What is cervical spine disease?
The stable structure of the normal cervical spine consists of cervical vertebrae, joints, intervertebral discs, ligaments and muscles, which maintain the stability of the cervical spine, limit excessive movement of the cervical spine, and allow the cervical spine to perform various physiological activities. Due to muscle strain, intervertebral disc degeneration and intervertebral space narrowing, ligamentous laxity and proliferative bone spurs can occur, thus decreasing the stability of the cervical spine, which will aggravate the chronic accumulative injury of the cervical spine and accelerate the degeneration of the cervical spine. Yang Cao, Department of Orthopedics, Wuhan Union Hospital
Cervical spondylosis, also known as cervical spine syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, cervical spine
Cervical spondylosis, also known as cervical spine syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome and cervical disc prolapse, which manifests as cervical disc degeneration and its secondary series of pathological changes, stimulating or compressing the adjacent nerve roots, spinal cord, vertebral artery and cervical sympathetic nerve and other tissues and causing various symptoms and signs.
Why do people get cervical spondylosis?
The cervical joints are very active in people’s daily life and have the function of flexion, extension and rotation. Due to the accumulation of a large number of activities and strain, chronic damage can be formed after a long time and degenerative lesions can easily occur, which is the intrinsic cause of the disease.
In addition, some external factors can also lead to accelerated development of cervical spondylosis.
Acute cervical spine trauma: 50% of medullary cervical spondylosis is related to cervical trauma, which often induces the generation of cervical spine symptoms.
Chronic cervical spine injury: mostly occurs in those who are engaged in embroidery, sewing, painting, writing, laboratory and mental labor for a long time.
Bad posture: lying in bed watching TV, reading books, high pillows, sleeping in the car are all incorrect postures and prone to cervical injury.
Infection of neck and pharynx: mainly pharyngitis, followed by dental caries, periodontitis, otitis media, etc. Inflammation in these areas stimulates the soft tissues of the neck or causes soft tissue lesions in the neck through the rich lymphatic system.
Dysplasia of the cervical spine structure: congenital small spinal canal, cervical degeneration, etc. are the basis for the pathogenesis of some cervical spondylosis.
Who is prone to cervical spondylosis?
By and large, cervical spondylosis is a common disease among middle-aged and elderly people, with the age group of 40-60 years old being the most common, and the age group of 45-55 years old having the most incidence. However, with the accelerated pace of work in society, people are under unprecedented physical and mental pressure, and the onset of cervical spondylosis is on a younger trend.
Cervical spondylosis is mostly seen in people who work with their head and neck in the same posture for a long time, or who have frequent head and neck activities and are engaged in occupations where the neck is prone to injury, such as surgeons, teachers, metrologists, people who work with computers, drivers, soccer players, adolescents with heavy learning tasks, and so on. In addition, people who are used to using high pillows and have a history of cervical spine trauma are prone to cervical spondylosis.
What are the symptoms of cervical spondylosis?
The symptoms of cervical spondylosis are diverse, and there are different sites and segments of herniated discs and bone spurs, resulting in different types and severity of compressed tissues, and therefore the symptoms vary greatly.
In the earliest stage, only the cervical nerves are irritated, causing neck discomfort, neck pain and restricted movement.
After compression of the spinal nerve roots on both sides, in addition to neck symptoms, the symptoms may also include radiating pain in the upper limbs, finger grip
In addition to neck symptoms, compression of the spinal nerve roots on both sides may also manifest as radiating pain in the upper extremities, weakness in grip and fingertip sensation.
If the vertebral artery is compressed, the main symptoms are headache, dizziness, and visual impairment; clinical symptoms similar to those of “coronary heart disease” or “gastrointestinal disorders” may also occur.
When the spinal cord is compressed, the main symptoms are numbness and weakness of the limbs, inflexibility, a feeling of thoracic and abdominal strapping, a feeling of walking on cotton, difficulty in walking, abnormal gait or even unsteadiness in standing and urinary and fecal dysfunction, while the symptoms of the neck may not be obvious at this time.
In addition, almost all cervical spondylosis patients have different degrees of cervical spine activity dysfunction, such as forward flexion and backward extension, lateral flexion and rotation, and other activities are limited.
