Cervical spondylosis is a common and multi-infarct disease that occurs in adults between the ages of 40 and 60, more in men than in women. Cervical spine pain is a comprehensive set of symptoms stimulated or caused by the gradual degeneration of human cervical intervertebral discs, cervical spine osteophytes, or changes in the normal physiological curve of the cervical spine. The main clinical symptoms of this disease include pain in the head, neck, arm, hand and forehead, and there may be progressive limb sensory and motor disorders, and in severe cases, it may lead to limb weakness, or even incontinence and paralysis.
Who is prone to cervical spondylosis: 1.
1. In terms of age, more middle-aged and elderly people suffer from cervical spondylosis. As we age, chronic strain on the cervical spine can cause degeneration of the intervertebral disc, formation of bone spurs at the vertebral body edge, thickening of ligaments and a series of degenerative changes, which are all factors in the formation of cervical spondylosis.
2, occupationally speaking, long-term low head ambulation work or head and neck often turn in a certain direction is prone to cervical spondylosis. These occupations include office workers, typists, computer workers, operating room nurses, long-term microscope viewers, traffic police and so on. These jobs have a higher incidence due to long-term head down, resulting in strain on the posterior cervical muscles, ligaments and other tissues.
3, from the sleep posture, the pillow is too high, too bottom or pillow parts improper, bad sleeping posture for a long time, are prone to cause paravertebral muscles, ligaments, joints balance imbalance and produce varying degrees of strain injury. Therefore, those who like to sleep on a high pillow and repeatedly “pillow” is prone to cervical spondylosis.
4, a history of head trauma and congenital deformities of the cervical spine are also susceptible to cervical spondylosis.
I. Clinical manifestations of cervical spondylosis
The clinical manifestations of cervical spondylosis vary according to the location of the lesion, the tissue under pressure and the severity of the compression. Some of the symptoms can be alleviated or relieved by themselves, but they can also recur, and individual cases have stubborn symptoms that affect life and work. According to the clinical symptoms, it is roughly divided into nerve root type, spinal cord type, vertebral artery type and sympathetic nerve type. However, there are often mixed types with mixed symptoms and signs between each type.
(I) Neurogenic cervical spondylosis
The disease can be triggered when the head is traumatized. The symptoms include neck, shoulder and back pain and cervical nerve irritation or compression. Specific performance can have the following.
1, the neck has different degrees of deformity and stiffness phenomenon.
2. The painful point is below the transverse process of the cervical spinal nerve and the area innervated by its dorsal branch.
3. Positive brachial plexus nerve pull test.
4, Positive intervertebral foramen compression test.
5.Positive subacromial pressure test.
6.When the cervical nerve is stimulated, its distal part shows painful hypersensitivity in the early stage; when it is compressed more heavily or for a longer period of time, its distal part shows hyposensitivity.
7.When the main nerves innervating the biceps and triceps tendons are excited, the tendon reflexes are active, and vice versa, the tendon reflexes are diminished or disappear.
8.After the nerve root is compressed, the strength of the innervated muscles is reduced in the lighter cases, and muscle atrophy is also seen in the heavier cases.
(B) Spinal cord type cervical spondylosis
Clinically, according to whether the compression is located in the center of the spinal cord or on one side, it can be divided into simple spinal cord type and mixed spinal nerve root type. Its main clinical manifestations are.
1. Upper limb symptoms: simple motor disorder, simple sensory disorder or both sensory and motor disorder in one or both upper limbs.
2. Lower extremity symptoms: neurological dysfunction in one or both lower extremities.
3.Lateral symptoms: sensory-motor disorders appearing in the upper and lower extremities on the same side.
4.Sympathetic symptoms: sensory or motor disorders appearing in one upper limb and the opposite lower limb
5.Extremity symptoms: neurological disorders appearing in the extremities.
6.Head symptoms: mainly manifested as headache and dizziness.
7.Sacral nerve symptoms: manifested as urination or defecation disorders.
(C) Vertebral artery type cervical spondylosis
The main clinical manifestations of this type of cervical spondylosis are
1.Typical symptoms of inadequate blood supply to the propelling artery: episodic vertigo, diplopia with nystagmus, sometimes nausea, vomiting, and even otorrhea and deafness.
2.Sudden collapse or coma.
3.Brainstem symptoms: numbness of limbs, abnormal sensation, holding objects to the ground.
4.Occipital throbbing pain.
(IV) Sympathetic cervical spondylosis
This type of cervical spondylosis is mainly sympathetic symptoms, including sympathetic inhibition symptoms, such as dizziness, droopy eyelids, lacrimation, nasal congestion, bradycardia, low blood pressure, increased gastrointestinal motility or warmth; and sympathetic excitation, gold stars in the visual field, etc.
Second, the prevention of cervical spondylosis knowledge
The prevention of cervical spondylosis should start early and be persistent, pay attention to the following points.
