Cervical spondylosis is a syndrome, also known as cervical spine syndrome. It is common in middle and old age. It is a comprehensive set of symptoms stimulated or caused by the gradual degenerative changes of the human cervical intervertebral discs, cervical spine osteophytes, or changes in the normal physiological curve of the cervical spine. It is also said to be a series of clinical symptoms caused by degenerative changes in the cervical spine and its surrounding soft tissues, resulting in damage to the neurovascular spinal cord, etc. These patients often feel numbness in the head, neck, shoulders and arms in the light case, and in the heavy case, it can lead to weakness of the limbs and even incontinence and paralysis.
Causes of cervical spondylosis
1, cervical degenerative changes: with the development of different stages of age, the cervical spine and intervertebral disc can undergo different changes, and while degenerative changes occur in the cervical vertebral body, the intervertebral disc also undergoes corresponding changes.
2, trauma factors: on the basis of intervertebral disc degeneration, strenuous activity or uncoordinated movement.
3, chronic strain: long-term poor labor posture, the intervertebral disc is subject to strain, extrusion or twisting from a variety of sources.
4, cold, moisture: especially on the basis of intervertebral disc degeneration, affected by cold, moisture factors, can cause local muscle tension increase, muscle spasm, increase the pressure on the intervertebral disc, causing damage to the fibrous ring.
Clinical typing of cervical spondylosis
Degenerative changes of the cervical disc tissue and its secondary pathological changes involve the surrounding tissue structures (nerve roots, spinal cord, vertebral artery, sympathetic nerve, etc.), and the corresponding clinical manifestations appear. For those who only have degenerative changes of the cervical spine without corresponding clinical manifestations, they should be called cervical degenerative changes.
1, nerve root type: there is often a history of trauma, prolonged ambulatory work and improper sleep posture. The main manifestations are restricted neck activities and pain in the neck and shoulder. The upper cervical spine lesion is characterized by pain in the cervical spine, radiation to the occipital area, and sensory disturbance or skin numbness in the occipital area. The lower cervical spine lesion has pain in the neck and shoulder and may radiate to the forearm, and the fingers show numbness and pain with nerve root distribution. It can also be accompanied by headache, dizziness, blurred vision, tinnitus and other manifestation symptoms, and the examination can see that the neck movement is restricted, and there are pressure points along the spinous process, paraspinous process or along the inner edge of the shoulder swelling bone.
2.Spinal cord type: It is caused by the stimulation or compression of sympathetic nerve fibers by the protrusion of cervical vertebrae, which reflexively causes spasm of spinal cord blood vessels and ischemia and produces the symptoms of spinal cord damage. It is manifested as neck and shoulder pain accompanied by numbness of limbs, weakening of strength or difficulty in walking. In severe cases, tetraplegia, urinary retention and bedridden may develop. Physical examination reveals insignificant restriction of neck movement. The distal limbs often have irregular sensory disturbances, hyperactive tendon reflexes, increased muscle tone and pathological reflexes
3. Vertebral artery type: mainly headache, dizziness, vertigo, and even quenching. Sometimes there may be nausea, tinnitus, deafness and blurred vision.
4.Sympathetic type: Most of them have mild symptoms of nerve tip irritation such as neck and shoulder pain. It manifests as dizziness, headache, head sinking, migraine, blurred vision, tinnitus, deafness, arrhythmia; regional numbness of limbs or face, abnormal sweating and other manifestations.
5.Mixed type: When two or more types exist at the same time, it is called mixed type.
Common symptoms of cervical spondylosis
The symptoms of cervical spondylosis are intricate and complex. The main symptom is neck and shoulder pain radiating to the head and occipital region and upper limbs, a few have vertigo, fall, or fever and abnormal sweating on one side of the face, and in severe cases, the activities of both lower limbs are affected, or even paraplegia. Specifically, patients may have stiffness, stiffness, pain, limited neck movement, heavy shoulders and back, hardened muscles, upper limb weakness, numbness of fingers, reduced skin sensation of limbs, and sometimes unconscious falling of objects in hands; some patients may have stiffness of lower limbs, seemingly not listening to command, or lower limbs are soft, as if walking on cotton; other patients may even have headache, dizziness, loss of vision, tinnitus, nausea and other abnormal sensations; more patients may have headache, dizziness, loss of vision, tinnitus and other abnormal sensations. Other patients may even have headache, dizziness, loss of vision, tinnitus, nausea and other abnormal sensations; a few patients may have loss of control of urination and defecation, sexual dysfunction, or even tetraplegia. Of course, not all the manifestations will show up in every patient with cervical spondylosis, but often only some of the symptoms appear, and most patients have a mild performance and a long course of disease, so there is no need to smell cervical spondylosis and become pale, not to mention the random number of seats. The complexity of cervical spondylosis symptoms is closely related to the anatomical structure of the neck, so to understand cervical spondylosis we must start by understanding its anatomy in general.
