I. Definition: cervical degenerative disc degeneration and its secondary degenerative intervertebral joint degeneration caused by damage to the spinal cord, nerves and blood vessels and the corresponding symptoms and signs. Cervical spondylosis is divided into: neurogenic, spinal cord, vertebral artery, sympathetic, mixed and other types according to the involvement of different tissue structures and the corresponding clinical manifestations. Clinical manifestations and diagnosis: (a) neurogenic cervical spondylosis 1. symptoms: the main symptom is radicular nerve pain, neck and shoulder pain with pain and numbness in one or both upper limbs, the pain is radiating, the pain can be aggravated by neck activity, coughing and sneezing, radicular muscular dysfunction can occur, there can be increased muscle tone in the early stage, but soon it will be weakened. 2. signs: collar spasm and neck stiffness can occur in the neck, and pain in the upper limbs can be detected. Nociceptive hypersensitivity or hyperalgesia in the area of distribution of the damaged nerve roots, muscle strength weakening or atrophy. The biceps and triceps tendon reflexes are weak or absent. The nerve root pull test (Eaton test) and intervertebral foraminal compression test (Spurling test) are positive. 3. Imaging manifestations: X-ray lateral films show reduced or absent physiological anterior convexity of the cervical spine, hyperplasia of the anterior or posterior edge of the vertebral body, narrowing of the intervertebral space; orthopantomographs sometimes show hyperplasia of the hook vertebral joint; bilateral oblique films show narrowing of the intervertebral foramen, deformation and hyperplasia of the synovial joint, etc. CT can show MRI can exclude disorders with clinical manifestations similar to cervical spondylosis in the spinal cord or spinal canal.3. Diagnosis: symptoms of neck and shoulder pain and upper limb radiological pain or numbness, consistent with the involved segment, pressure pain in the paravertebral and corresponding areas, positive nerve root pull test and intervertebral foraminal compression test, and radiographs showing 4. Differential diagnosis: thoracic outlet syndrome, nerve sheath tumor, ulnar neuritis, carpal tunnel syndrome, and myofasciitis of the back of the collar. (2) Spinal cord type cervical spondylosis 1. Symptoms: numbness and weakness of the limbs, starting with bilateral or unilateral numbness, sinking, stiffness, and weakness of the legs in the lower limbs, followed by difficulty walking, inability to walk fast, uncoordinated limb movements, and a feeling of stepping on cotton wool in both feet. Gradually, the gait develops into staggering, unstable walking, and increased muscle tone, which may lead to spastic paralysis. As the disease progresses, fine movements such as writing, holding chopsticks and tying buttons become difficult. A small number of patients exhibit intermittent claudication of spinal origin.2. Signs: The main manifestation of patients with spinal cervical spondylosis is upper motor neuron damage. Increased muscle tone in the extremities, there may be muscle spasms, physical examination may reveal active or even hyperactive tendon reflexes in the extremities, positive ankle twinge and patellar twinge, pathological reflexes are mostly positive, and unilateral positive Hoffman’s sign is more meaningful, which is an important sign of spinal cord compression. The abdominal wall reflexes may be weakened or disappear. 3, imaging manifestations: X-ray cervical physiological anterior curvature more straight or disappear, vertebral degeneration, power position can be found in the affected segment intervertebral instability. ct can visually reflect the degenerative disc protrusion and vertebral body posterior edge bone encroachment on the spinal canal. mri can clearly show the spinal cord morphology and its relationship with its compressor, can also reflect the changes in spinal cord degeneration. 4, diagnosis. Signs and symptoms of slowly progressive cervical spinal cord damage, increased muscle tone, hyperactive tendon reflexes, appearance of pathological reflexes, imaging showing cervical degeneration and signs of spinal cord compression.5. Differential diagnosis: amyotrophic lateral sclerosis, spinal cord cavernosity, spinal cord tumor, spinal cord vascular malformation. (3) Vertebral artery cervical spondylosis 1. Clinical manifestations: vertigo attacks are caused by head and neck activities, especially head and neck rotation, and episodic vertigo is the characteristic of this disease. Vertebral arteriogram, especially dynamic vertebral arteriogram, has reference value for the diagnosis of vertebral artery cervical spondylosis.3. Diagnosis: History of episodic dizziness related to neck rotational activities, physical examination can induce vertigo by rotating the neck, cervical degeneration hook joint hyperplasia and intervertebral instability can be seen on X-ray, vertebral arteriogram has reference value for the diagnosis.4. Differential diagnosis: ophthalmogenic vertigo, otogenic vertigo, inner ear Drug intoxication, cerebral atherosclerosis, positional vertigo, neurosis. (4) Sympathetic cervical spondylosis 1. Clinical manifestations: mainly sympathetic nerve dysfunction, sympathetic nerve excitation can appear head symptoms: headache, dizziness, occipital pain. Eye symptoms: eye soreness, dryness, post-ocular pain, blurred vision and decreased visual acuity. Cardiac symptoms: tachycardia, irregular heart rate, precordial pain or high blood pressure. As well as tinnitus, hearing loss, sensory disturbances in the head, neck, face and limbs, and excessive sweating. Sympathetic nerve suppression symptoms are mainly dizziness, bradycardia, low blood pressure, enhanced gastrointestinal motility, lacrimation, nasal congestion, etc. 2. Diagnosis: Patients have many complaints and few objective signs, and it is especially important to exclude other diseases when determining the diagnosis of the disease. Surgical treatment of cervical spondylosis (a) Indications for surgical treatment 1. progressive development of spinal cord and nerve root compression and impaired nerve function. 2. other types of cervical spondylosis for which non-surgical treatment is ineffective. (2) The purpose of surgical treatment: 1. to release the spinal cord and nerve compression, save the residual function of the spinal cord, and stop the progression of the disease; 2. to restore the intervertebral height and the physiological curvature of the normal cervical spine; 3. to rebuild the stability of the affected segment of the cervical spine. (3) Principles of surgical treatment 1. direct and complete removal of cervical spinal cord compression, restoration of normal spinal cord morphology and effective spinal canal volume. 2. restoration of normal cervical spine sequence, reconstruction of cervical spine physiological curvature and intervertebral height. 3. adequate and effective bone grafting and immediate stabilization after bone grafting to obtain firm bony fusion. 4. short segmental fixation as much as possible to maximize the preservation of cervical spine functional units. (4) Short segment fixation as possible to maximize the preservation of functional units of the cervical spine. (D) Surgical methods 1. Anterior approach surgery: Smith-Robinson method, Cloward method, Bailey-Badgley method, subtotal vertebral body resection. 2.Posterior approach surgery: cervical laminectomy spinal canal decompression, cervical canal enlargement and molding (single door canal enlargement and molding, double door canal enlargement and molding) 3.Cervical anterior and posterior combined surgery. (E) the application of cervical spine surgery internal fixation 1, cervical interbody fusion device (cervical CAGE) with threaded hollow cylindrical CAGE, anatomical CAGE. 2, anterior cervical spine plate. 3.Posterior cervical lateral block screw plate. 4.Artificial intervertebral disc of cervical spine.