Cervical spondylosis is a common disease of the middle-aged and elderly. As we age, degenerative changes occur in the cervical intervertebral discs, affecting the stability of the cervical spine and producing a series of pathological changes. These changes directly stimulate, compress or cause functional or structural damage to the cervical spinal nerve roots, spinal cord, vertebral artery and sympathetic nerves by affecting blood flow, causing the corresponding clinical symptoms.
Clinical manifestations Currently, most experts tend to classify cervical spondylosis into cervical, nerve root, spinal cord, vertebral artery and sympathetic nerve types.
I. Cervical cervical spondylosis
1. The pathology of cervical cervical spondylosis is characterized by the early stage of degeneration of the intervertebral disc, with partial destruction of the structure of the fibrous ring, mild bulging of the intervertebral disc tissue and mild hyperplasia of the vertebral bones, which have not yet constituted substantial compression of the nerves and vascular tissues, but can stimulate the sensory fibers of the sinus nerve distributed between them. The latter issues afferent impulses to the center, and through the pathway of spinal segmental reflexes and proximal segmental reflexes, resulting in a state of continuous tension in the muscles of the cervical collar and interscapular region, resulting in muscle tension pain in the region.
2.Due to the decrease of cervical spine stability, it is easy to cause paravertebral soft tissue injury and cervical spine segmental misalignment due to excessive movement in daily life.
3.Soreness at the muscular attachment of the inner edge of the scapula and easy fatigue of the neck.
4. Frequent episodes of “falling pillow” occur.
2.Neurogenic cervical spondylosis
1.The pathology of neurogenic cervical spondylosis is characterized by the formation of a mixed protrusion of cervical hook joint hyperplasia, synovial redundancy and injured and swollen soft tissues, which produces a double injury of mechanical compression and chemical stimulation to the nerve roots, causing typical radiological neuralgia.
2, cervical vertebrae misalignment and nerve root injury often have a direct causal relationship, misaligned vertebrae reduce the internal diameter of the intervertebral foramen and nerve root canal on one side by a small amount, further exacerbating the contradiction between its reduced volume and the volume of its contents, causing acute attacks of clinical symptoms.
3. The prominent manifestation is radiating pain transmitted to the upper limbs. Radiation neuralgia is often characterized by acute attacks or acute aggravation on the basis of chronic pain.
4.The skin innervated by the compressed nerve root may show hyperalgesia in the acute stage, and later show hyperalgesia; the innervated muscles often show muscle weakness, but obvious muscle atrophy is rare.
5. The range of motion of the neck is reduced, especially the range of motion of rotation and lateral flexion to the affected side is more obviously limited, and if rotation and lateral flexion are forced to the affected side, it may lead to aggravation of radiological neuralgia. In the special examination, the brachial plexus nerve pull test is positive; the buckling test and intervertebral foraminal compression test further reduce the upper and lower foraminal diameters and cause increased radiological pain in the upper extremity, which is positive; the cervical extension test reduces radiological pain by expanding the scale of the upper and lower foraminal diameters, which is also positive. Sometimes the biceps or triceps reflexes of the affected limbs are seen to be weakened.
C. Spinal cord type cervical spondylosis
1.The pathology of spinal cord cervical spondylosis is characterized by bulging cervical intervertebral disc tissue, hyperplastic vertebral body posterior margin bone redundancy, downward slipping vertebral body, thickened ligamentum flavum and swollen soft tissue in the spinal canal forming a mixed protrusion, causing compression of the spinal cord; or due to the involvement of vascular factors, resulting in ischemia, degeneration and necrosis of the spinal cord, and thus causing dysfunction of the long conduction bundle of the spinal cord.
2, manifested as wavy, progressive numbness and motor impairment of both lower limbs. Patients feel weakness in the lower extremities, unstable walking, clumsy gait, and complain of the feeling of “stepping on cotton” under the feet.
The symptoms of upper limbs are not typical, mainly heavy and weak, and radicular pain is not common.
4.The examination shows that the lower limb muscle tone is increased, muscle strength is decreased, knee and ankle reflexes are hyperactive, patellar clonus and ankle clonus can be seen, and pathological reflexes are positive.
5.Sensory impairment is unbalanced, generally pain and temperature sensory impairment is obvious while tactile sensory impairment is mild or normal, lower extremity sensory impairment is more severe while trunk sensory impairment is less severe.
6. On the lateral X-ray film, there is a more obvious bone redundancy at the posterior edge of the vertebral body and/or the vertebral body slips backward and downward along the oblique surface of the posterior articular eminence, but it is necessary to rely on CT or MRI examination to determine whether there is mechanical compression of the cervical spinal cord.