When there is a laterally proliferating bone spur above the 6th cervical vertebra, the pathological changes involving the vertebral artery are mainly mechanical compression and stimulation causing spasm of the vertebral artery and narrowing of the vascular lumen, resulting in a series of symptoms of inadequate intracranial blood supply. In addition, pathological changes such as early loosening and displacement of the small posterior joints, osteophytes, laxity of the surrounding ligaments, degeneration, sclerosis and calcification may occur in the adjacent tissues of the affected area and intensify with the course of the disease.
In fact, cervical spondylosis not only includes cervical spine dislocation, cervical spine osteophytes, soft tissue injury, cervical disc herniation, “falling pillow”, “low head syndrome”, pain and numbness of the neck, shoulder, back and hand, etc.; there is also a lack of blood supply to the brain caused by it, mainly in three aspects: 1.
1, insufficient cerebral blood supply: headache and dizziness, vertigo, motion sickness, seasickness, postural hypotension, foreign body sensation in front of the eyes, tinnitus, head-turning or squatting dizziness, cerebral hemogram examination shows cerebral vascular spasm, insufficient blood supply to the vertebrobasilar artery, etc.
2, brain dysfunction (excitement): insomnia and dreaminess, inattention, irritability, mental variability, etc.
3, brain damage: memory loss, slow reaction, Parkinson’s sign, Alzheimer’s disease, brain atrophy, brain nerve damage, brain tissue congestion, hemorrhagic edema, cerebral hemorrhage stroke, cerebral thrombosis, brain softening, cerebral infarction, etc. The human being is a whole person, and there is an intrinsic connection between illnesses. One problem causes many problems, and by solving the main problem, other problems will be solved. For example, cervical spondylosis and the lack of blood supply to the brain caused by it damage the brain, affect intelligence, and lead to multiple diseases throughout the body.
Misconceptions about the diagnosis and treatment of cervical spondylosis
1.Relying solely on imaging examination for diagnosis: X-ray plain film (including frontal, lateral and hyperflexion/extension lateral) is the most basic imaging examination, which is essential for understanding the basic condition of the skeletal structure of the cervical spine. Relying on CT and MRI examinations alone and neglecting clinical examination is a diagnostic misconception that should be avoided. In some patients, although the imaging examination shows that the spinal cord or nerve roots are already severely compressed, the clinical examination does not show any corresponding signs and symptoms of nerve damage, so cervical spondylosis cannot be diagnosed, and surgery cannot be performed regardless of the clinical manifestations. There are also patients with obvious clinical symptoms, but the imaging examination does not reflect any cervical spondylosis treatment.
2.Treatment does not distinguish the type of cervical spondylosis: usually, there is a large reserve gap around the spinal cord in the spinal canal. When the spinal canal is narrowed, the reserve gap becomes small, and the spinal cord is easily compressed once a disc herniation and bone spur generation occur. In China, the incidence of developmental cervical spinal stenosis is 10%. The fact that 68% of patients with spinal cord cervical spondylosis have developmental cervical stenosis indicates that spinal cord cervical spondylosis is more likely to occur in people with developmental spinal stenosis. If a patient is diagnosed with spinal cord cervical spondylosis, he or she should be operated actively, otherwise the more delayed it is, the more damage to the spinal cord and the worse the outcome will be.
Currently, surgery for spinal cord cervical spondylosis is divided into anterior and posterior approaches based on the access route. Anterior decompression is direct decompression, i.e., direct removal of the compressor; posterior decompression is indirect decompression, i.e., the spinal cord is moved backward by enlarging the spinal canal, thus avoiding the compressor. It has been proved that for spinal cord cervical spondylosis combined with developmental cervical spinal stenosis, if anterior decompression is adopted, the decompression range is often insufficient, incomplete, easy to recur or even ineffective. Therefore, choosing posterior decompression for patients with developmental cervical spinal stenosis is an important method to improve the efficacy of surgery.
3. For patients with all other types of cervical spondylosis, conservative therapy should be adopted as far as possible.