Cervical spondylosis, also known as cervical spine syndrome, is a slowly progressive degenerative disease of the cervical spine, mostly seen in middle-aged and elderly people, but can also develop in adolescents. It is mainly due to the degeneration and protrusion of cervical discs, resulting in secondary changes in the surrounding tissues and structures, and causing a series of clinical manifestations.
I. Classification
Generally, it can be divided into cervical type, nerve root type, vertebral artery type, sympathetic nerve type, spinal cord type, and esophageal type.
(I) Cervical type
It is the milder type of cervical spondylosis, dominated by cervical symptoms, in the beginning stage of cervical degeneration, and has a good prognosis. It is due to the dehydration of the nucleus pulposus and the fibrous ring of the intervertebral disc, degeneration with reduced tension, which in turn causes loosening and instability of the vertebral space, and the symptoms are often suddenly aggravated in the morning after rising, overwork, improper posture and cold stimulation.
1, symptoms: repeatedly fallen pillow, manifested as neck pain, swelling and discomfort and protective cervical muscle spasm. There is limited neck movement or forced position, transient upper limb numbness, abnormal sensation, etc.
2.Signs: cervical muscle tension, stiffness, pain when moving the neck with a smaller range of motion, pressure pain in one or both oblique muscles.
3.X-ray: the physiological curvature of the cervical spine changes to straightening or even reversion.
(II) Nerve root type
Common type, cervical spine hyperplasia, disc herniation, small joint hyperplasia, compression or stimulation of the nerve root, resulting in edema, inflammation, adhesion of the nerve root, and a series of clinical symptoms caused by the cervical 5-6 and cervical 6-7 gap.
1, symptoms: cervical stiffness and discomfort, neck, shoulder and arm pain can occur along the nerve root down the string and the arm has electric shock-like, pinprick-like numbness.
2.Signs: cervical spine movement is limited, cervical spine transverse process spine, supraspinal fossa, intra-superior and inferior scapular angle pressure pain, nerve root innervation area sensory and motor impairment, grip strength is weakened, pressure top test, brachial plexus pull test, head down test, head up test may be positive.
3.X-ray: abnormal physiological curvature of the cervical spine can be seen in ortho, lateral and left-right oblique positions, osteophytes on the anterior and posterior edges of the cone, narrowing of the intervertebral space, small joint hyperplasia, calcification of the anterior longitudinal ligament and collateral ligament, hyperplasia of the hook vertebral joint and narrowing of the intervertebral foramen.
(C) Vertebral artery type
Insufficient blood supply to the vertebral basilar artery caused by spasm or stenosis of the vertebral artery caused by hyperplasia of the hook vertebral joint, instability of the vertebral joint, loosening and displacement of the posterior joint, and stimulation or compression of the vertebral artery.
1, symptoms: headache, dizziness, cerebral ischemia is manifested as vertigo, nausea, vomiting, deafness, blurred vision and even sudden collapse when the head is turned to a certain orientation. When the head is in another orientation, or has fallen to the ground, it quickly improves.
2.Signs: positive rotation test, positive head-down and head-up test.
3.Imaging examination
(1) X-ray plain film: abnormal cervical physiological curvature, hyperplasia of the hook vertebral joint, narrow intervertebral foramen.
(2)Cerebral hemogram: abnormal
(3)Vertebral arteriogram: there may be compressive distortion, thinning or obstruction of the vertebral artery
(4) Magnetic resonance angiography may also show the travel path of the vertebral artery and its changes.
(D) Sympathetic nerve type
It is a symptom of cervical sympathetic nerve stimulation due to cervical conus minor joint hyperplasia and calcification of the posterior longitudinal ligament. It often coexists with inadequate blood supply to the vertebrobasilar artery because of the sympathetic nerve network around the cervical vertebral artery.
1. Symptoms: dizziness, headache, migraine, occipital or neck pain, blurred vision, cold limbs, tinnitus, deafness, etc.
2.Signs: tachycardia or bradycardia, unstable high and low blood pressure, low or tilted head test may induce symptoms or aggravate.
