Cervical spondylosis refers to the degeneration of the cervical spine disc itself and its secondary series of pathological changes (such as destabilization and loosening of the vertebral joint, nucleus pulposus protrusion or prolapse, bone spur formation, ligamentous hypertrophy and secondary canal stenosis, etc.), which stimulate or compress the adjacent nerve roots, spinal cord, pushing pulse and cervical sympathetic nerve and other tissues, and cause a variety of symptoms and signs of syndromes. This disease is also called cervical spine syndrome.
Clinical manifestations
1.Cervical cervical spondylosis Cervical cervical spondylosis is the lightest type of cervical spondylosis and is also the most common and easy to diagnose. Patients are mostly young adults, and the first onset may occur after the age of 45.
Patients often complain that they do not know where to place their head and neck, and about half of them have limited neck movement or are forced to be in a certain position, and individual patients may have transient sensory abnormalities in the upper limbs, which are generally reduced after lying down and aggravated in standing or sitting position.
2.Nerve root type cervical spondylosis
Nerve root type cervical spondylosis is more common and mainly involves neck stubbornness, restricted movement, radiating pain and numbness of the upper limbs. Root pain is brought to the attention of the patient at the early stage of onset, so the patient seeks medical attention early and the treatment is also effective, and about 90% of the patients can heal themselves.
3.Spinal cord type cervical spondylosis
Most of the symptoms of spinal cord cervical spondylosis are serious, and most of them develop in a “recessive” form, and most of them gradually appear after middle age with hand and foot sensory disorders and muscle weakness. It is usually a sudden fall or a “electric shock reaction” that attracts attention. Typical manifestations are weakness, stiffness and numbness of the limbs, unstable walking, high muscle tone, hyperreflexia, which may lead to pathological reflexes, and some have urinary and fecal disorders.
4.Vertebral artery type cervical spondylosis
Vertebral artery cervical spondylosis is a series of symptoms caused by the dysfunction of the vertebral artery due to external compression or stimulation. The onset of vertebral artery cervical spondylosis can be sudden, and there are no symptoms, but when the neck is turned in a certain direction, vertigo is immediate, and even dizziness is felt.
5.Mixed type of cervical spondylosis
There are more than two kinds of symptoms mentioned above.
[Psychological guidance
Patients with cervical spondylosis all have different degrees of spinal cord function damage, and because of the special surgical site, they are afraid that the operation will affect speech, eating, unsatisfactory postoperative effect and pain, etc. They are prone to psychological reactions such as fear, anxiety, pessimism, etc. Therefore, care should be provided for the psychological reactions of patients.
(1) Explain the necessity of surgery to the patient and family members.
(2) Ask patients cured of cervical spondylosis to communicate with them about the absence of pain during surgery, the duration of postoperative pain and methods of pain relief, and precautions, so that patients are fully psychologically prepared to cooperate with treatment.
(3) Explain the relationship between emotion and disease and explain that a good psychological state will promote the recovery and healing of the organism, otherwise the opposite, in order to obtain a positive and optimistic attitude of cooperation from the patient.
【Dietary guidance
1, cervical anterior surgery patients due to intraoperative stretching of the esophagus and trachea, most patients postoperative swallowing obstructive feeling, pain, affecting the feeding and postoperative nutrition. Patients are advised to eat a small amount of warm water 4h after surgery, and if there is no choking and coughing, they can eat a small amount of liquid diet, such as rice soup and fish soup, to reduce congestion and edema in the pharynx. Those who eat less can take intravenous rehydration to promote wound healing and enhance the body resistance. For 3 days after surgery, abstain from eating sweets, milk and other gas-producing foods to avoid abdominal distension. Avoid dry and hard, spicy and stimulating food to avoid accidents.
2.Reasonable tower with diet
Food is generally divided into two categories: one is the main food, mainly to provide heat, such as rice, noodles, belong to this category of food; the other category of food, can regulate physiological functions, called side dishes, such as beans, fruits and vegetables, etc.. The nutrients contained in the main and side dishes are different, so you can’t have a single partial diet. The main and secondary, coarse and fine, dry and thin with the overall nutrition can meet the needs of the body, to promote the recovery of patients and maintain the normal human body needs award.
3.Eating for the symptoms
Should be rich in calcium, protein, vitamin D, vitamin C and vitamin E diet, where calcium is the main component of bone, with milk, fish, pig tail bone, soybeans, black beans and other content for more. Protein is also an indispensable nutrient for the formation of ligaments, bones and muscles. Vitamins B and E can relieve pain and fatigue.
4, diet in moderation
Diet should be moderate, do not overeat.
Rest and activity guidance]
1.Pre-operative guidance
Patients can move appropriately before the operation, and carry out preoperative training at the same time.
(1) Intraoperative postural training: patient supine, shoulder pillow, so that the neck is posterior extension and braking, the beginning of training, 10-30 minutes / time, gradually increase to be able to adhere to 1 to 2 hours a time.
