According to the different tissues and structures involved, cervical spondylosis is divided into: cervical type (also called soft tissue type), nerve root type, spinal cord type, sympathetic type, vertebral artery type, and other types (currently mainly referring to the esophageal compression type). If two or more types exist at the same time, it is called “mixed type”.
I. Cervical cervical spondylosis
Cervical cervical spondylosis is caused by acute or chronic injury to the neck muscles, ligaments and joint capsule, degeneration of the intervertebral disc, instability of the vertebral body and misalignment of the small joints, etc. The body is attacked by wind and cold, cold, fatigue, improper sleeping posture or inappropriate pillow height, which makes the cervical spine over-extend or over-flex, and certain muscles, ligaments and nerves in the neck are strained or compressed. It mostly develops at night or in the morning, and has the tendency of natural remission and recurrent attacks. 30-40 years old women are more common.
Nerve root type cervical spondylosis
Neurogenic cervical spondylosis is caused by irritation and compression of cervical nerve roots in the spinal canal or intervertebral foramen due to disc degeneration, herniation, segmental instability, osteophytes or bone redundancy formation. It has the highest incidence among all types, accounting for about 60-70%, and is the most common type in clinical practice. Mostly unilateral and single-root onset, but there are also bilateral and multi-root onset cases. It is most common in people aged 30-50 years and usually has a slow onset, but there are also cases with acute onset. There are more males than females by a factor of one.
C. Spinal cord type cervical spondylosis
The incidence of spinal cord cervical spondylosis accounts for 12-20% of cervical spondylosis and has a high disability rate because it can cause limb paralysis. It usually starts slowly and is more common in middle-aged people aged 40-60. When combined with developmental cervical spinal stenosis, the average age of onset is younger than that of patients without spinal stenosis. Most patients have no history of cervical trauma.
IV. Sympathetic cervical spondylosis
Sympathetic nerve dysfunction arises due to factors such as disc degeneration and segmental instability, which cause stimulation of sympathetic nerve endings around the cervical spine. Sympathetic cervical spondylosis has a wide range of symptoms, most of which are sympathetic excitation symptoms and a few are sympathetic inhibition symptoms. Since the surface of the vertebral artery is rich in sympathetic nerve fibers, when sympathetic nerve dysfunction occurs, the vertebral artery is often involved, resulting in abnormal diastolic function of the vertebral artery. Therefore, sympathetic cervical spondylosis is often accompanied by inadequate blood supply to the vertebrobasilar system along with symptoms of several systems in the body.
V. Vertebral artery type cervical spondylosis
In normal people, when the head is tilted or twisted to one side, the vertebral artery on the same side is squeezed and the blood flow of the vertebral artery is reduced, but the vertebral artery on the opposite side can compensate, thus ensuring that the blood flow of the vertebrobasilar artery is not greatly affected. When segmental instability and narrowing of the intervertebral space occur in the cervical spine, the vertebral artery can be distorted and compressed; the vertebral artery can be compressed directly by the vertebral edges and the bony bulge at the hook vertebral joint, or the sympathetic nerve fibers around the vertebral artery can be stimulated, causing spasm of the vertebral artery and instantaneous changes in vertebral artery blood flow, resulting in inadequate blood supply to the vertebrobasilar system and symptoms, so that there are no symptoms outside the vertebral artery system.
Clinical manifestations of cervical spondylosis
I. Cervical cervical spondylosis
1, cervical straightness and pain, there may be pain and stiffness in the whole shoulder and back, unable to nod, tilt the head, and turn the head, in a sloping neck position. When the neck needs to be turned, the trunk must be turned at the same time, and the symptoms of dizziness may also appear.
2. A few patients may have reflex shoulder, arm and hand pain, swelling and numbness, and the symptoms do not worsen when coughing or sneezing.
3.Clinical examination: In the acute stage, the cervical spine activity is absolutely limited, and the range of motion of the cervical spine in all directions is nearly zero. There is pressure pain in the cervical paraspinal muscles, thoracic 1 to thoracic 7 paraspinal or rhomboid muscles, sternocleidomastoid muscles, and there may also be pressure pain in the supraspinatus and infraspinatus muscles. If there is secondary spasm of the anterior oblique muscle, the spastic muscle can be found on the medial side of the sternocleidomastoid muscle, which is equivalent to the level of the transverse process of cervical 3 to cervical 6, and with slight pressure, radiating pain in the shoulder, arm and hand can occur.
Second, nerve root type cervical spondylosis
1. Neck pain and neck stiffness are often the earliest symptoms. Some patients also have pain in the shoulder and the medial edge of the scapula.
2.Radiation pain or numbness in the upper extremities. This pain and numbness radiates along the course and innervation area of the affected nerve root and is characteristic, hence the term root-type pain. The pain or numbness can be episodic or persistent. Sometimes there is a clear relationship between the appearance and relief of symptoms and the position and posture of the patient’s neck. Neck movement, coughing, sneezing, exertion and deep breathing can cause aggravation of symptoms.
