Cervical spondylosis is a common and frequent disease with a prevalence of about 3.8%-17.6% and a male to female ratio of about 6:1. The Second National Symposium on Cervical Spondylosis (Qingdao, 1992) defined cervical spondylosis as a degenerative change of the cervical disc and its secondary pathological changes involving the surrounding tissues (nerve roots, crestal medulla, vertebral artery, sympathetic nerve, etc.) with corresponding clinical manifestations. The cervical spondylosis is defined as degenerative changes of the cervical disc and its secondary pathological changes involving the surrounding tissues (nerve roots, crestal medulla, vertebral artery, sympathetic nerve, etc.) with corresponding clinical manifestations. Degenerative changes of the cervical spine without clinical manifestations are called cervical degenerative changes.
With the increase in the number of people working with their heads down in modern times, such as the widespread use of computers and air conditioners, the chances of people flexing their necks and suffering from wind, cold and dampness are increasing, resulting in a rising prevalence of cervical spondylosis, and the trend of a younger age of onset.
Classification of cervical spondylosis
According to the different tissues and structures involved, cervical spondylosis is divided into: cervical type (also called soft tissue type), nerve root type, crestal medullary type, sympathetic type, vertebral artery type, and other types (currently, it mainly refers to esophageal compression type). If two or more types exist at the same time, it is called “mixed type”.
Cervical cervical spondylosis: Cervical cervical spondylosis is caused by acute and chronic injury to the neck muscles, ligaments and joint capsule, degeneration of the intervertebral disc, instability of the vertebral body, misalignment of small joints, etc. The body is attacked by wind and cold, cold, fatigue, improper sleep posture or inappropriate pillow height, causing the cervical spine to be over-extended or over-flexed, and certain muscles, ligaments and nerves in the neck and collar are stretched 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.
Neurogenic 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. The number of men is one times higher than that of women.
The incidence of cremasteric 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.
Sympathetic cervical spondylosis is caused by factors such as intervertebral disc degeneration and segmental instability, thus causing stimulation of sympathetic nerve endings around the cervical spine and producing sympathetic nerve dysfunction. 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 artery system in addition to the symptoms of several systems in the body.
When a normal person’s 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 instantaneous changes in vertebral artery blood flow and resulting in inadequate blood supply to the vertebrobasilar system, 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 entire shoulder and back, and it is impossible to nod, tilt the head and turn the head, and it is 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, and 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 cervical 3 to cervical 6 transverse process, and with slight pressure, radiating pain in the shoulder, arm and hand can occur.
II. Nerve root type cervical spondylosis
1. Neck pain and stiffness of the neck 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 inspiration 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. Cervical spondylosis of the crestal medullary type
1. Most patients first develop numbness and heaviness in one or both lower limbs, and then gradually develop difficulty in walking, tightness 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 limbs 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, arrhythmias, 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 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.
Diagnostic criteria of cervical spondylosis
I. Clinical diagnostic criteria
1, cervical type: with a typical history of falling pillow and the above-mentioned cervical symptoms and signs; imaging examination can be normal or only have physiological curvature changes or mild spinal space narrowing, with little bone formation.
2, neurogenic type: symptoms (numbness, pain) and signs of radicular distribution; positive intervertebral foramen squeeze test or/and brachial plexus pull test; imaging findings are basically consistent with clinical manifestations; pain due to extra-cervical pathology (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder, biceps long head tenosynovitis, etc.) is excluded.
3.Crestal medullary type: clinical manifestations of cervical crestal medullary damage; imaging shows cervical degenerative changes, cervical spinal canal stenosis, and confirms the presence of cervical crestal medullary compression compatible with clinical manifestations; except for progressive amyotrophic crestal lateral sclerosis, crestal medullary tumor, crestal medullary injury, secondary adhesive arachnoiditis, multiple peripheral neuritis, etc.
4, sympathetic type: the diagnosis is more difficult, and there is a lack of objective diagnostic indicators. Clinical manifestations of sympathetic nerve dysfunction and imaging show segmental instability of the cervical spine are present. In some patients with atypical symptoms, if the symptoms are reduced after planetary ganglion closure or high cervical epidural closure, it will help the diagnosis. Vertigo due to other causes besides.