It is worth mentioning that cervical spondylosis is a common disease, so the public is prone to misunderstandings, such as neck pain and thinking it is cervical spondylosis. In reality, the diagnosis of cervical spondylosis requires a combination of medical history, imaging (such as X-ray) and systematic examination by a physician. If you experience one or more of the above symptoms, you should go to a regular hospital for relevant examinations and be treated according to your doctor’s professional advice.
How to prevent cervical spondylosis?
Degenerative changes (aging) in the cervical discs as we age are almost inevitable, but if we can pay attention to avoiding some factors that promote degenerative disc changes in life and work, it will help prevent the occurrence and development of cervical spondylosis.
Low indoor temperatures tend to cause stiffness in the neck muscles, so it is important to keep warm when the seasons change.
The neck is placed in a physiological state of rest: placed in a neutral position is appropriate, the general adult neck cushion height of about 10 centimeters is better, “high pillow without worry” is not appropriate, high pillow is harmful to health. It is best to use a soft texture of the yuan Bao type pillow (height to about 10cm is appropriate), in order to maintain the physiological curvature of the cervical vertebrae protrusion, and play a relative braking effect on the head and neck.
Prevent neck trauma: If you sleep in a car and do not wear a seat belt, when the emergency brake, it is also very easy to accidental injury, serious cases may even occur paraplegia.
Early and thorough treatment of soft tissue strain in the neck, shoulder and back to prevent them from developing into cervical spondylosis.
Avoid the influence of infection: Inflammation of the throat and upper respiratory tract infection may become a cause of cervical spondylosis once they spread to the cervical spine and joint capsule via the lymphatic system.
Avoid long-term low posture: long-term low office, this position so that the neck muscles are strained for a long time, prone to cervical back muscle strain. Therefore, the document can be placed obliquely padded reading and writing, etc.
Lying on the sofa, the neck placed on the armrest to watch TV or sleep, is also harmful to the bad posture.
What measures are beneficial to the health of the cervical spine?
Correct posture
Adjust the height of the table and chair to the best state with the right proportion of their height, more importantly, the waist is straight, shoulders naturally back, the distance between the eyes and the desktop is about 35 cm.
In between work to often do with breathing natural after lifting action: about every 10 minutes to raise the head or back to rest for a moment, so that the head, neck, shoulders, chest in a slightly tense normal physiological curve of the state, and try to avoid excessive head and neck tilt forward
or backward tilt.
The hips should be in full contact with the chair surface, and can often be used to rest on the back of the chair for a short break.
Reasonable diet
Cervical spondylosis to the middle-aged and elderly, the diet should be light, easy to digest, avoid greasy and thick products.
For those with insufficient liver and kidney function, eat more wolfberry, chrysanthemum, sesame and cinnamon, and avoid spicy and stimulating foods.
Blurred vision, tears, it is appropriate to eat more food containing calcium, selenium, zinc. Such as soy products, animal liver, eggs, fish, mushrooms, etc.
Reasonable exercise
When you are tired of sitting in front of the computer, you can let your neck do the “rice” exercise to move your muscles.
Kite flying, swimming, badminton and yoga are all suitable exercises, especially swimming, which allows the neck muscles to move in all directions and is a good exercise for the cervical spine.
Playing table tennis requires frequent head bowing, which is not suitable for people at risk of cervical spondylosis.
Non-surgical treatment of cervical spondylosis
Rest: rest can relax the neck muscles and reduce the pressure on the intervertebral disc due to muscle spasm and head weight; reduce the neck activity, which is conducive to the decreasing of tissue congestion and edema, especially beneficial to the decongestion of the protruding intervertebral disc.
Collar and neck brace: both can play the role of braking to protect the cervical spine, reduce nerve wear, reduce the role of intervertebral joint traumatic reaction, and is conducive to the decreasing of tissue edema and consolidate the effect of treatment.
Physiotherapy: It is also a more effective and commonly used treatment method.
Cervical traction therapy: It is a more effective and widely used treatment for cervical spondylosis, applicable to all types of cervical spondylosis, effective for early cases, and attention should be paid to the time, intensity and angle of traction for patients with serious degenerative changes in cervical spondylosis.
