1.What is cervical spondylosis?
Cervical spondylosis (cervical spondylosis) is a term that refers to the clinical symptoms and signs of cervical spondylosis, but the current international consensus is that cervical spondylosis refers to the corresponding symptoms and signs of damage to the spinal cord, nerves and blood vessels caused by degenerative degeneration of the cervical intervertebral disc and its secondary intervertebral joints.
2.Which types of cervical spondylosis are there?
Cervical spondylosis is divided into the following five main types.
(1) Neurogenic cervical spondylosis, which clinically starts with neck and shoulder pain, worsens within a short period of time and radiates to the upper limbs, and later may have sensory abnormalities such as numbness and allergy.
(2) Spinal cord type spondylosis, the early stage of this type of cervical spondylosis is not obvious neck pain, but weakness of the limbs and unsteadiness in walking are the first symptoms, with the aggravation of the disease, bottom-up upper motor neuron paresis may occur.
(3) Sympathetic cervical spondylosis, the pathogenesis of this type is still unclear, clinically manifested as sympathetic excitation and sympathetic inhibition, sympathetic excitation manifested as headache or migraine, dizziness, especially when the head turns, sometimes accompanied by nausea, vomiting; blurred vision, vision loss, pupil expansion or narrowing, accelerated heartbeat, arrhythmia and other symptoms. Sympathetic depression mainly manifests as dizziness, blurred eyes, lacrimation, nasal congestion, bradycardia, decreased blood pressure and gastrointestinal distension.
(4) Carotid cervical spondylosis, clinical manifestations include
(1) vertigo, which may be rotational, floating or shaking vertigo, and may be aggravated or induced by head movement
(2) Headache, mainly manifested as occipital and parieto-occipital pain, which may also radiate to the occipital region.
③Sudden collapse, mostly occurs when the head suddenly rotates or flexes and extends, and normal activity can be achieved after standing up again after falling.
④There may also be motor and sensory disorders or mental symptoms of different degrees.
(5) Mixed cervical spondylosis, that is, the above two types or multiple types of symptoms appear at the same time, but generally dominated by one type.
3.What is a herniated disc?
The intervertebral disc is the connecting structure between the vertebrae, consisting of the nucleus pulposus in the middle and the peripheral fibrous ring. It can be caused by degeneration, trauma, etc., resulting in the rupture of the fibrous ring and the protrusion of the nucleus pulposus to irritate or compress the nerve roots or spinal cord, resulting in a series of clinical symptoms.
4.What is the difference between a bulging disc and a herniated disc?
The intervertebral disc is composed of the nucleus pulposus located in the middle and the peripheral fibrous ring. When the injury causes complete rupture of the fibrous ring, the nucleus pulposus protrudes from the fibrous ring to the spinal canal behind, it is called a herniated disc. If there is a partial rupture of the annulus fibrosus, but the surface is intact, the nucleus pulposus bulges towards the back of the spinal canal due to pressure, but the surface is smooth, then it is called a bulging disc.
5.Is it normal to have a bulging disc and a herniated disc?
Disc bulge and protrusion are both damage to the intervertebral disc and are not normal. If the above situation occurs, treatment measures should be taken promptly to avoid aggravation of the condition.
6.Does whipping-like movement cause disc expansion?
Acute injury can lead to aggravation of the original degenerated disc damage, resulting in disc protrusion or bulging, and excessive movement of the cervical spine can cause damage to the disc, including excessive whip-like movement.
7.If I feel pain, do I need an MRI?
Neck pain is not always caused by cervical spondylosis, but if you experience neck pain, an MRI can be performed to confirm the diagnosis of cervical spondylosis or to rule out cervical spondylosis.
8. Do I want to do some exercises to avoid surgery?
If you have cervical spondylosis, you can use self-care therapy, change your posture regularly at work, do gentle neck activities and upper limb activities, which will help to regulate the neck and shoulder muscles and improve blood circulation, and the lighter cervical spondylosis will be improved.
9.Is there any other treatment method to treat pain?
There are two methods of conservative treatment and surgical treatment for cervical spondylosis. The methods of conservative treatment include: traction; cervical brace fixation and collar fixation; tui-na massage; physical therapy; self-care; and oral medication such as non-steroidal anti-inflammatory drugs, muscle relaxants and sedatives. All these methods can relieve pain to a certain extent, but if cervical spondylosis develops to a certain extent, only surgery can be adopted.
10.When do I need surgery?
Surgery is suitable for those whose diagnosed cervical spondylosis has been ineffective with conservative treatment, or who have recurrent attacks, or whose symptoms of spinal cord-type cervical spondylosis have been progressively aggravated.
