It is clearly stated that soft tissue damaging pain should be diagnosed according to anatomical typing, which can be divided into three types: intra-vertebral canal, extra-vertebral canal and mixed intra- and extra-vertebral canal. All three types of pain are caused by chemical irritation of aseptic inflammatory lesions in the soft tissues of the body (that is, the skeletal attachments of the extradural skeletal muscles, fascia, and ligaments, as well as the intravertebral ligament or degenerative bone flab or fatty tissue between the nucleus pulposus and the nerve root sheath and dura), which act on the nerve endings.
Acute mechanical compression alone on normal nerve tissue will only cause numbness, tingling or paralysis; chronic mechanical compression alone on normal nerve tissue will not cause any signs due to the latter’s strong resistance to compression. Therefore, the traditional theory of pain caused by nerve root compression has been abandoned because it does not conform to objective reality. All the traditional diagnostic criteria for so-called “lumbar disc herniation” or “cervical spondylosis (except spinal cord type)” are actually signs and symptoms common to intra-vertebral canal or extra-vertebral canal soft tissue damage lesions; they are never “lumbar disc herniation”. Lumbar disc herniation” or “cervical spondylosis” are not inherent.
In the past, the use of such erroneous diagnostic criteria as the basis for the treatment of “lumbar disc herniation” or “cervical spondylosis” has led to unsatisfactory or completely ineffective treatment results. Therefore, the traditional diagnostic criteria for “lumbar disc herniation” or “cervical spondylosis” should be re-recognized as a matter of urgency. In this regard, the author reported in the article “A new understanding of the traditional diagnostic criteria for lumbar disc herniation” published in the Chinese Medical Journal (Vol. 61, No. 2, p. 114) as early as 1981; and now through 18 years of continuous clinical practice;
Now, through 18 years of continuous clinical practice, the correctness and necessity of this understanding have been reinforced. However, it must be pointed out that in cases of simple soft tissue damage in the lumbar spinal canal (i.e., “lumbar stenosis”, “lumbar stenosis”, etc.) involving nerve roots, there will be complaints of severe lumbosacral pain, hip pain, or conduction pain between the transverse gluteal stripe and the carotid fossa, sometimes combined with posterior calf or In some cases, there is a combination of posterior or posterolateral calf dangling sensation, soreness and numbness, or tingling sensation transmitted to the soles of the feet and toes, which is called atypical lower extremity conduction pain (now called “dry pain” or “plexiform pain” in traditional concept);
Only a few still have the typical “sciatic nerve radiating pain” along the posterior lateral thigh and lateral calf (now called “radicular pain” in the traditional concept); while the pain in the simple lumbar, hip or lumbar-hip region (combined with soft tissue damage in the root of the thigh) is confined to the extravertebral canal In contrast, the pain of simple lumbar, gluteal or lumbar gluteal (combined with soft tissue damage to the thigh roots) is confined to the extravertebral canal, but not to the spinal canal.
For more than half a century, the classification of lower extremity conduction pain has included “radiating sciatica”, “reflex sciatica” and “involvement pain”. However, the relationship between the three has always been ambiguous, so it is not very helpful to clarify the diagnosis of low back pain.
Nowadays, some people use “radicular pain”, “dry pain” and “cluster pain” to replace the above three classifications, which only have the advantage of simplifying and compressing the old terminology. Since there is no qualitative change, it is the same as the old terminology and still does not help to innovate the diagnostic criteria. Therefore, it is imperative to explore the diagnostic criteria of this disease in clinical practice to further improve the quality of medical treatment.
1, in distinguishing lesions inside and outside the lumbar spinal canal, scoliosis test, prone lumbar spinal extension and flexion pressure test (referred to as the chest and abdomen pillow test) and tibial nerve flick test (three referred to as the lumbar spinal column “three tests” test) are used, because the common positive signs of the three are soft tissue damage lesions in the lumbar spinal canal (nerve root involvement). The common positive signs are specific for soft tissue lesions in the lumbar spinal canal (nerve root involvement), so they are decisive in the differential diagnosis. The author describes the new diagnostic criteria for lumbar leg pain as follows.
(1) Where the traditional diagnostic criteria for “lumbar disc herniation” are found to be accompanied by typical “sciatic nerve radiating pain” (including atypical lower limb conduction pain), positive peroneal nerve compression test, and a series of highly regular pains in the lumbar region, buttocks and thigh The diagnosis of simple lumbar, gluteal or lumbar-hip soft tissue damage can be clarified when a series of highly sensitive pressure points appear in the lumbar, gluteal and thigh roots in a regular manner and the “three tests” of the lumbar spine are negative. This type of case is the most common in clinical practice.
The typical “sciatic nerve radiating pain”, positive common peroneal nerve pressure test and regular pressure points are the most common signs and symptoms of extravertebral soft tissue damage in low back pain.
