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Abstract: Neurogenic cervical spondylosis is a common cervical spondylosis that is characterized by signs and symptoms of radicular compression or irritation due to degenerative changes of the cervical intervertebral discs and intervertebral joints themselves and their secondary pathological changes involving the cervical nerve roots of the corresponding segments. In this paper, we present a case of a female, 50 years old, who, after being afflicted by the disease for 7 months, went to the hospital and recovered well with relief of symptoms after cervical traction, as well as 2 weeks of pharmacological treatment.
Basic information】Female, 50 years old
Disease Type】Cervical spondylosis (neurogenic cervical spondylosis)
Hospital】The First Hospital of China Medical University
Date of consultation】April 2022
Treatment plan】Surgery (cervical traction) + medication (ibuprofen extended-release capsule, diclofenac sodium enteric dissolved tablet, vitamin B complex tablet, methylcobalamin tablet, mannitol injection)
Treatment period】Inpatient treatment for 2 weeks, long-term follow-up
Treatment effect] The patient’s symptoms were relieved and he recovered well
I. Initial consultation
The patient developed numbness and pain in the neck and upper extremities with no obvious cause 7 months ago, accompanied by decreased grip strength in both hands, mainly on the left side. There was no headache, dizziness, nausea, vomiting, unconsciousness, abdominal pain, or numbness in the lower limbs bilaterally. CT examination of the cervical spine was performed in the outpatient clinic, and the results showed that C4/5 and C5/6 discs were herniated and the cervical spine was degenerative. The patient was admitted to our department for treatment of cervical disc herniation, and the preliminary diagnosis was “cervical radiculopathy”. Since the onset of the disease, the patient was clear and mentally competent, and had a good diet and no urinary or fecal incontinence.
II. Treatment history
After admission, the patient completed physical examination and orthopedic examination. The results showed that the physiological curvatures of the spine were normal, there was no scoliosis, no pressure pain in the cervical spine, good movement of the cervical spine, no painful allergy and tenderness in the skin of the forearm, wrist and back of the hand bilaterally, and the extent of the patient’s condition was clear. After communication with the patient, treatment was carried out for the patient, starting with cervical traction to increase the intervertebral foramen and intervertebral space and adjust the direction of cervical vertebral alignment, which could alleviate the degree of numbness in the neck and upper limbs to a certain extent. The patient is also given pain-relieving drugs such as ibuprofen extended-release capsules and diclofenac sodium enteric soluble tablets to relieve the patient’s pain. In addition, vitamin B complex tablets and methylcobalamin tablets should be taken to nourish the nerves and repair the damaged nerves in the neck, while mannitol injection should be used to eliminate nerve edema.
III. Treatment effect
Before treatment, the patient had numbness and pain in the neck and left upper limb, accompanied by decreased grip strength of both hands, and CT examination of cervical spine: C4/5 and C5/6 intervertebral disc protrusion. The pain was gradually reduced after admission with ibuprofen extended-release capsules and diclofenac sodium enteric dissolved tablets. After performing cervical traction and taking vitamin B complex tablets and methylcobalamin tablets for 2 weeks, the symptoms of spinal cord compression were relieved, and the symptoms of numbness in the neck and upper limbs and decreased grip strength of both hands began to gradually return to normal, and the CT examination was repeated: C4/5 and C5/6 discs returned to normal position.
IV. Precautions
The patient’s condition improved after treatment and he could work and live normally, I was also sincerely happy for the patient.
1.After the patient finished the treatment, I advised him to strengthen the management of the neck posture and correct the bad habits, such as playing with the cell phone with the head down, working with the desk for a long time, sleeping on a high pillow, etc.
2, pay attention to the neck warmth, according to the seasonal changes in a timely manner to increase or decrease clothing, to protect the neck, to avoid cold.
3, appropriate outdoor physical exercise, pay attention to mastering the correct exercise methods to avoid strain on the neck muscles.
4.Cervical spondylosis is common in middle-aged and elderly people, so it is recommended that patients adhere to regular physical examination after discharge to know whether there are neck lesions.
V. Personal insight
Cervical spondylosis occurs in middle-aged and elderly people, and the initial onset of the disease is mostly characterized by neck pain and stiffness, and with the progress of the disease, numbness, weakness and limitation of activities of the limbs will appear. People at risk for the disease should insist on regular medical checkups to obtain a clear diagnosis at an early stage of the disease and take treatment to effectively inhibit the development of the disease. As in the case of the patient in this article, targeted treatment was carried out 7 months after the onset of the disease. Early detection and treatment can largely reduce the patient’s pain and improve his or her quality of life.