Mr. Shi, 61, has been suffering from cervical spondylosis for many years, and he used to walk normally with occasional neck pain. When he fell on his face while riding a bicycle, his limbs became numb and he was unable to move on his own. At that time, he was seen in an outside hospital, and no obvious fracture trauma was detected in the head and neck.
After careful examination, it was found that the patient had multiple stenoses in the cervical spinal canal, compressing the spinal cord. This trauma led to a significant aggravation of the cervical spondylosis that had been developing for many years, and the compressed spinal cord had to be completely freed before the sensory and motor functions of the limbs could be restored. After detailed discussion and careful planning by our treatment team, a posterior cervical single-opening spinal canal enlargement and internal fixation surgery was performed. After the surgery, the patient gradually recovered the function of the limbs, and when he came back to the clinic two months later, he had recovered as before. The potential harm of this disease is great, and the patient’s awareness of it is inadequate and erroneous, resulting in delayed treatment.
Slow invisible invasive onset, aggravated by minor trauma leading to serious consequences
People who work with their heads down for a long time or have frequent neck activities, such as office workers, computer operators, teachers, accountants, sewers, drivers, etc., are at high risk for spinal cervical spondylosis. Long-term improper sleep posture such as lying in bed watching TV, reading books, high pillow, sleeping in a sitting position and chronic throat infection are the main reasons for the development of cervical spondylosis. Patients with congenital or developmental cervical spinal stenosis have a one-fold higher incidence of cervical spondylosis than normal people. 50% of spinal cervical spondylosis is related to neck trauma. In some patients, the cervical spinal canal is in a critical state of stenosis due to cervical spine osteophytes, cervical disc bulge, and soft tissue lesions in the spinal canal, and cervical trauma often triggers the symptoms.
Spinal cord type cervical spondylosis refers to cervical spondylotic stenosis or disc degeneration and herniation due to cervical degeneration, bone spurs at the posterior edge of the vertebral body, hypertrophy and calcification of the ligamentum flavum, and calcification of the posterior longitudinal ligament, which protrude into the cervical spinal canal and cause direct compression and stimulation of the cervical spinal cord; or cervical spondylosis characterized by chronic progressive tetraplegia due to ischemic degeneration of a segment of the cervical spinal cord.
The spinal cord is highly tolerant of static chronic compression. In some patients, the spinal cord is obviously compressed and deformed in a depressed manner during physical examinations or MRI for some reason, and the compression is even seen on X-ray to be convex into the spinal canal, reaching about half of the anterior and posterior diameter of the spinal canal, while the patient’s symptoms are quite mild or even asymptomatic. Clearly, dynamic compression factors are also involved in the development of this type of cervical spondylosis. In cervical flexion, the cervical spinal canal is elongated and the spinal cord is elongated and thinned; in posterior extension, the cervical spinal canal is shortened, the cross-sectional area is reduced by 11-16%, and the cervical spinal cord is compressed and thickened. Therefore, on the basis of the pathology of multisegmental cervical spinal stenosis, acute cervical spinal cord injury is easily caused by slight external force during cervical hyperextension or hyperflexion.
The normal cervical spinal canal is smallest at cervical 4 and cervical 5, and since degeneration of the cervical spine first occurs at cervical 5 and cervical 6, degenerative cervical spinal stenosis is most common at cervical 4, 5, and 6 segments. The degenerated disc bulges into the spinal canal and the bone spur at the posterior edge of the vertebral body compresses the spinal cord from the front of the spinal canal, while the posterior ligaments of the cervical spinal canal become hypertrophic and compress the spinal cord via the posterior side of the spinal canal. As a result of the “anterior compression and posterior compression”, the cervical spinal cord is often in a passive state in the spinal canal.
Studies of the natural course of multisegmental spinal cord cervical spondylosis suggest a poor prognosis. In most patients, spinal cord neurological function deteriorates after a period of stable plateauing, with an overall stepwise deterioration. Paraplegia may occur in some patients due to minor trauma such as braking, accidental falls, or even bending over to tie a shoelace.