(2) If the above signs and symptoms are present but the “three tests” of the lumbar spine are positive, the diagnosis should be mixed soft tissue damage low back pain inside and outside the vertebral canal. This is a mixture of “lumbar disc herniation” (or “lumbar spinal stenosis”) and lumbar hip soft tissue damage, which is misdiagnosed by traditional concepts, and has a high incidence of intra-vertebral canal lesions, but a much lower incidence of total lumbar pain than early pure extra-vertebral canal soft-tissue-damaged low back pain.
(3) In clinical examination, only lumbosacral pain (some involving the buttocks) or complicated by atypical lower limb conduction pain, except for deep pressure pain in the lumbosacral region which is highly sensitive, the pressure points in other parts of the waist and buttocks are not sensitive, but a positive test of “three tests” of the lumbar spine should be diagnosed as simple soft tissue damage within the lumbar spinal canal. However, it is difficult to see this early onset in time. Because this disease becomes a mixed type of lumbar pain after a long period of time, it is misdiagnosed as “lumbar disc herniation” or “lumbar spinal stenosis” by the traditional concept.
It is impossible to distinguish whether this kind of leg pain with mixed soft tissue damage inside and outside the spinal canal comes from aseptic inflammatory lesions in the fat around the lumbar nerve roots or from aseptic inflammatory lesions outside the spinal canal in the soft tissue attachments of the lumbar hip and thigh roots during clinical examination. It is only when the lower extremity conduction pain from extra-vertebral soft tissue damage is eliminated by soft tissue release surgery of the lumbar hip and thigh root in mixed cases, that the inherent signs and conduction pain of intra-vertebral soft tissue damage can be screened out and recognized for what they are. These objective things have never been recognized in the past.
For more than 20 years, the author has applied the new criteria mentioned above to diagnose intra-vertebral canal, extra-vertebral canal and mixed intra- and extra-vertebral canal soft tissue damage low back pain, which often has decisive significance in clinical examination.
2, in the distinction of cervical spinal canal inside and outside the lesion, can use the cervical spine “six kinds of activity function combined with pressure pain point strong stimulation massage” examination.
(1) If the signs and symptoms of “vertebral artery type, nerve root type, sympathetic nerve type or mixed type cervical spondylosis” disappear completely or improve significantly by performing strong stimulation massage on a series of regular pressure pain points in the head, neck, back and shoulder, it can be clearly identified as extra-vertebral soft tissue damage head, neck, back, shoulder and hand pain, and completely excluded. The traditional standard diagnosis of “cervical spondylosis” is completely excluded.
This massage therapy is the most commonly used treatment of choice in the author’s clinic, and often has an immediate effect on acute attacks or cases with mild lesions; for recalcitrant cases, the use of intensive pressure pain point silver needle acupuncture therapy, as well as the use of stereotyped soft tissue release surgery of the cervical back and shoulder combined with the supraclavicular fossa for cases with severe signs that have failed to be treated by various non-surgical therapies, have mostly had unexpected and satisfactory results.
Among the 94 cases of “soft tissue release surgery for ‘mixed cervical spondylosis, head, neck, back and shoulder soft tissue damage with the same symptoms” in the 1986 National Conference on Combined Chinese and Western Medicine and Soft Tissue Pain, 65 cases (69.15%) were cured, 22 cases (23.40%) were effective, 4 cases (4.26%) were effective, and 4 cases (4.26%) were ineffective. In the other article of the above-mentioned “Soft tissue release surgery for soft tissue damage of the neck, back and shoulder with the same signs of ‘neurogenic cervical spondylosis'”, out of 26 cases, 22 cases (84.62%) were cured and 3 cases (3.19%) were ineffective. 84.62%), 2 cases (7.69%) with significant effect, 2 cases (7.69%) with effective effect, and no invalid cases.
The mean observation time was 10.88 years for the former and 9.68 years for the latter, with satisfactory near-term and long-term outcomes. The etiology of the ineffective cases and the residual signs of the effective cases in both papers were not caused by degenerative bone flab in the cervical spinal canal by case analysis. Therefore, judging from the therapeutic effect of the above-mentioned surgical treatment, the four types of “cervical spondylosis” treated are all pain caused by soft tissue damage in the head, neck, back, shoulder and supraclavicular fossa outside the spinal canal.
(2) If the signs and symptoms of these four types of “cervical spondylosis” do not improve after strong stimulation of pressure point massage, medical diseases such as cerebral artery sclerosis should be considered more often in cases of “vertebral artery type cervical spondylosis”; in cases of “nerve root type cervical spondylosis In cases of “neurogenic cervical spondylosis”, more consideration should be given to diseases such as lateral sclerosis and “thoracic outlet syndrome”. The final diagnosis of the three mixed ineffective cases in the previous article was these three diseases.