(2) Tracheoesophageal pull training: use one finger to pull the tracheoesophagus to the side of the non-surgical incision, the other hand to assist in pushing, pulling to make the tracheoesophagus over the median line, pulling time each time to adhere to 10-20 minutes, gradually increase to be able to tolerate 30-60 minutes / times, generally in the 3-5 days before surgery to start practice. Be careful not to use too much force to avoid edema and pain in the throat. At the same time, it is necessary to prohibit smoking, take good care of the mouth, and do not eat irritating food to prevent choking and coughing during the operation. For those who are fat and have a short neck, it is more difficult to push and the time should be extended appropriately. Patients who are unable to push themselves can teach their family members to assist.
(3) Pre-operative endurance training: perform limb exercises in bed, mainly for upper and lower limb extension and flexion, lifting and hand and foot activities, 10-20 minutes/time, 3-5 times/day.
(4) Defecation exercises in bed: postoperative cervical spondylosis requires bed rest, so preoperative adaptive exercises should be performed, i.e., practice defecation in bed.
(5) Bladder training.
(1) suprapubic region tapping method: use fingers to tap the suprapubic region to cause contraction of the detrusor muscle and produce urination; (2) breath-holding method: lean forward, breathe rapidly for 3 to 4 times, then take a deep breath and hold it, and force the defecation action downward until urination.
2.Postoperative instruction
(1) Postoperative bed rest for 1 to 3 days, and get out of bed under the guidance of the physician.
(2) lying position guidance: supine pillow should not be too high, lateral lying head can be slightly elevated, shoulder and head the same height; after postoperative open door, pay attention to the neck can not be padded pillow, can be padded pillow behind the pillow. When lying on the side, put a soft pillow on the back of the waist and between the legs, so that the patient can lie in a comfortable position.
(3) Turning: instruct family members to assist in turning, a thin pillow can be padded under the head, the shoulder is the same height as the head, so that the neck and trunk to maintain a straight line does not deviate in any direction, in the form of rolling blanket turning, that is, one hand holding the patient’s shoulder, the other hand holding the waist, another person to support the patient’s head and neck, two people at the same time evenly force, along with the trunk at the same time rolling, pay attention to the spine can not be twisted, a straight line rolling turning.
3.Limb function exercise
(1) Massage the gastrocnemius muscle of both lower limbs from bottom to top, 2-3 times/day. 30 minutes/time on the day after surgery.
(2) active functional exercise of the limbs: hand function exercises, spinal cord type spinal cord compression injury, can cause interphalangeal muscle paralysis, resulting in finger together and grip strength disorders, so the main exercise hand pinch and grip function. Methods: ① thumb to finger exercises; ② hand fist and then force to extend the finger; ② finger exercises abduction, such as paper clamping fingers; ④ knead turning stone balls or walnuts; ⑤ pinch rubber balls or wringing towels, 20-30 minutes / time, 3-5 times / day.
(3) Walking exercises: postoperative walking activities can be done under the protection of the neck brace, and the activity time should not be fatigued.
Common complications prevention care guidance
1. Upper respiratory tract obstruction and swallowing difficulty
(1) Patients should quit smoking before surgery, and those who have respiratory diseases should be treated actively and given anti-infection and cough and sputum treatment.
(2) Preoperative tracheal nudge training.
(3) Keep the respiratory tract unobstructed after surgery: take more deep breaths, encourage patients to cough and cough up sputum effectively, and when sputum is sticky and not easy to cough up, ultrasonic nebulized inhalation is feasible to humidify the airway, while strengthening turning and buckling the back, and electric aspiration when necessary. Instruct patients to eat correctly, mainly cold liquid, and gradually transition to semi-liquid and general food.
2.Supraglottic nerve injury
(1) Pay attention to the clinical symptoms after supraglottic nerve injury, such as choking and coughing when the patient eats liquid or drinks water.
(2) When nursing, instruct the patient to abstain from liquid diet until choking and coughing is restored, a small amount of soft solid food such as steamed bread and rice can be given according to the situation, and instruct the patient to chew and swallow slowly, and notify the doctor in time. Generally, choking symptoms disappear and swallowing function returns to normal within 3 weeks after surgery.
3.Returning laryngeal nerve injury
(1) The patient’s voice should be correctly assessed after surgery, and the patient should be greeted promptly after awakening from anesthesia and voice changes should be noted. Transient hoarseness is usually temporary. Dexamethasone 5mg can be given by adding 10ml of saline to ultrasonic nebulized inhalation twice daily to reduce symptoms.
(2) Instruct the patient in vocal training, starting with simple letters or individual words, such as
”a”, “o” to promote the patient’s voice recovery
4.Cervical hematoma
(1) Routinely prepare a tracheotomy kit after anterior cervical surgery, and closely observe the patient’s breathing and incision, blood circulation and sensory movement of the extremities for 24 hours after surgery, especially for 12 hours.