11.If the surgery is delayed, will it cause irreversible damage?
The spinal cord is a relatively delicate tissue. If the compression time is short, the effect of surgical decompression will be obvious, but if the compression time is too long, it will produce degeneration of the nerve tissue and the effect of surgical decompression will not be obvious.
12.When does spinal fusion need to be performed?
At present, as far as the surgical treatment of cervical spondylosis is concerned, simple anterior disc removal is rarely used. Spinal fusion as a technique is often used in combination with decompression, which is very effective in relieving symptoms and maintaining postoperative outcomes. Fusion should be performed when there is a wide range of diseased segments, large disc herniation, narrowing of the intervertebral space, instability of the intervertebral segments, or when postoperative stability of the cervical spine is expected to be compromised. Only fusion can achieve stability of the spine; otherwise, there will be adverse consequences such as instability of the spine, formation of pseudarthrosis and breakage of the internal fixation.
13.Why are most surgeries performed through the anterior cervical region?
Cervical spine surgery is generally divided into anterior and posterior surgery according to the access route. When the lesion is located in the front, anterior surgery is undoubtedly simple and convenient. Most cervical spondylosis is clinically characterized by compression of the intervertebral disc, which is located in the anterior part of the spine. Therefore, the surgery is mostly performed through the anterior part.
14.What is the effect of spinal fusion on the remaining cervical spine?
After spinal fusion, the fusion of the vertebrae will increase the activity load of the adjacent vertebrae to a certain extent and cause certain effects, but due to the greater mobility of the cervical vertebrae, there is a greater compensatory capacity, which usually will not cause adverse consequences.
15.Should I choose homograft bone or autograft bone?
Homograft bone and autograft bone have their own advantages and disadvantages, and the choice of graft bone should be decided according to your specific situation. The advantage of allogeneic bone is that there are sufficient sources and a large amount of bone implants, and the patient can avoid the trauma caused by taking autologous bone; the disadvantage is that the fusion ability is theoretically poorer than autologous bone, and the rate of non-fusion of multiple segments is clinically high, and it requires some additional cost, and there is a certain risk of graft rejection and infectious diseases. The advantage of autologous bone is that autologous bone has a strong ability to induce osteogenesis and a high fusion rate; the disadvantage is that a separate incision is required for bone extraction, which increases trauma, and the bone extraction area (usually the iliac bone) may be painful for a long time after surgery, in addition to fewer sources, which cannot meet a large number of bone implants.
16.Will the surgery reduce my mobility?
The surgery usually does not reduce the flexibility of the neck, but in case of fusion fixation of longer segments, it will have some effect on the movement of the neck.
17.Why do I sometimes have hoarseness and difficulty swallowing after surgery?
There are more nerves in the neck, among which the more important ones are the recurrent laryngeal nerve, and its damage can cause hoarseness after surgery. If it is caused by pulling, contusion, or postoperative hematoma compression during surgery, it is mostly a temporary damage and can be recovered. After surgery, there is usually edema in the neck larynx, which will cause difficulty in swallowing.
18.Will I have pain after surgery?
Postoperative incisional pain is certain, but it can be gradually reduced on its own within a few days if no complications arise. Analgesic medication can also be used to help relieve the pain during the first few days.
19.What is the success rate of my surgery?
The current anterior cervical decompression and fusion procedure is a fairly mature procedure, and based on previous cases, the success rate is very high. For each patient, the success rate depends on many aspects, including the correct diagnosis, the patient’s own physical condition, the timing of the surgery, the experience and level of the surgeon, and the postoperative management and complications.
20.Will there be any risks associated with the surgery?
There are risks associated with any surgery, and cervical spine surgery is no exception, and cervical spine surgery is often major surgery. Risks include general surgical risks such as anesthesia accidents and incisional infections, as well as risks specific to cervical spine surgery, such as spinal cord injury, neurovascular injury, esophageal-tracheal injury, non-fusion of bone graft, etc.
21.Do I need to wear a neck brace after surgery?
After cervical spine surgery, a period of cervical brace fixation is generally required, especially for patients with ligament tears or posterior structural fractures in the neck, or when 3 or more segments are fused.
22. When will I be able to return to my normal activities or driving?
After spinal surgery, after the fusion of the implants and after regular radiological examination shows that the implants have fused, in principle, you can carry out normal activities and driving, but this recovery should be gradual and should be followed by certain functional exercises and adaptations before you can really carry out normal activities and driving.