In view of the fact that the stimulation of chronic mechanical compression of nerve tissues by cervical degenerative bone flab is neither likely to cause pain nor serious signs of nerve compression; as well as the fact that the author has not yet encountered one case requiring cervical decompression surgery due to pain caused by cervical degenerative bone flab in more than 20 years of clinical research on head, neck, back, shoulder, arm and hand pain. Therefore, I do not have a proper understanding of simple intra-cervical spinal canal lesions or mixed intra- and extra-cervical spinal canal lesions, so I dare not make subjective assumptions and jump to conclusions on diagnostic criteria in this book.
(3) Evaluation of vertebral arteriogram and cerebral hemogram for “vertebral artery cervical spondylosis”. The above two tests are nowadays recognized as the most reliable diagnostic tools to clarify the disease. However, the author has a different view on this. For vertebral arteriography, only bilateral involvement of the vertebral arteries leading to disturbance of the blood supply to the vertebrobasilar artery will cause cranial signs such as vertigo.
If someone does not perform such a scientific vertebral arteriogram to clarify the intrinsic or extrinsic causes of vertebral artery disease, and proceeds with anterior or posterior cervical spine surgery based on the positive results of cT scan or MRI alone, it will not cause signs. Since such advanced instruments can only show the mechanical compression of blood vessels or nerve tissues by intra-vertebral canal bones or disc protrusions, it is impossible to indicate whether these chronic compressions are sufficient to produce complete blockage of blood vessels or nerve tissues that have caused dysfunction, and whether there is a positive basis for aseptic inflammatory lesions in the fat between the compressions and the nerve sheath.
Therefore, the diagnosis is still unclear, leading to blindness in this surgery; it would be the biggest risk in treatment for the anterior cervical lateral anterior decompression surgery, which has a high mortality rate. Therefore, in the case of “cervical spondylosis”, vertebral arteriography is routinely performed, which can be said to be an important and indispensable measure for patient responsibility. The traditional diagnosis of ”vertebral artery cervical spondylosis” is scientific.
At present, in terms of vertebral arteriography, because of the complexity and low success rate of retrograde cannulation through the femoral artery or its branches, direct puncture through the vertebral artery or subclavian artery or retrograde cannulation through the brachial artery is preferred, especially the latter is listed by some scholars as a routine examination before vertebral artery decompression surgery. However, the latter two types of imaging can only show the unilateral vertebral artery and not the contralateral vertebral artery.
Even if there is objective evidence of unilateral vertebral artery compression and obstruction, the diagnosis of the disease cannot be established because the pathogenic condition of the contralateral vessels is unknown. Therefore, this routine preoperative examination of unilateral vertebral artery angiography is not helpful to improve the quality of treatment, but rather superfluous. Is it not a self-deceiving misconception to take this as an objective basis for the indication of surgery for “vertebral artery cervical spondylosis”?
As for the cerebral hemogram, the cerebral hemogram of vertigo patients can only indicate the data of whether there is blood supply disorder in vertebrobasilar artery, but it cannot determine the diagnosis of whether the disorder is caused by bony or muscular factors. In 40 cases with the same clinical manifestations of “vertebral artery cervical spondylosis” and typical bony degeneration of the cervical spine, which were diagnosed as “cervical spondylosis” according to the traditional criteria and inevitably ineffective in massage treatment, the author completely relieved the signs of pressure pain point strong stimulation massage.
When the cerebral hemogram was reexamined after pressure point stimulation, 67.50% of the abnormal cerebral hemograms were normalized, 25.00% were improved and 7.50% were disturbed as before. Secondly, the author also sampled 15 cases of “cervical spondylosis” in which the cranial signs were cured by extra-vertebral soft tissue release surgery 10 years ago as a control, and they worked normally for a long time after surgery without a history of recurrence of the signs, while the results of cerebral hemogram still suggested disorders of vertebrobasilar artery blood supply in 60% of cases.
This leads to the following.
(1) the cervical spondylosis (except spinal cord type) can be cured by strong stimulation of the pressure points of the head, neck, back and shoulder without dealing with the degenerative cervical spine and bone redundancy, which means that the cranio-cerebral signs have nothing to do with the bone redundancy and the real cause of the disease belongs to the soft tissue damage of the head, neck, back and shoulder outside the spinal canal;
The disappearance of cranial signs is not equal to the return of normal cerebral hemogram changes, and there is no inevitable causal relationship between the two (for details, see “Clinical study on the pathogenesis and diagnostic criteria of ‘vertebral artery cervical spondylosis'” in the above-mentioned “Compilation of papers”).
At present, many disciplines, especially internal medicine and physical diagnostics, tend to diagnose patients with severe cranio-cerebral signs complicated by soft tissue damage in the neck, back, and shoulder outside the spinal canal as “vertebrobasilar artery insufficiency”. Such a diagnosis is not consistent with… It is an important and urgent matter to make a diagnosis that is in line with the objective reality, and to be discussed in depth by the relevant colleagues, and to understand its essence and make a self-transformation.