(1) Otogenic vertigo: vertigo is caused by vestibular dysfunction in the inner ear. For example, Meniere’s syndrome and embolism of the auditory artery in the ear.
(2) Ophthalmogenic vertigo: refractive error, glaucoma and other ophthalmic disorders.
(3) Brain-derived vertigo: inadequate blood supply in vertebrobasilar artery due to atherosclerosis, lacunar cerebral infarction; brain tumor; sequelae of traumatic brain injury, etc.
(4) Vertigo of vascular origin: vertebrobasilar artery insufficiency due to stenosis of V1 and V3 segments of vertebral artery; hypertensive disease, coronary heart disease, pheochromocytoma, etc.
(5) Other causes: diabetes, neurosis, overexertion, long-term sleep deprivation, etc.
(5) Vertebral artery type: previous sudden collapse attack with cervical vertigo; positive spin neck test; imaging shows segmental instability or hook joint hyperplasia; except for other causes of vertigo; positive neck motion test.
II. Imaging and other auxiliary examinations
X-ray examination is an important tool for the diagnosis of cervical spine injury and certain disorders, and is also the most basic and commonly used examination technique for the neck, and is an important examination method that cannot be ignored even under the highly developed conditions of imaging technology.
X-rays provide an imaging basis for determining the severity of the injury, treatment selection, and treatment evaluation. The whole cervical spine frontal and lateral radiographs, cervical extension and flexion dynamic lateral radiographs, oblique radiographs, and cervical 1-2 open radiographs and tomography films are often taken when necessary. Orthopantomographs can be seen as acromegaly or transverse hyperplasia of the hook vertebral joint and narrowing of the intervertebral space; lateral films can be seen as poor compliance of the cervical spine, retroflexion, narrowing of the intervertebral space, formation of bone redundancy at the anterior and posterior edges of the vertebral body, osteosclerosis of the upper and lower edges of the vertebral body (motion endplate), and developmental cervical spinal stenosis; hyperflexion and hyperextension lateral positions can have segmental instability; left and right oblique films can be seen as narrowing and distortion of the intervertebral foramen. Sometimes a high-density striated shadow at the posterior edge of the vertebral body can be seen – ossification of posterior longitudinal ligament (OPLL) of the cervical spine.
Cervical spinal canal measurement: on a lateral cervical spine radiograph, the ratio of the midsagittal diameter of the spinal canal to the midsagittal diameter of the vertebral body is diagnosed as developmental cervical spinal stenosis if it is less than or equal to 0,75 on any of the vertebral segments C3 through C6. Segmental instability is important in the diagnosis of sympathetic cervical spondylosis and is measured: i.e., on a lateral cervical hyperflexion-hyperextension film, the sum of the distance between the point where the extension of the posterior border of the vertebral body line and the inferior border of the slipped vertebral body intersect to the posterior border of the same vertebral body is ≥2 mm; the angle between the vertebral bodies is >11°. CT can show the shape of the spinal canal and the extent of OPLL and the degree of encroachment on the spinal canal; cremasteromyelography with CT examination can CT can show the shape of the spinal canal and the extent of OPLL and its encroachment on the spinal canal; cremasteromyelography with CT can show compression of the dural sac, cremaster and nerve roots.
MRI of the neck, on the other hand, can clearly show the changes within the spinal canal, the internal changes of the crestal medulla, as well as the sites and morphological changes of the crestal medulla compression, which is of great value for the diagnosis of cervical spine injury, cervical spondylosis and tumor. When the cervical intervertebral disc degenerates, its signal intensity also decreases, and the diagnosis of disc herniation can be accurately made in both the sagittal and cross-sectional planes. In the diagnosis of cervical spine diseases, magnetic resonance imaging can not only show the extent and degree of cervical fracture and disc herniation compressing the dural crestal sac backward, but also reflect the pathological changes after crestal medullary injury. Intramural hemorrhage or substantial damage to the crestal medulla generally appears as a dull and gray image on T2-weighted images. In contrast, crestal medullary edema often appears as a uniformly dense striated or pyknotic signal.