1, read some books about the prevention and treatment of cervical spondylosis, understand the occurrence of cervical spondylosis is related to neck injury, fall injury, wind, cold and damp, improper pillow height, etc., so as to prevent against these pathogenic factors.
2.Keep an optimistic attitude, establish the idea of fighting hard against the disease, and actively cooperate with the doctor’s treatment to reduce recurrence.
3.Strengthen the exercise of neck and shoulder muscles, and insist on doing relevant medical gymnastics.
4.Create good habits of living and posture. For example, avoid sleeping with a high pillow; change your head position regularly when you are working at a desk; keep your spine straight when talking or reading; avoid overworking your head and neck, don’t carry weight, don’t doze off in a car, and prevent falls and bruises when working or walking.
5, pay attention to the neck and shoulders to keep warm, avoid wind, cold and dampness invasion.
6, timely and thorough treatment of soft tissue strain in the neck, shoulder and back to prevent the occurrence of cervical spondylosis.
7, diet should often take foods such as walnut, shamrock and black sesame that have the effect of delaying the degeneration of cervical joints, which can nourish the kidney and benefit the marrow and strengthen the tendons and bones.
Third, the examination and diagnosis of cervical spondylosis
(A) Physical examination of cervical spondylosis
1. Forward flexion and neck rotation test: the patient’s neck is flexed forward today and is asked to rotate to the left and right. If there is pain in the cervical spine, it is clear that there is degenerative degeneration in the small joints of the cervical spine.
2, intervertebral foramen squeeze test: the patient’s head is tilted to the affected side, the examiner’s left palm placed on the top of the patient’s head, the right hand clenched fist lightly tapping the left hand back, then there is radiological pain or numbness in the limbs, indicating that the force downward transmission to the intervertebral foramen becomes smaller, there is radicular damage; for radicular pain is strong, the examiner with both hands overlapping on the top of the head, between the pressure, can induce or intensify the symptoms.
3, brachial plexus pull test: the patient lowers his head, the examiner holds the patient’s head and neck with one son, holds the wrist of the affected limb with the other hand, and pushes and pulls in the opposite direction to see if the patient feels radiating pain or numbness.
(B) X-ray examination of cervical spondylosis
Normal men over 50 years old and women over 60 years old have about 90% of cervical vertebral bones. However, patients with radiographic changes do not always have clinical symptoms. The x-ray manifestations of cervical spondylosis are.
1, change of curvature: cervical spine straightening, physiological protrusion disappeared or reverse curvature.
2, bone superfluous: the front and rear of the vertebral body near the intervertebral disc can produce osteophytes and ligament calcification.
3, narrowing of the intervertebral space: the intervertebral disc can be thinned because of the protrusion of the nucleus pulposus and the reduction of the water content of the intervertebral disc and fibrous degeneration, which is manifested in the narrowing of the intervertebral space on the x-ray.
4. Calcification of the collateral ligament: Calcification of the collateral ligament is one of the typical lesions of cervical spondylosis.
(C) CT and MRI examination of cervical spondylosis
CT and MRI examinations are of great value in diagnosing cervical spondylosis, understanding the spinal cord compression and deciding the treatment method of cervical spondylosis.
(IV) Electromyography examination of cervical spondylosis
Both cervical spondylosis and cervical disc herniation can cause degeneration of the nerve roots due to long-term compression, thus losing the inhibitory effect on the innervated muscles. Due to the wide range of damaged nerve roots, there are more muscles that appear to be denervated. Electromyography can be used to understand the extent of the denervated muscles and to determine the compression of the nerve roots.
Diagnosis of cervical spondylosis.
There are two diagnostic criteria for cervical spondylosis, provided that other disorders are excluded.
1.The diagnosis can be confirmed if the clinical manifestations and the x-ray film are consistent with cervical spondylosis.
2.With typical clinical manifestations of cervical spondylosis, but no abnormality has appeared on the X-ray film.
IV. Treatment of cervical spondylosis
At present, there are many methods for the treatment of cervical spondylosis at home and abroad, which can be divided into two categories: non-surgical treatment and surgery.
(I) Non-surgical treatment of cervical spine pain
Non-surgical treatment can reduce the symptoms of cervical spondylosis and make it significantly better, which is especially beneficial to patients with early cervical spondylosis. Indications for non-surgical treatment of cervical spondylosis.
①Cervical disc herniation;
②Nerve root type, sympathetic nerve type and vertebral artery type cervical spondylosis;
③Patients who are too old and weak or have poor heart, liver and kidney function to tolerate surgery;
④Patients with severe neurological disorders or mental disorders with cervical spondylosis.
Non-surgical treatment for cervical spondylosis includes manipulation, Chinese and Western medicine, neck collar, neck pillow, cervical traction, local closure, physiotherapy, acupuncture and functional exercise, one or three of which can be used according to different situations and applied simultaneously or alternately.
