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Abstract: Spinal cord cervical spondylosis is a type of cervical spondylosis, which is a degenerative disease of the cervical spine. These diseases are more serious, and clinical symptoms should be sought promptly once they appear. In this case, a 45-year-old male, who had unstable walking symptoms for 5 years without any treatment during that period, came to our hospital with difficulty in walking 3 days ago, and was clearly diagnosed with spinal cord-type cervical spondylosis after examination and given surgical treatment, as well as medication, and was discharged from the hospital after his symptoms improved, and was instructed to adhere to rehabilitation exercises and to be reviewed after 1 month.
Basic information】Male, 45 years old
Disease Type】Cervical spondylosis (spinal cord type cervical spondylosis)
Hospital】The First Hospital of China Medical University
Date of consultation】April 2022
Treatment plan】Surgery (anterior cervical surgery) + medication (methylcobalamin tablets, ceftriaxone sodium for injection, amoxicillin sodium clavulanate potassium for injection)
Treatment Period】Post-operative hospitalization for 2 weeks, review 1 month after discharge
Treatment effect] The patient regained normal walking ability
I. Initial consultation
The patient came to our hospital 5 years ago with no obvious cause of unstable walking, no upper limb numbness, no limitation of movement, no extremity pain, no headache, no dizziness, no nausea, no vomiting, no confusion, no abdominal pain, repeatedly came to our hospital and was given oral medication (specific details unknown) with poor results, and 3 days ago had difficulty walking and came to our hospital for further treatment. Outpatient cervical spine X-ray and CT film showed: cervical 2-3 vertebral fusion degeneration; C3/4, C4/5, C5/6 disc protrusion; C2, 3 fused vertebral deformity; L5/S1 disc mild protrusion; L4 vertebral body old compression fracture. The patient was initially diagnosed as “spinal cervical spondylosis” and admitted to our department for treatment. Since the onset of the disease, the patient had a clear consciousness, was mentally competent, could eat and drink, and had no urinary or fecal incontinence.
Treatment history
After the patient was admitted to the hospital, we communicated with the patient and his family and informed them that surgery was the main treatment for spinal cord cervical spondylosis, and that drug treatment could only relieve the patient’s discomfort and could not treat the disease fundamentally. Initially, the patient was nervous when hearing about the surgical treatment, but after understanding the safety and necessity of the surgery, he expressed his understanding, so our hospital actively carried out treatment measures. After further improvement of the MRI examination, the site and extent of the lesion were clarified, and the plan of anterior cervical surgery was determined. The diseased disc was removed and bone grafting was performed between the vertebral bodies, while internal fixation was performed to maintain the height of the intervertebral space and the normal physiological curvature of the cervical spine. After the operation, we took methylcobalamin tablets to nourish the local nerves as prescribed by the doctor, and used sodium ceftriaxone for injection and potassium amoxicillin sodium clavulanate for injection intravenously to prevent the occurrence of postoperative infection.
III. Treatment effect
Before treatment, the patient had unstable walking, X-ray and CT examination: C3/4, C4/5, C5/6 disc protrusion, and old compression fracture of L4 vertebrae. After admission for treatment via anterior cervical surgery, repeat X-ray examination: C3/4, C4/5 and C5/6 discs returned to normal position, L4 vertebrae fused well with bone graft, and the vertebral space was normal. The patient was observed walking with a stable gait and good recovery. The patient reported no other discomfort and no other postoperative complications, and the patient and his family requested to be discharged. The patient was discharged after assessing the patient’s overall condition. The patient was instructed to return to the hospital for a review one month after discharge, and to go to the hospital promptly if the symptoms of unstable walking or neck discomfort recurred during the period.
IV. Precautions
The patient’s clinical symptoms improved after treatment, and I was sincerely happy for the patient. I believed that the patient could recover better by adhering to rehabilitation exercises. Therefore, I advise the patient that in order to prevent poor postoperative recovery, the following points still need to be noted after discharge.
1. Do not lower your head or ambulate for too long after discharge, do not perform strenuous exercises during the recovery period, and pay attention to gentle movements when turning and lifting your head.
2, daily diet adjustment, choose food rich in high quality protein, vitamins and other nutrients, can promote wound healing and post-operative recovery.
3, patients should also strengthen their awareness of self-protection after discharge to avoid accidental injuries such as neck impact and falls.
4. Although the weather gradually warms up after discharge, patients still need to pay attention to neck warmth and avoid cold wind blowing directly on the neck to avoid damage to the neck muscles.
V. Personal insight
The main pathological feature of spinal cord cervical spondylosis is the compression of the spinal cord and irreversible changes such as demyelination of nerve cells, which leads to clinical symptoms such as unstable walking, numbness of both upper limbs, weakness of holding objects, numbness of the lower limbs, and a feeling of stepping on cotton when walking. Most patients, such as the patient in this case, are afraid of surgical treatment because they are worried about the trauma of surgery on the one hand and the poor postoperative efficacy on the other. Therefore, before determining the treatment plan, we need to actively communicate with patients to inform them of the safety of surgery and the better postoperative results, so as to change their traditional understanding of surgery and help them to actively cooperate with rehabilitation treatment after surgery and achieve satisfactory recovery results.