Transcranial color Doppler (TCD), DSA, and MRA can probe basilar artery blood flow and intracranial blood flow in the vertebral artery and presume vertebral artery ischemia, which is an effective means of examining inadequate blood supply to the vertebral artery and is a common test for clinical diagnosis of cervical spondylosis, especially vertebral artery cervical spondylosis. Vertebral arteriogram and vertebral artery “ultrasound” can be helpful in diagnosis.
Treatment of cervical spondylosis
The treatment of cervical spondylosis is divided into surgical and non-surgical.
Most patients with cervical spondylosis have excellent results through non-surgical treatment, and only a small percentage of patients need surgery because non-surgical treatment is ineffective or the condition is serious. I. Non-surgical treatment Currently, it is reported that 90-95% of patients with cervical spondylosis are cured or relieved by non-surgical treatment. At present, non-surgical treatment mainly adopts comprehensive therapies such as Chinese medicine, Western medicine, combination of Chinese and Western medicine and rehabilitation treatment, and Chinese medicine treatment means combined with Western medicine such as anti-inflammatory and analgesic, vasodilator, diuretic and dehydrating, and nerve-nourishing drugs.
I. Traditional Chinese medicine treatment
1, Chinese medicine evidence-based treatment: Chinese medicine evidence-based treatment: should be the basic method of classification and evidence-based medicine.
(1) Cervical cervical spondylosis: it is appropriate to dredge the wind and relieve the surface, disperse the cold and ventilate the ligaments, commonly used Gui Zhi plus Ge Gen Tang (Gui Zhi, Paeonia, Licorice, Ginger, Jujube, Ge Gen) or Ge Gen Tang (Ge Gen, Ma Huang, Gui Zhi, Paeonia, Ginger, Jujube, Licorice), accompanied by throat inflammation, plus Yuan Shen, Pan Lan Gen, Jin Yin Hua, etc.
(2) neurogenic cervical spondylosis: divided into: pain-oriented, partial stasis blocking cold condensation, it is appropriate to dispel blood stasis and open the ligaments, commonly used in body pain and remove blood stasis soup (Angelica sinensis, Chuanxiong, myrrh, peach kernel, Qiangwu, safflower, Wu Lingliang, Gentiana, aromatic herb, cow’s knee, Di Long, roasted grass); such as partial damp-heat, it is appropriate to clear heat and dampness, with angelica fever soup (Angelica sinensis, Dang Shen, bitter ginseng, Cang X, Bai X, Sheng Ma, Fang Ji, Qiang Wu, Ge Ge Ge, Zhi Mu, pig ling, Yin Chen If accompanied by numbness, add spasm stopping powder (centipede, whole scorpion) to the above formula.) If numbness is predominant and accompanied by muscle atrophy, take the method of benefiting qi, resolving stasis and opening up the ligaments, and commonly use the formula of tonifying yang and returning to the fifth soup (astragalus, angelica, Chuanxiong, peony, peach kernel, safflower, di dragon) plus centipede and whole scorpion.
(3) vertebral artery type cervical spondylosis, divided into: dizziness with headache, blood stasis is appropriate to remove blood stasis and pass through the ligaments, dampness and calm the liver, commonly used in Blood Mansions and Stasis Soup (angelica, Chuanxiong, red peony, raw earth, peach kernel, safflower, cow knee, Chai Hu, Citrus aurantium, orris, licorice); partial phlegm and dampness, appropriate Han Xia Bai Zhu Tian Ma Tang (Han Xia, Bai Zhu, Tian Ma, Fu Ling, Chen Pi, licorice, jujube) and so on. Dizziness and head distension like wrapping, drowsiness, mouth pain, insomnia, is bile-stomach disharmony, phlegm-heat internal disturbance, it is advisable to regulate qi and resolve phlegm, clear bile and stomach, commonly used in warming bile soup (Radix et Rhizoma Polygoni, Poria, Pericarpium Citri Reticulata, Citrus aurantium, Glycyrrhiza glabra). For dizziness, fatigue and weakness, with a less florid complexion, it is advisable to benefit Qi and transform dampness, commonly used in Yi Qi Smart Tang (Astragalus, Radix Codonopsis, Radix Paeoniae Alba, Phellodendron, Radix et Rhizoma, Radix et Rhizoma Glycyrrhizae).