1.Cervical spine traction therapy
This is a more effective and widely used treatment method for cervical spondylosis, which is applicable to all kinds of cervical spondylosis and more effective for early cases. Its therapeutic effect is to limit the cervical spine activities, which is conducive to the decreasing of tissue congestion and edema; release the spasm of the neck muscles, thus reducing the pressure on the intervertebral disc. Usually the pillow tie traction method is used, both seated and horizontal, and intermittent traction is used for mild patients, l-3 times a day, for half an hour to l hour each time. In severe cases, continuous traction is feasible, with 6-8 hours of traction per day. The traction weight can start from 3-4 kg and gradually increase to 5-6 kg. Later, the traction weight and traction time can be adjusted appropriately according to the patient’s gender, age, physical strength, neck muscle development and the patient’s response to traction treatment. The course of treatment: 30 times of small weight traction is a course of treatment, if it is effective, traction can be continued for 1-2 courses or longer, with a rest period of 7-10 days between two courses of treatment, and traction generally requires mild forward flexion of the neck by about 20 degrees, but it is better to be in a position where the patient feels that the symptoms can be reduced, without forcing a specific position. After traction, the patient should wear a neck brace for protection.
2.Medication
Drugs can play an auxiliary symptomatic treatment role in the treatment of this disease, can choose to apply painkillers, sedatives, vitamins (such as B1, B12, Veloxan), vasodilators and Chinese herbs, etc., which have a certain effect on the relief of symptoms.
3.Physiotherapy
In the treatment of cervical spondylosis, physiotherapy can play a variety of roles and is a more effective and commonly used treatment method. It is generally believed that iontophoresis, ultrasonic waves, ultraviolet rays or intermittent currents are feasible in the acute stage; ultrasonic waves, iodine iontophoresis, induction electricity or other heat therapy are used after the pain is reduced.
4.Massage and massage therapy
This is the main method of cervical spondylosis treatment in Chinese medicine, its therapeutic effect is to relieve the tension and spasm of the cervical and shoulder muscles to restore cervical activity, release the nerve roots and soft tissue adhesions to relieve the symptoms, widen the vertebral space, expand the intervertebral foramen to release the neurovascular stimulation and compression, promote local blood circulation and receive the effect of relaxation, relief of spasm and analgesia. However, the treatment of manipulation should be operated under the guidance of an experienced specialist to prevent accidents.
5.Bed rest
Bed rest can reduce the weight-bearing of the cervical spine and the tension of its surrounding tissues, so that the pressure on the nerve and reactive edema can be reduced, thus accelerating the relief of symptoms. Since the lower limbs of patients with cervical spondylosis are mostly unaffected and move freely, patients and even doctors often neglect the problem of rest, so it is very important to emphasize this point.
6.Functional exercise
In the acute stage, when the patient’s pain symptoms are heavy, it is appropriate to rest, and only after the symptoms are reduced and the displaced affected vertebrae are more stable, the patient can start functional exercises for the neck, shoulder and back, and the range of neck activities should be smaller when exercising, and the force should not be too violent.
(B) Surgery for cervical spondylosis
For patients with cervical spondylosis whose symptoms of spinal cord, nerve root and blood vessel compression are progressively aggravated or have recurrent attacks, which seriously affect work and life, surgery should be considered. Surgical treatment for cervical spondylosis includes posterior laminectomy and decompression, anterior discectomy, intervertebral bone grafting, osteotomy and vertebral artery decompression, etc. The appropriate method should be selected according to the patient’s condition. Pre-operative preparation Patients should psychologically eliminate concerns and fears about surgery and build up confidence in overcoming the disease; physiologically exclude all kinds of factors that are unfavorable to surgery and enhance tolerance to surgery. If there are doubts, you can ask your doctor about your condition, treatment and treatment effect. The day before surgery, for those who are overly emotional, take Valium 5mg before going to bed to ensure a good rest. After 10 p.m., fasting from food and drink begins. In the early morning of the day of surgery, the patient should finish the bowel movement and urine. Before entering the operating room, remove dentures, watches, earrings and other belongings for safekeeping. The patient should be brought into the operating room with all kinds of examination materials (X-ray, CT, MRI, etc.) and antibiotics used during the operation. Postoperative care Patients should wear a neck brace for protection after surgery. When the patient is moved, the head and neck should be kept in a natural neutral position, avoiding twisting, overflexion and overextension. If there is any change in blood pressure, pulse and respiratory condition when moving, the patient should stop moving and ask the doctor to deal with it in time to prevent accidents. The drainage strip should be removed 24 hours or 12 days after surgery. The stitches should be removed about 7 days after surgery. Functional exercise is very important, and the recovery and reconstruction of function after surgery is directly related to the exercise situation.