Drugs: can play a supplementary symptomatic treatment role in the treatment of cervical spondylosis. The doctor will choose the appropriate medication for you according to your condition.
Traditional massage and tui-na therapy: It is a more effective treatment measure for cervical spondylosis. However, for cervical spine small joint disorder, cervical spine subluxation, serious osteoporosis and other disorders, cervical spine rotation reset technique must be used with caution and prohibited.
Local application of various topical medicines: it has good effect on reducing the pain caused by myofasciitis and muscle strain.
Surgical treatment and indications for cervical spondylosis
What are the surgical treatments for cervical spondylosis?
When non-surgical treatment is not effective, surgical treatment must be considered. The objectives to be achieved through surgery are to enlarge the nerve root canal, transverse foramen, intervertebral foramen and spinal canal, and to relieve or release the irritation and compression of nerves, blood vessels and cervical medulla; to remove the diseased intervertebral disc, bone superfluous and overly thick or ossified ligaments to achieve decompression and eliminate irritation, compression and adhesions; to restore or enhance the stability of the cervical spine and restore its physiological curve by intervertebral bone grafting, or to limit local activities to prevent further spinal cord and nerve compression.
Surgical treatments include posterior laminectomy and decompression, anterior discectomy, interbody bone grafting, spur resection, and vertebral artery decompression. During treatment, your doctor will choose the appropriate method based on your condition.
Who should choose surgical treatment?
In general, surgical treatment is indicated for the following groups of people.
Cervical disc herniation whose radicular pain is not relieved or continues to worsen after non-surgical treatment, seriously affecting life and workers.
Cervical spondylosis with symptoms of spinal cord involvement and partial or complete obstruction by myelography.
Patients with cervical spondylosis who suffer from sudden cervical trauma or acute spastic paralysis of limbs without obvious trauma
Cervical spondylosis causing repeated cervical vertigo, syncope or sudden collapse, which is ineffective by non-surgical treatment.
Cervical spondylosis with definite sympathetic symptoms, which is ineffective by non-surgical treatment and seriously affects workers.
Those with cervical spondylosis with anterior vertebral body bones causing symptoms of esophageal or laryngeal recurrent nerve compression.
Preoperative preparation and procedure for cervical spondylosis
What do I need to do before surgery?
Good and adequate preoperative preparation not only facilitates the smooth implementation of surgery, but also greatly reduces the risk of postoperative complications, which will lay a solid foundation for your return to health. Therefore, before the surgery, you should cooperate with your surgeon in all aspects of preparation.
Cooperate with various laboratory tests, which will help your surgeon to have a complete understanding of your physical condition.
Eliminate nervousness and fear and maintain a positive attitude.
Practice surgical positions and perform tracheal nudging exercises under the guidance of your surgeon, which will make your body tolerate the surgery more easily.
Train to urinate and defecate in bed to prevent urinary retention from occurring after surgery.
Pass a bowel movement the day before surgery and stop eating.
If bone grafting is required during surgery, you will need to cooperate with your surgeon for the necessary preparations.
What are the steps involved in cervical spine surgery?
There are many different types of surgery for cervical spondylosis, but the main principles are similar in that they all involve removing parts of the vertebrae and discs to reduce or remove their compression of the nerves or blood vessels.
Anesthesia: Starting with an intravenous cannula, the anesthesiologist will put you to sleep with anesthetic drugs in the vein.
Incision: After anesthesia, your body will be turned over to expose the surgical site and the surgeon will make an incision according to the established preoperative plan.
Decompression: The surgeon will cut through the skin and muscle tissue, locate the lesion, remove the part of the lesion that is causing pressure on the nerve root canal or spinal cord, and remove the bone spur.
Reconstruction: A small piece of bone (from your own or artificial bone) will then be implanted in the intervertebral space to promote fusion between the vertebrae and increase stability. Alternatively, an intervertebral fusion and nail bar system may be chosen as an internal fixation.
Suturing: The procedure is completed when the surgeon closes the wound layer by layer. The surgery typically takes between forty and ninety minutes.
What are the possible complications of cervical spondylolisthesis during and after surgery?