(4) Cervical spondylosis of the crestal medullary type: increased muscle tone and a feeling of girdling in the chest and abdomen are taken to dispel blood stasis and open the internal organs, using Fuyuan and invigorate blood soup (rhubarb, Chai Hu, red flowers, peach kernel, angelica, smallpox powder, piercing sorrel, roasted licorice). If the lower limbs are weak and the muscles are atrophied, take the method of tonifying the middle and benefiting the qi and nourishing the spleen and kidneys, Dihuang Drink (Radix et Rhizoma Polygonati, Gui Zhi, Cistanches, Cornu Cervi Pantotrichum, Radix Rehmanniae, Bacopa Monnieri, Acorus Calamus, Yuan Zhi, Dendrobium, Poria, Mai Dong, Wu Wei Zi) combined with Sheng Gui Tang (Astragalus, Radix Codonopsis, Radix Angelicae Sinensis, Radix Paeoniae Alba, Chuan Xiong, Radix Rehmanniae, Chai Hu).
Sympathetic cervical spondylosis has more symptoms, so it is appropriate to treat the symptoms according to the condition.
2.Therapeutic method of Chinese herbal medicine: Chinese herbal medicines with different effects such as promoting qi and dispersing stasis, warming the meridians and dispersing cold, relaxing tendons and activating the channels or clearing heat and detoxifying the toxins are made into different dosage forms and applied to the relevant parts of patients with cervical spondylosis. The common treatment methods of external treatment of cervical spondylosis Chinese medicine include teng medicine, compress medicine, spray medicine, etc.
3.Tui na and orthopedic manipulation: it has the function of adjusting the internal organs, balancing yin and yang, promoting the generation of qi and blood, activating blood circulation and eliminating blood stasis, promoting tissue metabolism, releasing muscle tension, and managing tendon reset. The basic techniques include massage, kneading, pointing, pressing and wrenching.
Special emphasis is placed on the fact that massage must be carried out by a medical professional. Cervical spondylosis manipulation should be gentle and not violent. Patients with vertebral artery type and crestal medullary type should not apply posterior joint manipulation. It is difficult to exclude lesions such as tumors in the vertebral canal, developmental stenosis of the vertebral canal, crestal medullary compression symptoms, bony destruction of the vertebral body and attachments, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occiput, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is prohibited.
4, acupuncture therapy: including acupuncture and moxibustion method. Acupuncture is the use of refined metal needles into certain parts of the body, with appropriate techniques to stimulate, while moxibustion is the use of moxa or moxa cones ignited and smoked acupuncture points for stimulation, through stimulation to achieve the adjustment of the human meridian organs qi and blood function, prevention and treatment of disease.
Second, rehabilitation treatment
1.Physical factor therapy: The main function of physical factor therapy is to dilate blood vessels, improve local blood circulation, release the spasm of muscles and blood vessels, eliminate inflammation and edema of nerve roots, crestal pulp and surrounding soft tissues, reduce adhesions, regulate the function of vegetative nerves, and promote the recovery of nerve and muscle functions. Commonly used treatment methods.
(1)Direct current ion introduction therapy Commonly used with various western drugs (glacial acetic acid, VitB1, VitB12, potassium iodide, nufcaine, etc.) or traditional Chinese medicine (Wu Tou, Wei Ling Xian, Safflower, etc.) placed on the back of the neck, connected to the anode or cathode according to the performance of the drug, opposed or diagonally opposed to another electrode, each time electrified for 20 minutes, applicable to all types of cervical spondylosis.
(2) Low-frequency modulated medium-frequency electrotherapy
Generally, IF electricity of 2000Hz-8000Hz is used as the carrier frequency, and low frequency electricity of different waveforms (square wave, sine wave, triangle wave, etc.) of 1-500Hz is used as the modulating waveform, which is modulated in different ways and compiled into different prescriptions. The prescriptions are selected according to different conditions, and the electrodes are placed in the same way as DC. Each treatment generally lasts 20-30 minutes and is suitable for all types of cervical spondylosis.