3. The affected upper extremity feels heavy, has reduced grip strength, and sometimes appears to hold objects falling down. There may be vasomotor nerve symptoms, such as swelling of the hand. Muscle atrophy can occur in the late stage.
4. Clinical examination: neck stiffness and restricted movement. Tension in the affected neck muscles, pressure pain in the spinous process, paraspinal process, medial edge of the scapula and muscles innervated by the affected nerve roots. The presence of pressure pain in the intervertebral foramina with radiating pain or numbness in the upper extremities, or aggravation of existing symptoms, has localizing significance. A positive intervertebral foramen crush test and a positive brachial plexus nerve pull test are indicated. Careful and comprehensive neurological examination can help localize the diagnosis.
C. Spinal cord type cervical spondylosis
1. Most patients first experience numbness and heaviness in one or both lower limbs, and then gradually experience difficulty in walking, tightening of various groups of muscles in the lower limbs, slow lifting and inability to walk fast. Then, when going up and down the stairs, it is necessary to hold the puller with the upper limb to ascend the steps. In severe cases, the gait is unstable and walking is difficult. Patients have the feeling of stepping on cotton in both feet. Some patients start insidiously, often trying to catch a bus that is about to leave, but suddenly find that their legs cannot walk fast.
2. Numbness and pain in one or both upper limbs, weakness and inflexibility in both hands, difficulty in completing fine movements such as writing, fastening, holding chopsticks, etc., and easy to drop objects. In severe cases, the patient cannot even eat by himself.
Patients often feel a belt-like binding sensation in the chest, abdomen, or both lower limbs, called “belt sensation”. At the same time, there may be burning and cold sensation in the lower extremities.
4. Some patients have bladder and rectal dysfunction. Such as weak urination, frequent urination, urgent urination, incomplete urination, urinary incontinence or urinary retention and other urinary disorders, constipation. Sexual function is reduced.
Further development of the disease, the patient must be crutches or with the help of others to walk, until the emergence of spastic paralysis of both lower limbs, bedridden, unable to take care of their own lives.
5. Clinical examination: There are no physical signs in the neck. The upper extremities or trunk have segmental distribution of superficial sensory disorders, deep sensation is normal, muscle strength is reduced, and grip strength of both hands is reduced. The muscle tone of the extremities is increased, and there may be a sense of folding knife; tendon reflexes are active or hyperactive: including biceps, triceps, radial membrane, knee tendon, Achilles reflex; patellar clonus and ankle clonus are positive. Positive pathological reflexes: such as Hoffmann’s sign, Rossolimo’s sign, Barbinski’s sign and Chacdack’s sign in the upper limbs. Superficial reflexes such as abdominal wall reflex and tic reflex are diminished or absent. If the tendon reflexes of the upper extremity are diminished or absent, it suggests that the lesion is at the level of that nerve segment.
IV. Sympathetic cervical spondylosis
1. Head symptoms: such as dizziness or vertigo, headache or migraine, head sinking, occipital pain, poor sleep, memory loss, difficulty in concentration, etc. Occasionally, people may fall down due to dizziness.
2. Eye, ear, nose and throat symptoms: eye swelling, dryness or tearfulness, vision changes, blurred vision, fog in front of the eyes, etc.; tinnitus, ear blockage, hearing loss; nasal congestion, “allergic rhinitis”, foreign body sensation in the throat, dry mouth, vocal cord fatigue, etc.; taste changes, etc.
3, gastrointestinal symptoms: nausea or even vomiting, bloating, diarrhea, indigestion, belching and foreign body sensation in the throat, etc.
4.Cardiovascular symptoms: palpitations, chest tightness, heart rate changes, arrhythmia, blood pressure changes, etc.
5. Excessive sweating, no sweating, chills or fever on the face or a certain limb, sometimes pain and numbness but not according to the distribution of nerve segments or travels.
The above symptoms are often clearly related to neck activities, aggravated when sitting or standing, and alleviated or disappeared when lying down. It is obvious when there are many neck activities, prolonged head bowing, long working hours in front of computer or exertion, and improves after rest.
6.Clinical examination: the neck activity is normal, and the soft tissue around the interspinous process of the cervical spine or the paravertebral small joints is painful. Sometimes it may also be accompanied by changes in heart rate, heart rhythm, blood pressure, etc.
V. Vertebral artery type cervical spondylosis
1. Episodic vertigo with diplopia accompanied by nystagmus. Sometimes it is accompanied by nausea, vomiting, tinnitus or hearing loss. These symptoms are related to the change in the position of the neck.
2.Sudden weakness of lower limbs and sudden collapse, but consciousness, mostly occurs when the head and neck are in a certain position.
3. Occasionally, there is numbness and abnormal sensation in the limbs. Transient paralysis and episodic coma may occur.