Inadequate preoperative preparation and exercise can lead to
Poor urination and constipation and bloating due to unaccustomed urination and defecation in bed.
Respiratory complications such as dyspnea, pulmonary infection and atelectasis after surgery due to poor preoperative breathing training and painful surgical incisions, and fear of deep breathing and coughing.
Intraoperative injury to nerves or blood vessels can lead to.
Choking and swallowing difficulties, hoarseness, and dysphonia.
Hematoma in the surgical area compressing the trachea, leading to breathing difficulties.
In addition, the following complications may occur in the early postoperative period.
Stiffness, soreness and discomfort in the neck.
Nausea and vomiting, usually due to incisional infection caused by the irritation of intraoperative anesthetics.
It is worth mentioning that the above-mentioned complications rarely occur after cervical spine surgery with careful operation by the surgeon and good cooperation from the patient, and timely reporting of complications to the medical staff and timely treatment of related symptoms can minimize the danger of various complications.
What are the postoperative precautions for cervical spondylosis?
Body position: When returning to the ward from the operating room, a good neck collar should be worn. The trunk together with the head can be elevated by 10-15 degrees, or semi-recumbent or side-lying position, but it should be noted that the head and neck and trunk should maintain the same axial position and should not be excessively flexed, posteriorly extended or rotated.
Diet: You can have a semi-liquid diet for 1-2 days after surgery, and then gradually resume a normal diet.
You should practice deep breathing 5-6 times/hour after surgery, and cough up any phlegm in time to reduce the occurrence of respiratory complications.
Wound: If you find that the gauze dressing is wet with blood, the drainage tube is twisted and folded, or the negative pressure drainage ball connected to the drainage tube is leaking, you should inform the doctor for treatment. The drainage sheet or drainage tube is usually removed 12-48 hours after surgery. After removal, the wound will no longer be prone to blood leakage.
Activity: If the implant is stable during the surgery, after the drainage is removed, with the consent of the doctor and nurse, you can first sit up or swing the head of the bed up to sit up, and if there is no dizziness or other discomfort, you can move down to the floor. If there is no dizziness or other discomfort, you can move to the floor. If you have weakness in the lower limbs, you should move gradually with the support of nursing staff. Early movement to the floor will help the recovery of general condition, wound healing and prevention of pulmonary complications.
Discharge: In general, stitches are usually removed about 5 days after surgery for neck wounds and 10 to 14 days after surgery for wounds at iliac bone extraction. After all sutures are removed, you can be discharged home to recuperate if there are no special circumstances.
How do I rehabilitate after surgery?
Rehabilitation after surgery is very important and greatly affects the patient’s future work, study and all aspects of daily life.
After the traumatic reaction period, rehabilitation can be started if the patient’s condition is stable. The first thing is to perform some deep breathing exercises, which can prevent lung infections; at the same time, some small-scale joint movements of the distal extremities can be performed, such as fist clenching, dorsal foot flexion and extension.
During the recovery period, the movement of the limbs should be gradually changed from the prone position to the semi-prone position, sitting position, and then the movement out of bed. During this process, the amount of muscle training should be gradually increased. In particular, hand activities, such as finger pairs, finger splitting, grasping and other movements should be focused on training; lower limb training first through straight leg raising, lower limb weight lifting, extension and flexion activities to strengthen muscle strength and joint range of motion, and gradually with the help of crutches, canes, lower limb functional brace training standing, stepping, and then transition to walking.
For the surgical site, appropriate activities can be performed under the protection of a cervical brace, but activities such as violent head twisting should be avoided to prevent the deterioration of cervical spondylosis caused by post-traumatic injury. Until the incision and tissues (especially bone tissues) heal, the cervical spine should be avoided from excessive and
excessive activity, reduce its load, and maintain local braking as much as possible. Physiological activities should also be carried out gradually during the recovery period to facilitate smooth recovery.
Eliminating pessimism and impatience, establishing confidence in fighting the disease, and maintaining a good mental state will also contribute to a better recovery after surgery.
Finally, you should come to the hospital for follow-up examinations at 3 months, 6 months, 1 year and 2 years after surgery to understand the post-operative recovery.