(3) Ultrashort wave therapy Treatment with ultrashort wave of wavelength about 7m. Generally, two medium-sized electrode plates are used, which are placed behind the neck and the extensor side of the forearm of the affected limb, or monopolar placed behind the neck. In the acute stage, no heat is applied once a day for 12 to 15 minutes, and in the chronic stage, micro heat is applied for 15-20 minutes each time. 10-15 times is a course of treatment. Suitable for nerve root type (acute phase) and cremasteric type (cremasteric edema phase).
(4) Ultrasonic therapy Ultrasonic therapy machine with a frequency of 800kHz or 1000kHz, sound head in close contact with the skin of the neck, moving along the vertebral space and the paravertebral area, intensity with 08 ~ 1W/cm2, hydrocortisone cream can be used as a contact agent, once a day, 8min each time, 15-20 times a course of treatment. For the treatment of crestal medullary cervical spondylosis. Ultrasound frequency as above, sound head moving along both sides of the neck with two supraganglial fossa, intensity 08～1,5W/cm2, 8-12min each time, the rest as above, used for the treatment of neurogenic cervical spondylosis.
(5) ultrasonic conductivity targeting transdermal drug delivery treatment Using ultrasonic conductivity instrument and ultrasonic conductivity gel patch, transdermal drug selection 2% lidocaine injection. The patch was first fixed in the treatment transmitter head of the instrument, and 1 ml of prepared lidocaine injection was added to the two coupling gel patches respectively, and then the patch was fixed to the front of the patient’s neck together with the treatment transmitter head. The treatment parameters were selected as conductivity 6, ultrasound intensity 4, frequency 3, treatment time 30 minutes, once a day, 10 days as a course of treatment. It is used to treat vertebral artery type and sympathetic nerve type cervical spondylosis.
(6) High potential therapy Using high potential therapy instrument, the patient sits on the plate electrode or treatment seat with the foot on the insulating pad, and each treatment lasts 30-50 minutes. It can be used for all types of cervical spondylosis, among which sympathetic cervical spondylosis has the best effect.
(7) Light therapy
Ultraviolet therapy: the back of the neck on the flat hairline down to the second thoracic vertebra, the amount of erythema (3-4 biological amount), once every other day, 3 times a course of treatment, together with ultra-short wave treatment of nerve root type acute stage. Infrared therapy: various infrared instruments are available, behind the neck irradiation, 20 ~ 30min / time. Used for soft tissue type cervical spondylosis, or with cervical traction therapy (infrared therapy before cervical traction).
(8) Other therapies: such as magnetic therapy, electrical excitation therapy, audio electrotherapy, interference electrotherapy, wax therapy, laser irradiation and other treatments are also frequently used in the physical therapy of cervical spondylosis, and the proper choice can achieve certain results.
2.Traction therapy: Cervical traction is a common and effective method for treating cervical spondylosis. Cervical traction helps to release the muscle spasm of the neck, relax the muscles and relieve the pain; release the soft tissue adhesions, stretch the contracted joint capsule and ligaments; improve or restore the normal physiological curvature of the cervical spine; increase the intervertebral foramen and relieve the stimulation and compression of the nerve roots; enlarge the vertebral space and reduce the pressure in the intervertebral disc. Adjust the microscopic abnormal changes of the small joints, so that the synovial membrane of the joint embedment or the misalignment of the synovial joint can be reset; the three main elements of the direction (angle) of traction force, weight and traction time must be mastered when cervical spine traction treatment is carried out in order to obtain the best therapeutic effect of traction.
(1) traction mode: commonly used occipito-maxillary band traction method, usually using sitting traction, but the condition is heavy or can not sit traction horizontal traction. Continuous traction, intermittent traction or a combination of both can be used.
(2) traction angle: generally according to the lesion site, such as lesions mainly in the upper cervical segment, traction angle should be 0-10 °, such as lesions mainly in the lower cervical segment (neck 5-7), traction angle should be slightly forward, can be between 15-30 °, while pay attention to the combination of patient comfort to adjust the angle.
(3) Traction weight: the weight of intermittent traction can be determined by 10%-20% of its own body weight, and continuous traction should be reduced appropriately. Generally, the initial weight is light, such as 6 kg to start, and then gradually increase.
(4) traction time: traction time to continuous traction 20 minutes, intermittent traction is 20-30 minutes is appropriate, once a day, 10-15 days for a course of treatment.