Unsteady walking and weak grip are precursors
Unsteadiness in walking and weakness in gripping objects are the earliest symptoms of spinal cord cervical spondylosis. Gradually, pain, numbness, stiffness and trembling, and weakness of the lower limbs appear bilaterally or unilaterally, and there is often a feeling of stepping on cotton. In severe cases, the lower limbs spasm, walking difficulties, easy to fall, and even bedridden. The development of the disease can appear bilateral upper limb sensory and motor disorders, such as pain, numbness, soreness, burning sensation, weakness and inflexibility, and even can not do the bowl, button, pencil, chopsticks and other movements. In the late stage, there may be constipation, difficulty in urination, urinary retention or urinary incontinence.
The disease should be considered in middle-aged patients with numbness and motor dysfunction of the limbs, pathological reflex signs, and chronic progressive worsening of symptoms. The diagnosis can be confirmed when the absolute value of sagittal diameter is less than 13 mm; cervical spine MRI shows gourd bead-like changes in the spinal cord, multi-segmental worm-like changes or abnormal high signal in the T2-weighted spinal cord.
Early surgical treatment is the only effective method for multisegmental spinal cord cervical spondylosis
Once multi-segmental spinal cord cervical spondylosis is diagnosed, surgery should be performed as soon as possible to obtain better results. Surgery is less effective in patients with a long preoperative history and more severe symptoms. Patients with delayed surgical treatment have even worse outcomes.
Although some of the compression in multisegmental cervical spondylosis is from the anterior aspect of the spinal cord and anterior cervical decompression is a common surgical approach, anterior surgery alone is not sufficient to completely relieve all compressions on the anterior and posterior aspects of the spinal cord. In cases of cervical degeneration of multiple segments (more than 3 segments) or disc herniation, or in combination with severe spinal stenosis, as well as cervical posterior longitudinal ligament ossification, posterior decompression needs to be performed as a priority. In the past three years, our treatment team has adopted the posterior cervical single-opening canal enlargement and ARCH titanium plate internal fixation, which can preserve the cervical spine plate structure intact and is closer to the physiological state of the cervical spine after surgery.
Misconceptions about spinal cord cervical spondylosis
In clinical practice, many patients have insufficient knowledge and misconceptions about this disease, resulting in many patients not receiving timely and correct surgical treatment.
Misconception 1, that cervical spondylosis cannot be prevented: Many patients mistakenly believe that cervical spine degeneration is an irresistible natural law, but early aging and accelerated aging are abnormal. Many patients’ cervical spondylosis is due to an unhealthy lifestyle, and it is not difficult to prevent it. It is important to do a good job of self-protection and prevention, so as to effectively avoid developing cervical spondylosis.
Myth 2: Traction therapy is feasible for all types of cervical spondylosis: cervical traction is applicable to all types of cervical spondylosis other than spinal cord type. In clinical practice, cases of cervical spine traction treatment for patients with spinal cord type cervical spondylosis aggravate the symptoms and should be taken seriously.
Myth 3: Middle-aged and young people do not get spinal cord cervical spondylosis: It is an indisputable fact that spinal cord cervical spondylosis occurs mostly in the elderly. However, there are more and more young people with cervical spondylosis in hospitals. The pace of life is accelerating, the pressure of work is increasing, and young people often work overtime and bury their heads in computer operations. Cervical spine for a long time to maintain a bad posture, over time prone to spinal cervical spondylosis.
Myth 4: Mistaking spinal cord cervical spondylosis for other diseases: The symptoms of cervical spondylosis are highly variable, and it is reported that about 5% of atypical cervical spondylosis is easily confused with Meniere’s disease, arteriosclerosis, peptic ulcer, neurosis, menopause syndrome and coronary heart disease, hypertension, etc.
Myth 5: Fear of surgery, missing the best time for surgery: Some patients with spinal cord cervical spondylosis repeatedly delay visiting the hospital for fear of surgery, do not listen to the doctor’s advice, and think of the difficulty and risk of surgery, they know the difficulties and retreat. When the condition gradually worsens and they are willing to have surgery, they cannot tolerate the surgery because they are old and suffer from hypertension, diabetes and coronary heart disease at the same time. The more time passes, the more irreversible degeneration occurs in the compressed spinal cord, and even if the patient receives surgery at this time, the recovery effect is generally poor, resulting in lifelong disability.