Cervical spondylosis is a common and frequent disease among middle-aged and elderly people, and is a series of clinical syndromes caused by cervical spine osteophytes, degenerative changes in cervical discs and neck injuries that compress or stimulate cervical nerve roots, spinal cord, cervical sympathetic nerve roots and vertebral arteries, also known as cervical spine syndrome. The disease mostly occurs in people aged 30-60. In recent years, due to changes in dietary structure, living habits and work pressure, the incidence of this disease has been on the rise, especially among young people, computer workers and those who lack physical exercise. Clinical manifestations vary according to the location of the lesion and the tissue under pressure. In mild cases, numbness and pain in the head, neck, shoulders, arms and fingers, dizziness, nausea, which can be relieved by itself or repeatedly, and in severe cases, sinking and weakness of the upper or lower limbs, stiffness of the neck, limitation of movement, radiating pain, sudden collapse, and even incontinence, paralysis or life-threatening. The lesions are most likely to occur in the intervertebral discs between cervical 5-6, followed by those between cervical 6-7 and cervical 4-5.
According to Chinese medicine, this disease is caused by external evil, guest in the meridians, or sedentary exhaustion, strain on the tendons and bones; or sprain and injury, stagnation of qi and blood, paralysis of the meridians and bones; or old age and physical decline, liver and kidney deficiency, loss of nourishment of the tendons and bones. This disease belongs to the Chinese medical term “Xiangqiang”, “Xiang tendon urgency”, “dizziness”, “Xiang shoulder pain”. “paralysis”, “impotence”.
(1) Cervical type cervical spondylosis.
(1) Complaints of abnormal sensations such as pain in the occipital, temporal, auricular and other lower head, neck and shoulder, with corresponding pressure points.
(2) The cervical spine on x-ray shows manifestations such as changes in curvature and instability of vertebral interrogative joints.
(3) Tinnitus and hearing impairment, etc.
(4) X-rays showing segmental instability or osteophytes of the hook vertebral joints.
(5) Excluding ophthalmogenic, cardiogenic, cerebral and otogenic vertigo.
(6) MRA or vertebral artery ultrasound showing limited stenosis or torsion signs in the second segment of the vertebral artery (V I II).
(7) Excluding insufficient blood supply to the basilar artery caused by compression of vertebral artery segment I (the segment of the vertebral artery before entering the transverse foramen of cervical 6) and vertebral artery segment III (the segment of the vertebral artery before exiting the cervical spine into the skull).
(8) MRA or digital subtraction vertebral arteriography (DSA) is required before surgery to help clarify the diagnosis.
(2) Nerve root type cervical spondylosis.
(1) With more typical radicular symptoms (numbness and pain in the arm), the extent of which is consistent with the area innervated by the cervical spinal nerve.
(2) Positive cervical compression test or arm-from-draw test.
(3) Imaging (x-ray, MR) findings consistent with the clinical presentation.
(4) Excluding disorders caused by extra-cervical spine lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, frozen shoulder and biceps tenosynovitis, etc.) with pain in the upper extremity as the main cause.
(3) Spinal cord type cervical spondylosis.
(1) Clinical manifestations of cervical spinal cord damage, dominated by motor, sensory and reflex impairment of the extremities.
(2) Imaging findings confirm spinal cord compression and coincide with clinical symptoms.
(3) Excluding amyotrophic lateral sclerosis, spinal cord tumor, acute spinal cord injury, secondary adhesive arachnoiditis, and multiple peripheral neuritis.
(4) Vertebral artery type cervical spondylosis.
(1) Previous episodes of sudden collapse with cervical vertigo.
(2) Positive rotational neck test.
(3) Mostly accompanied by cranial symptoms, including blurred vision, tinnitus and hearing impairment.
(4) X-rays showing segmental instability or osteophytes of the hook vertebral joint.
(5) Excluding ophthalmogenic, cardiogenic, cerebral and otogenic vertigo.
(6) MRA or vertebral artery ultrasound showing limited stenosis or torsion signs in the second segment of the vertebral artery (V I II).
(7) Excluding insufficient blood supply to the basilar artery caused by compression of vertebral artery segment I (the segment of the vertebral artery before entering the transverse foramen of cervical 6) and vertebral artery segment III (the segment of the vertebral artery before exiting the cervical spine into the skull).
(8) MRA or digital subtraction vertebral arteriography (DSA) is required before surgery to help clarify the diagnosis.
(5) Sympathetic cervical spondylosis: Since the diagnostic criteria for this subtype are still more controversial and have yet to be further discussed, no revision is proposed for the time being.
Sympathetic cervical spondylosis Clinical manifestations include a series of sympathetic symptoms such as dizziness, blurred vision, tinnitus, hand numbness, tachycardia, pain in the precordial region, instability or degeneration on X-ray, and negative vertebral arteriogram.
(6) Other types of cervical spondylosis.
(1) Esophageal compression type cervical spondylosis: difficulty in swallowing, especially when the neck is tilted; X-ray plain film shows obvious bone superfluous formation in front of the vertebral joints; barium meal examination shows signs of esophageal compression; mostly combined with other types of cervical spondylosis symptoms.
(2) Cervical spine instability (destabilization) type: the exact meaning is subject to further discussion.
(3) Anterior central spinal artery compression type: the exact meaning is subject to further discussion.
(7) Mixed cervical spondylosis: those with two or more of the aforementioned types of cervical spondylosis are of this type. It is mostly seen in those with long disease duration and high age.
3.Treatment
(1) Electroacupuncture
Take the cervical pinch points, dazhi, fengchi, shoulder, da loom and tianzong. Take 2 to 4 points each time, and after acupuncture, connect the electro-acupuncture instrument and stimulate for 20 minutes.
(2) Body acupuncture
Local acupuncture points are mainly taken from the neck, Fengchi, Dazhi, Tianzhu, Houxi, cervical spine pinch points, and A-Yi points.
(3) Ear acupuncture
Take the cervical spine, shoulder, neck, Shen Men, sympathetic, adrenal, subcortical, liver and kidney. Take 3 to 4 points each time, with strong stimulation by milli-needle, and leave the needle for 20 to 30 minutes; or use Wang Bu Liuxing seeds to apply pressure.
(4) Skin needling
The skin is red and bleeds a little.
(5) Acupoint injection therapy
Take Da Loom, Shoulder Middle Yu, Shoulder Outer Yu and Tianzong. Use 2ml of 1% procaine or 2ml each of vitamin B1 and vitamin B12, and inject 0.5ml into each point.
Note: Some patients need to do cervical spine frontal and lateral X-ray and cervical MRI, once the diagnosis of cervical spondylosis is confirmed by clinicians, then consider whether to take conservative treatment or surgery, and surgery is generally adapted to patients with spinal cord-type cervical spondylosis or those for whom conservative treatment is ineffective.