(5) precautions: individual differences should be fully considered, the elderly and frail people should traction weight lighter, traction time shorter, young and strong can hold heavier and longer; traction process should pay attention to observe and ask the patient’s reaction, such as discomfort or aggravation of symptoms should immediately stop traction, find the cause and adjust, change the treatment plan.
(6) traction contraindications: traction after there is obvious discomfort or symptoms aggravated, after adjusting the traction parameters still no improvement; crestal marrow pressure is obvious, segmental instability is serious; aging vertebral joint degeneration is serious, spinal canal is obviously narrow, ligament and joint capsule calcification ossification is serious.
3.Manipulation therapy: manipulation therapy is one of the important means of cervical spondylosis treatment, based on the anatomical and biomechanical principles of the cervical vertebrae and joints as the basis of treatment, for its pathological changes, the crestal vertebrae and small joints of the crestal vertebrae are pushed, pulled, rotated and other techniques for passive activity treatment, in order to adjust the anatomical and biomechanical relationship of the crestal vertebrae, while the muscles and soft tissues related to the crestal vertebrae are loosened and smoothed to improve The aim is to improve joint function, relieve spasm and reduce pain.
Commonly used methods are Chinese and Western techniques. Chinese techniques refer to the traditional Chinese massage and tui-na techniques, which generally include bone and joint repositioning techniques and soft tissue massage techniques. Western-style techniques commonly used in China include McKenzie (Mckenzie) method, joint loosening (Maitland technique), crestal spine correction (chiropractic) and so on.
It should be especially emphasized that manipulation of cervical spondylosis must be performed by trained medical professionals. Manipulation should be controlled according to individual conditions, as gentle as possible, and should not be violent. It is difficult to exclude lesions such as tumors in the vertebral canal, developmental stenosis of the vertebral canal, crestal medullary compression symptoms, bony destruction of the vertebral body and accessories, ossification of the posterior longitudinal ligament or cervical deformity, acute inflammation of the pharynx, larynx, neck and occiput, obvious neurosis, and in cases where the diagnosis is unknown, the use of any massage and orthopedic manipulation is cautiously used or prohibited.
4.Exercise therapy: Exercise therapy for cervical spine refers to the use of appropriate exercise for the neck and other related parts as well as the whole body. Exercise therapy can enhance the muscle strength of the neck, shoulder and back muscles, stabilize the cervical spine, improve the function of the joints between the vertebrae, increase the range of motion of the cervical spine, reduce nerve stimulation, reduce muscle spasm, eliminate pain and other discomfort, correct abnormalities or deformities in the alignment of the cervical spine, and correct poor posture. Long-term adherence to exercise therapy can promote the body’s adaptation to the compensatory process, thereby achieving the purpose of consolidating the therapeutic effect and reducing recurrence.
Cervical spine exercise therapy is commonly used in the form of freehand exercises, stick exercises, dumbbell exercises, etc. Mechanical training is also available when available. Types usually include cervical spine flexibility exercises, cervical muscle strength training, cervical spine correction training, etc. In addition, there are whole-body exercises such as running, swimming, ball games, etc. are also common therapeutic exercises for cervical spine disorders. Patients with cervical spondylosis can be instructed to adopt the “Neck and shoulder disease exercise prescription”. Exercise therapy is suitable for patients with all types of cervical spondylosis in remission and post-operative recovery. The specific methods and approaches vary according to different types of cervical spondylosis and different individual physiques, and should be carried out under the guidance of a specialist.
5.Orthopedic brace application: Orthopedic brace of cervical spine is mainly used for fixing and protecting cervical spine, correcting abnormal mechanical relationship of cervical spine, reducing neck pain, preventing over-extension, over-flexion and over-rotation of cervical spine, avoiding further damage to crestal medulla and nerve, reducing crestal edema, reducing traumatic reaction of intervertebral joint, helping repair of tissues and relief of symptoms, and cooperating with other treatment methods at the same time, can consolidate the therapeutic effect and prevent recurrence.
The most commonly used are cervical enclosures and cervical braces, which can be applied to patients in the acute stage or with severe symptoms of all types of cervical spondylosis. Cervical braces are also used for patients with cervical fractures and dislocations who still have intervertebral instability or subluxation after early treatment. Wearing a neck brace for protection is necessary when riding in high-speed cars and other means of transportation, whether with or without cervical spondylosis. However, unreasonable long-term use should be avoided as it may lead to cervical muscle weakness and poor cervical mobility.
