Sympathetic cervical spondylosis is a disease in which the sympathetic nerves in the neck are stimulated and excited or inhibited by factors such as degeneration of the cervical spine or trauma, and manifest a variety of symptoms. Precisely because the clinical manifestations of sympathetic cervical spondylosis are complex and diverse, mostly subjective symptoms, and lack of specific objective indicators for diagnosis, the diagnosis of sympathetic cervical spondylosis is more difficult to determine. Zhang Qiang, Department of Orthopedics, Beijing Ditan Hospital 1, symptoms and signs In general, sympathetic cervical spondylosis is characterized by many complaints but few objective signs, and a variety of symptoms. In the case of middle-aged female patients, the symptoms are attributed to menopausal syndrome or neurosis, thus delaying diagnosis and treatment. The first category is sympathetic excitatory symptoms, which are more common, and the second category is sympathetic inhibitory symptoms, which are less common. 1.1 Sympathetic excitatory symptoms ① Head symptoms: headache and migraine, the site of pain is mainly located in the occipital or forehead, and the nature is dull pain. Sometimes it is accompanied by dizziness, which is not aggravated when turning the neck. Patients often complain of mental confusion and drowsiness, and some even have memory loss; some patients also have nausea and vomiting. The symptoms are mostly triggered by overwork and poor sleep. ② Symptoms of the five senses: eye swelling and pain, dryness, blurred vision, or even blindness, dilated pupils and enlarged eye fissures. Throat discomfort or foreign body sensation. Tinnitus, hearing loss or deafness. Slurred pronunciation, or even loss of voice. (iii) Peripheral vascular symptoms: cold and fearful of cold limbs, there may be little sweating on one limb, tingling sensation or numbness and pain when cold. Local skin temperature is reduced, pain and temperature sensation are normal. ④ Cardiac symptoms: transient tachycardia and elevated blood pressure, arrhythmia, and pain in the precordial region. ⑤ Blood pressure abnormalities: hypertension. (6) Sweating abnormalities: excessive sweating, mostly on the head, face, neck, hands, feet, and one side of the trunk. (7) Sphincter symptoms: bladder detrusor diastole, sphincter contraction, difficult or incomplete urination, constipation. 1.2 Sympathetic inhibition symptoms ① Head symptoms: dizziness and dullness. ② Five sensory symptoms: droopy eyelids, sunken eyes, narrow pupils, lacrimation, nasal congestion, salivation. ③ Peripheral vascular symptoms: redness and swelling of the fingertips, or burning sensation, fear of heat and preference for cold, and burning sensation in the chest and back. ④ Cardiac symptoms: bradycardia. ⑤ Blood pressure abnormalities: hypotension. (6) Abnormal sweating: no sweating or little sweating, more at night or in the morning. ⑦ Sphincter symptoms: urinary frequency, urinary urgency, or diarrhea. 1.3 Signs The objective signs of sympathetic cervical spondylosis are few. In general, stiffness and pressure pain can be found in the sphenoid process, the pars transversus muscle and the suprascapular region in the neck. The flexion test and brachial plexus pull test may be positive. 2, auxiliary examination 2.1 Imaging examination The imaging changes of sympathetic cervical spondylosis have no obvious features, and the general degenerative changes of cervical spine are common. Cervical spine X-ray examination can reveal different degrees of cervical spine osteophytes, degenerative changes, or narrowing of the vertebral space, vertebral instability, especially C3 to 4, C4 to 5 are the more common vertebral segment instability, and changes such as calcification of the anterior and posterior longitudinal ligaments and straightening of the physiological curvature. However, some patients may not show any abnormalities on x-ray. 2.2 Laboratory tests of sympathetic nerve function At present, laboratory tests of sympathetic nerve function are less commonly used in clinical practice and are useful for diagnosis. ① Sympathetic vasoconstrictor reflex (SVR) Some scholars use SVR to show sympathetic nervous system activity. The rationale is that performing a deep inspiration excitation test can cause a brief sympathetic response and skin vasoconstriction. Also, some scholars used laser multispectral flowmetry to measure skin blood flow at the ends of two fingers. Data were taken at a frequency of 20 Hz. The ratio of blood flow changes after deep inspiration was calculated using laboratory software. ② Sympathetic skin response (SSR) SSR is used to measure sympathetic nerve activity. It can be used in patients with spinal cord injury, cervical spondylosis, and spinal stenosis to assess abnormalities in their sympathetic nervous system function. However, SSR wave amplitude can be affected by the number of intermediate nerve fibers that are effectively excited. SSR is a valuable test that provides objective information about the sympathetic nervous system. Latency is a stable component of SSR, while wave amplitude is variable and can be adaptively attenuated by frequent stimulation, and the bilateral latency difference and wave amplitude ratio are relatively stable. ③ Muscle sympathetic nerve activity (MSNA) The electrical activity of the peroneal nerve was recorded directly with a tungsten microelectrode in the right N fossa in the supine position. Sympathetic nerve function was observed using skin blood flow changes. Blood flow changes were recorded in the right ear with a laser multispectral flowmeter. The basic wave, a regular periodic activity of the cutaneous vessels 5-10 times in 1 min, was recorded with a stylus or recorder. It is a reflection of the automatic movement of blood vessels due to sympathetic nerve activity), while blood flow is recorded every 10 s with a digital tracer. Changes in sympathetic nerve activity indirectly cause changes in blood flow through changes in the cyclic activity of the underlying waves. 3. Diagnosis of sympathetic cervical spondylosis: Sympathetic cervical spondylosis lacks specific auxiliary tests to make a clear diagnosis, and there are no exact criteria for diagnosing sympathetic cervical spondylosis. Cervical spine X-ray is the most important examination tool, but some other diagnostic tools are needed because the degree of lesion it shows is mostly not parallel to the clinical symptoms. In fact, a significant proportion of outpatients with sympathetic cervical spondylosis with headache, dizziness, blurred vision, tinnitus or tachycardia are misdiagnosed as neurological or internal medicine diseases, which directly affects the treatment outcome. According to current clinical experience, the following principles can be followed for diagnosis: ① Sympathetic excitation symptoms or sympathetic inhibition symptoms ② There are mostly no obvious signs, and some patients may have slight discomfort when flexing, extending or rotating the neck. ③ X-ray shows cervical degeneration or narrowing of the intervertebral space and vertebral instability, especially C3 to 4 and C4 to 5 are the more common segments of vertebral segment instability. However, some patients may show no abnormalities on x-ray. ④ Excluding organic lesions of the brain, eyes, ears and heart with symptoms similar to sympathetic cervical spondylosis, such as glaucoma, Meniere’s syndrome, as well as neurosis and menopausal syndrome. ⑤ Laboratory tests of sympathetic nerve function include sympathetic constrictor reflex (SVR), sympathetic skin response (SSR), and muscle sympathetic nerve electrical activity (MSNA), and sympathetic nerve function is observed using changes in skin blood flow as an indicator. (6) The diagnosis of sympathetic cervical spondylosis is also supported by diagnostic treatments such as cervical stellate ganglion block, high epidural capsular closure and cervical braking, if effective.