3.X-ray: degenerative changes of cervical spine
(E) Spinal cord type
It is the most serious type of cervical spondylosis, but the incidence is low, the onset is insidious, the symptoms are complicated, and it is often missed and misdiagnosed. Symptoms arise from developmental spinal stenosis, hyperplasia at the posterior edge of the cervical spine, and intervertebral disc lesions (bulge, protrusion, prolapse) compressing the spinal cord.
Symptoms: Symptoms vary depending on the location and degree of spinal cord compression, often starting with tightness in the lower extremities, numbness, difficulty walking, inability to walk fast, feet seemingly stepping on cotton, and a feeling of girdling in the chest or waist. Then there is numbness of one or both upper limbs, weakened hand grip, easy to hold objects falling, muscle atrophy, and in severe cases, quadriplegia (spastic paralysis) and urinary and fecal incontinence.
2.Signs: muscle atrophy, increased muscle tone, biceps, triceps, radial reflex, knee reflex, hyperactive Achilles reflex, positive pathological reflexes such as Hoffman, Babinski, ankle clonus.
3.X-ray plain film: osteophytes at the posterior edge of the cervical spine, narrowing of the spinal space, ossification of the posterior longitudinal ligament, etc. MRI examination: abnormal cervical curvature, vertebral body posterior margin hyperplasia, disc bulging, protrusion, prolapse, dural sac or spinal cord compression and deformation, and high signal in the spinal cord seen in a few TW2 images (suggesting focal ischemia or edema in the spinal cord).
(vi) Esophageal type
It is due to the stimulation or compression of the esophagus by the bone flab in front of the conus, causing mechanical compression by esophageal spasm and causing dysphagia.
1, symptoms: early difficulty in eating hard food, tingling, burning sensation, gradually affected to eat soft food also have difficulties.
2.Signs: difficulty in swallowing, aggravated when the neck is tilted up and reduced when the neck is flexed.
3.X-rays: Bone flab in front of the cone is obvious. Barium meal imaging: posterior esophageal compression and esophageal stricture.
II. Rehabilitation assessment
(I) Routine examination
1.Medical history
2.Symptoms: With the different subtypes of multi-type cervical spondylosis, there can be different symptoms.
3.Signs: With different subtypes of cervical spondylosis, there may be different signs and so on.
(II) Physical examination
1. Pressure top test. (also known as Spurling test), is the compression of the intervertebral foramen, triggering the appearance or aggravation of symptoms.
2, brachial plexus pull test. Positive if the patient has pain and numbness in the upper limbs.
3. Neck pulling test. That is, the intervertebral foramen separation test, the upper limb numbness and pain symptom reduction is positive.
4. Forward flexion and rotation test. If there is pain in the cervical spine, it is positive. It suggests degenerative changes in the small joints of the cervical spine.
5. Neck rotation test. Positive if the patient has dizziness. It is used to check vertebral artery type cervical spondylosis.
6. Head down test. Positive if the above symptoms are present.
7. Head tilt test. Significant for the diagnosis of different types of cervical spondylosis
(C) Special examination
1.X-ray plain film examination, which is an important basis for the diagnosis of cervical spondylosis.
2.CT examination, to understand disc protrusion, posterior longitudinal ligament calcification, spinal canal stenosis, transverse foramen size, etc. It is important for the diagnosis of ossification of the posterior longitudinal ligament.
3, MRI examination, to understand the degree of disc protrusion (bulging, protrusion, prolapse), dural sac and spinal cord compression, ischemia and edema foci in the medulla, whether cerebrospinal fluid interruption, nerve root compression, ligamentum flavum hypertrophy, spinal canal stenosis, etc.
4.Electromyography examination. It can identify neurogenic or myogenic muscle atrophy, and is meaningful for the diagnosis of nerve root type and spinal cord type.
5, cerebral hemogram examination. It is helpful for the diagnosis of sympathetic nerve type and vertebral artery type cervical spondylosis.
III. Rehabilitation treatment