surgical treatment: anterior (single segment) or posterior (multi-segment) spinal canal expansion decompression and internal fixation, because compression and instability are two indispensable pathogenic factors of cervical spondylosis.