IV. Vertebral artery type cervical spondylosis
1, the pathology of vertebral artery type is characterized by distortion of the vertebral artery due to disc degeneration and misalignment of the superior cervical spine, torsion of the bony noncontinuous canal of the transverse foramen, or compression of the vertebral artery due to osteophytes at the posterior outer edge of the vertebral body and the barbicular process, or spasm of the terminal branch of the artery due to stimulation of the sympathetic plexus of the vertebral artery, causing ischemia in the vertebral artery supply areas such as the brainstem, cerebellum, and occipital lobe of the brain.
2.Vertigo is the main symptom of vertebral artery type cervical spondylosis.
It manifests as chronic and persistent vertigo due to long-term inadequate blood supply to the vertebral artery.
Due to transient blockage of vertebral artery blood supply, it is manifested as episodic severe vertigo, and the onset of vertigo is often related to the change of head position.
3. Mental depression, lethargy and drowsiness.
4.Tinnitus and deafness; reduced visual acuity.
5.Brain ultrasound can detect the blood flow status of intracranial branches of vertebral artery through the skull, which theoretically has special diagnostic significance for vertebral artery type cervical spondylosis.
6. Vertebral arteriography has positive guiding significance for this type of cervical spondylosis.
V. Sympathetic cervical spondylosis
1.The pathology of sympathetic cervical spondylosis is characterized by the stimulation of cervical sympathetic nerve fibers by the hyperplastic bone flab, spastic prevertebral muscle groups and inflammatory mediators, causing abnormal increase or inhibition of sympathetic nerve tension and the dysfunctional activities of glands, blood vessels and internal organs in the corresponding areas of the body.
2. Chronic headache is the most prominent symptom of sympathetic cervical spondylosis. Headaches tend to be persistent and appear mainly in the frontal area, especially in the eye sockets and brow ridge bones.
3.When the eyes are affected, due to sympathetic excitation, the secretion of atrial fluid is inhibited, and the intraocular pressure drops, patients often experience pain in the eyes with nausea and vomiting.
4.When the mucous membrane of the throat and esophagus is involved, the disruption of mucosal gland secretion and smooth muscle activity may produce throat discomfort, dryness and foreign body sensation, belching, etc.
5, interference with the sympathetic tension of the heart can cause the so-called “coronary heart syndrome”, the patient feels suffocated in the anterior chest area, palpitations and palpitations; electrocardiogram examination has sinus arrhythmia, premature ventricular oscillation, tachycardia and other abnormal electrocardiographic activity. When it leads to systemic sympathetic tension, it can cause cervical hypertension.
VI. Treatment
Objective: to loosen the strained, tense or even spastic cervical muscles, especially the cervical extensor muscles, improve their mechanical properties, interrupt the pain-muscle tension-pain vicious cycle chain, and promote the elimination of soft tissue injury inflammation; to adjust the abnormal displacement or angle of cervical vertebral segments, reduce the disc load, slow down the cervical degeneration process, expand the intervertebral foramen, spinal canal and transverse process The effective space of discontinuous bony canal of foramen, spinal canal and transverse process can be enlarged, the high stress state and nerve root tension inside and outside the cervical spinal canal can be improved, the mechanical compression and stimulation of nerve and blood vessel can be reduced or eliminated, and the balance of dynamic and static force of cervical spine can be restored.
Treatment: loosening, adjusting the site and acupuncture points: the site is mainly in the cervical collar, posterior occipital region, scapular region, posterior transverse process node and thoracic spine; acupuncture points are mainly Fengchi, cervical spine, Tian Ding, shoulder well, Tian Zong and A’s point.
Manipulation: Stimulating manipulation and cervical spine adjustment manipulation are used, with stimulating manipulation as the basis; cervical manipulation is combined with meridian manipulation stimulation, with cervical manipulation as the main principle. The specific choice is one-finger meditation pushing method, 扌衮 method, pulling and stretching method, pushing method, taking method, pressing and kneading method and cervical spine fine-tuning method.
Prognosis: After the onset of cervical spondylosis, if patients can receive reasonable and appropriate treatment, with the corresponding functional exercise, and pay attention to self-protection, the prognosis is generally quite good. However, if the spinal cord type cervical spondylosis further deteriorates and develops, the prognosis is poor; if the nerve root type, vertebral artery type and sympathetic type cervical spondylosis develop without regular treatment, it will seriously affect the life and work of patients.
Maintenance.
1, cervical spondylosis patients should usually implement the principle of “head up and arm up, coordination and balance”, in order to exercise the posterior extension muscles of the neck, balance the long-term low head position caused by the stress and stability of the neck balance disorders.
2, pay attention to correct the usual bad habits posture, based on the prevention.
3.Pay attention to the reasonableness of the pillow.
4. Pay attention to the warmth of the shoulder and neck.