(2) Observe the blood leakage from the incision dressing, keep the wound drainage tube continuously open, and observe the amount and nature of drainage fluid.
(3) Listen to the patient’s complaints. If the patient feels labored breathing, observe the pressure and swelling of the incision, much blood leakage from the incision dressing, thickening of the neck, excessive drainage fluid and bright red color, active bleeding should be considered, promptly notify the doctor and actively deal with it. In mild cases, the hematoma can be absorbed by itself with the application of hemostatic drugs. In severe cases, the incision suture should be removed immediately, and hematoma debridement and effective hemostasis should be performed.
5. Cerebrospinal fluid leakage
After surgery, the amount, color, and nature of the wound drainage fluid should be closely observed. If it changes from dark red bloody fluid to light red or yellow cool fluid, the patient should be alerted to the occurrence of cerebrospinal fluid leakage, and the doctor should be notified immediately, and the patient should be given a flat position with the neck braked. The drainage device is changed to positive pressure drainage or extubated. If the patient has symptoms of dizziness, nausea and vomiting, elevate the end of the bed 30~45 degrees, give a head-low-foot-high position, input balanced fluid and apply antibiotics to prevent infection as prescribed by the doctor, supplement albumin, prevent coughing and coughing up sputum to avoid increasing cerebrospinal fluid outflow.
Examination guidance]
1.Test examination of cervical spine
(1) Forward flexion and rotation test: make the patient’s neck flex forward and ask it to rotate to the left and right. If there is pain in the cervical spine, it indicates degenerative changes in the small joints of the cervical spine.
(2) Intervertebral foramen compression test (pressure top test): make the patient’s head tilt to the affected side, the examiner’s left palm on the top of the patient’s head, the right hand clenched fist lightly tapping the left hand back, then there is radiating pain or numbness in the limbs, indicating that the force downward transmission to the intervertebral foramen becomes smaller, there is radicular damage; for those with severe radicular pain, the examiner with both hands overlapping on the top of the head, intermittent pressure, can induce or exacerbate the symptoms. A positive pressure test when the patient’s head is in a neutral or posterior extension position is called a positive Jackson head press test.
(3) Brachial plexus pull test: the patient lowers his head, the examiner holds the patient’s head and neck with one hand and the wrist of the affected limb with the other hand, pushing and pulling in the opposite direction to see if the patient feels radiating pain or numbness, which is called the Eaten test. If pulling and then forcing the affected limb for internal rotation, it is called the Eaten strengthening test.
(4) Upper limb posterior extension test: the examiner places one hand on the shoulder of the healthy side to play a fixed role, and the other hand holds the wrist of the affected limb and makes it gradually stretch backward and outward to increase the pulling on the cervical nerve root, if the affected limb has radiating pain, it indicates that the cervical nerve root or brachial plexus has been compressed or injured.
2.X-ray examination of cervical spondylosis
About 90% of normal men over 40 years old and women over 45 years old have bone spurs in the cervical vertebrae. Therefore, if there are changes in X-ray plain film, there may not be clinical symptoms.
3.Electromyography examination of cervical spondylosis
4.CT examination of cervical spondylosis
Discharge guidance]
1.Protect the neck brace for 3 months after surgery to prevent excessive neck activities. Keep the collar clean and dry. Prohibit heavy physical labor for six months, choose a pillow of moderate height, maintain the normal physiological bending of the neck and spine, avoid long-term suspension, flexion or supination of the neck, and change the position frequently.
2.Continue hand function exercise, the same method as after surgery, and make limb and neck massage, and further practice finer activities, such as writing, needlework, knitting sweater, etc.
3.Maintain the correct posture and move the neck once every hour after a long ambulation time.
4.In daily life, pay attention to keeping the neck warm, cold and damp, keep the neck straight, avoid sitting for a long time, and do squatting or knee bending when picking up things. Keep your pillow at a suitable height when you sleep.
5.After the clinical healing of the cervical implant block, start to carry out functional exercise of the neck, method: rotate the neck back and forth and left and right, the neck muscles must be under tension when rotating, not too relaxed, 15-30 minutes/day.
6, vertebral artery type cervical spondylosis, when changing position, it is forbidden to tilt the head back and turn the head sharply to prevent the vertebral artery from being compressed and accidents occur.
7.Use the interphalangeal muscle of the hand to hold the head backward and forward respectively, head and hand confrontation, 10 minutes / time, 3 / day.
8.Guiding the patient to improve life skills exercises
Instruct patients to adapt to the status quo, and when they have difficulty in fine hand movements, to avoid using chopsticks and eat with a spoon instead; to avoid wearing buckles and wear buckled clothes instead; to avoid wearing lace-up shoes and wear shoes without laces instead.
9. Follow the doctor’s instructions and go to the hospital for follow-up after discharge. Go to the hospital promptly when abnormalities occur.