Regardless of that type of cervical spondylosis, the basic principle of its treatment is to follow the basic principle of non-surgical treatment first and then surgery after it is ineffective. This is not only because of the pain and injury and complications associated with surgery itself, but more importantly because the majority of cervical spondylosis itself can be stopped, improved or even cured through non-surgical treatment. Unless there are a few cases with clear indications for surgery, regular non-surgical treatment should be started and continued for 3 to 4 weeks, which is generally effective. For individual cases with progressive development (mostly crestal cervical spondylosis), it is necessary to make an immediate decision and perform surgery as early as possible.
II. Surgical treatment
The main purpose of surgical treatment is to relieve the serious pressure on the crestal medulla or blood vessels caused by disc herniation, bone superfluity formation or ligament calcification, and to rebuild the stability of the cervical spine. Once cervical spondylosis of the crestal medulla is diagnosed, it should be actively treated by surgery if the non-surgical treatment is ineffective and the condition is getting aggravatedf; if the symptoms of cervical spondylosis of the nerve root type are heavy, affecting the patient’s life and work, or if there is muscle movement disorder; if the conservative treatment is ineffective or the efficacy is not consolidated and other types of cervical spondylosis have recurrent attacks, surgery should be considered. The indications for minimally invasive treatment (myelolysis, percutaneous aspiration, PLDD, radiofrequency ablation, etc.) must be strictly mastered.
The surgical procedure is divided into anterior cervical approach and posterior cervical approach.
1.Anterior cervical surgery: the anterior cervical approach is used to remove the diseased disc and posterior bone spur and to insert bone between the vertebral bodies. The advantage is that the crestal medulla is directly decompressed and the cervical spine is permanently stabilized after fusion of the bone graft. The use of titanium plates for internal fixation at the same time as the bone graft can improve the fusion rate of the bone graft and maintain the physiological curvature of the cervical spine. Indications for anterior discectomy interbody bone graft fusion surgery: nerve root or crestal medullary ventral compression due to disc herniation or bony bulge in 1-2 segments; segmental instability. Bone graft material can be autologous iliac bone, allogeneic bone, artificial bone such as hydroxyapatite, calcium phosphate, calcium sulfate, coral ceramic, etc. The intervertebral fusion device (Cage) has the function of maintaining the intervertebral height, enhancing local stability, and improving the fusion rate. At the same time, due to its advantages of low incision, it can significantly reduce the postoperative foreign body sensation in the pharynx and swallowing difficulties, and the special iliac bone extraction device can achieve minimally invasive bone extraction. For isolated OPLL; limited spinal stenosis, etc., subtotal laminectomy, large intervertebral bone graft, and titanium plate internal fixation can be used. If the titanium cage is filled with autologous bone (resected vertebral body) and the titanium plate is internally fixed, bone retrieval can be avoided. For patients with mild intervertebral joint degeneration and no significant narrowing of the intervertebral space, artificial disc replacement can be performed after removal of the diseased disc.
2.Posterior approach surgery: the cervical spinal canal is enlarged through the posterior cervical approach so that the crestal medulla can be decompressed. The commonly used procedures are single-opening and double-opening spinal canal enlargement. Indications for surgery: cervical spondylolisthesis with developmental or multi-segmental degenerative spinal stenosis; multi-segmental OPLL; cervical ligamentous hypertrophy or ossification resulting in ventral and dorsal compression of the crestal medulla. Those with segmental instability can also perform lateral titanium plate screws or internal fixation via pedicle screws and bone graft fusion.
3.Rehab therapy The rehabilitation therapy in the “perioperative period” of cervical spondylosis is conducive to consolidating the efficacy of surgery, making up for the deficiency of surgery, and relieving the local and systemic trauma brought about by surgery, so as to achieve the purpose of restoring the physical and mental health of patients. The basic method of perioperative treatment is inseparable from the rehabilitation medical treatment of cervical spondylosis (such as traditional Chinese medicine, physical therapy, sports therapy, hyperbaric oxygen, etc.), and cannot ignore some new pathological factors, such as the mental burden of anxiety and panic brought to patients by surgery, as well as the trauma of surgery and postoperative weakness. The “cervical spine rehabilitation and health care work” is used for the prevention and supplementary treatment of cervical spine disease, and can be planned to be extended to the community, reflecting the academic idea of rehabilitation and prevention.
4.Efficacy assessment
The Japanese Orthopedic Society has formulated the criteria for assessing the function of the crestal medulla for patients with cervical crestal disease (referred to as the 17-point method), which has been accepted by international scholars. According to China’s national conditions, the corresponding standard (referred to as the 40-point method) has also been formulated and has been promoted and applied in China.
Prevention of cervical spondylosis
It is almost inevitable that degenerative changes occur in the cervical intervertebral discs as we grow older. However, if attention is paid to avoiding some factors that promote degenerative changes of the intervertebral disc in life and work, it will help prevent the occurrence and development of cervical degenerative changes.
First, the correct understanding of cervical spondylosis, establish confidence to overcome the disease.
The course of cervical spondylosis is relatively long, the degeneration of the intervertebral disc, the growth of bone spurs, ligament calcification, etc. is related to ageing and aging of the body. The disease is often recurrent, and the symptoms may be heavy during the attack, affecting daily life and rest. Therefore, on the one hand, we must eliminate the fear of pessimism, and on the other hand, we must prevent the mentality of getting by and giving up active treatment.
Second, regarding rest.
Patients with acute attacks or first attacks of cervical spondylosis should pay proper attention to rest, and those with serious conditions should even take bed rest for 2-3 weeks. From the perspective of cervical spondylosis prevention, it is better to choose a bed that is conducive to the stability of the disease and to maintain the balance of the crest column. The position, shape and material of the pillow should be selected, and a good sleeping position is also needed to maintain the physiological curvature of the entire crest column and to make the patient feel comfortable, so as to relax the muscles of the whole body and adjust the physiological state of the joints.
Third, on health care.
1, the exercise of medical sports health care exercises: without any symptoms of cervical spondylosis, you can perform slow flexion, extension, left and right lateral flexion and rotation of the neck several times a day in the morning and evening. Strengthen the cervical back muscle isometric resistance contraction exercise. It is significant for cervical spine patients to quit smoking or reduce smoking to relieve their symptoms and recover gradually. Avoid overexertion resulting in recurrent inflammation of the throat, avoid excessive weight bearing and human vibration and thus reduce the impact on the intervertebral disc.
2, avoid long-term low posture: to avoid prolonged low work, banking and accounting professionals, office ambulatory work, computer operations and other personnel, this position so that the neck muscles, ligaments are strained for a long time and strain, prompting the cervical disc degeneration. Change the position after about 1 hour of work. Change the bad work and life habits, such as lying in bed reading, watching TV, etc.
3, the neck is placed in the physiological state of rest: the general adult neck padding about 10 centimeters higher is better, high pillow so that the neck is in a flexed state, the result is the same as the low head posture. When lying on the side, the pillow should be raised to the height of the head does not appear lateral flexion.
4, to avoid neck trauma: take a car to go out should wear a good seat belt and avoid sleeping in the car, so as to avoid injury to the cervical spine due to relaxation of the neck muscles when the emergency brake. When neck, shoulder and arm pain occurs, after a clear diagnosis and excluding cervical spinal stenosis, a gentle massage is feasible, avoiding overly heavy rotation techniques to avoid damage to the intervertebral disc.
5, avoid wind and cold, humidity: summer attention to avoid fans, air conditioners blowing directly to the neck, do not blow cold wind directly after sweating, or rinse the head and neck with cold water, or sleep on a cool pillow.
6, pay attention to adolescent cervical spine health: with the intensification of the competitive pressure of adolescent schooling, long hours of reading and studying have caused great harm to the cervical spine health of the majority of adolescents, resulting in the trend of cervical spondylosis at a younger age. It is recommended that in primary and secondary schools and even universities, vigorously promote health care knowledge about the cervical spine, educate students to establish awareness of cervical spine health care, pay attention to cervical spine health, establish the concept of scientific learning and healthy learning, and intercept cervical spondylosis at the source.