The clinical manifestations of cervical spondylosis are complex, and according to the different tissue structures and symptoms, the cervical spine is divided into six types: cervical, nerve root, vertebral artery, spinal cord, sympathetic nerve and mixed.
1. Cervical type cervical spondylosis.
Clinical performance characteristics of neck pain, often the first symptom of cervical spondylosis, acute onset is commonly known as “pillow” accounted for 80% of cervical spondylosis, the duration of this type of disease is long, sometimes light and sometimes heavy, can last for several months to several years. Clinical symptoms are induced by improper head and neck position during sleep, cold or sudden twisting of the neck during physical activity, with persistent soreness or pain, aggravated when the head moves, spreading to the back of the shoulder and the upper limb behind the head, pain accompanied by a stiff feeling in the neck, and a ringing sound in the neck when turning.
①. Some people have a skewed neck. Normal or restricted movement . There are often pressure points in the trapezius, rhomboid, supraspinatus, infraspinatus, scaphoid or large and small circular muscles, and sternocleidomastoid muscle exhaustion and pressure pains may also occur with paraneoplastic involvement.
(2) On palpation of the neck, there may be swelling and tenderness of the superior ligament and paraspinal tenderness, mostly without radiating pain. There may be interspinous changes and lateral protrusion of the spinous process, which is more common in the lower cervical spine.
③Intervertebral foramen compression test and brachial plexus nerve pull test are negative, muscle tone is normal, there is no hypotonia and muscle atrophy, upper and lower tendon reflexes are normal, and there is no pathological reflex.
The orthopantomogram showed “bilateral” and “double protrusion” signs of the posterior cervical joints, unequal width of the adjacent hook vertebral joints and asymmetry of the hook vertebral joints on both sides. Lateral radiographs can show changes in the physiological curve of the cervical spine, such as straightening, reversion, interruption, angulation or step-like changes. It can be more obvious in functional radiographs or dynamic observation of the cervical spine. In some cases, overshadowing and incongruent changes of the synovial joints can be seen. In a few patients, there are no radiographic changes or only changes in the physiological curve of the cervical spine.
2.Nerve root type cervical spondylosis.
The neurogenic type mainly develops in middle-aged and elderly people, and the incidence is second only to the cervical type. The cause is mainly due to nerve compression and stimulation caused by lesions of the cervical spine, intervertebral foramen, adjacent tissue adhesions and joint misalignment, among which cervical 5, 6 and 7 nerve involvement is common. The symptoms are electric shock-like radiation from single or several nerve roots on the affected side from the neck to the shoulder, arm, forearm and hand, often with drilling pain or cutting pain, and most of them can also show sensations such as heaviness and weakness of the affected upper limbs and numbness.
On examination, the patient’s neck is stiff, movement is limited, the cervical physiological foreshortening becomes smaller, there are multiple pressure points in the neck, and the most diagnostic significance is the radiological pressure pain on both sides of the corresponding cervical spine. The head press test, supination test and brachial plexus nerve pull test are often positive. On X-ray examination, the physiological anterior convexity of cervical vertebrae is reduced or disappears, the vertebral space becomes narrow, the hook vertebral joint spur, the intervertebral foramen narrows, and a few have changes such as vertebral body or joint dislocation.
3.Vertebral artery type cervical spondylosis
(1) Vertigo: It is the most common, and almost every patient has vertigo of varying severity, mostly accompanied by diplopia, nystagmus, tinnitus, deafness, nausea and vomiting. During the attack, the head is heavy and the feet are light, and the standing is unstable, as if oneself and the surrounding scenery are rotating in a certain direction; some of them feel that they and the ground are moving, tilting and swaying. Vertigo or dizziness often occurs when the head is moved, such as when the head is tilted upward, when the head is suddenly turned or when the head is repeatedly turned from side to side, and in severe cases, dizziness or coma may occur. Some patients can only turn their heads to one side, but turning to the opposite side can easily lead to an attack, and turning to the opposite side again can reduce the symptoms; some patients also complain of an attack when they look at the blackboard while taking notes with their heads down. In short, the activity of the head and neck and posture change induce or aggravate vertigo is an important feature of this disease.
(2) Sudden collapse: It is a symptom unique to this type. Some of them occur when the vertigo is intense or when the neck is active, and they can suddenly fall down with numbness and weakness of limbs, but they are clear and can get up by themselves mostly. Such attacks are associated with sudden head movement or postural changes. Some people think it is caused by ischemia of the medulla oblongata, while others think it is caused by sudden ischemia at the intersection of vertebral bodies.
(3) Headache: A vascular headache caused by vasodilatation of the collateral circulation due to insufficient blood supply to the vertebrobasilar artery, which occurs episodically and lasts for minutes or hours or even days. The pain is persistent, often appearing or worsening in the morning, during head movement, or when riding in a car. The pain is mostly located in the occipital region, top of the occipital region or temporal region, and is throbbing (pulsating pain), burning pain or swelling pain, which can be directed to the back of the ear, face, teeth, top of the occipital region. It may radiate to the postauricular region, face, teeth, top of the occipital region, or even the orbital region and the root of the nose. During the attack, there may be nausea, vomiting, sweating, salivation, panic, breath-holding, and blood pressure changes and other symptoms of vegetative nerve dysfunction. In individual cases, there is pain, numbness, tingling or foreign body sensation in the face, hard palate, tongue and pharynx during the attack. Therefore. Similar to the manifestation of migraine, some people call it cervical migraine.
(4) Ocular symptoms: such as visual haze, flashing lights in front of the eyes, dark spots, transient dark haze, temporary visual field defects, vision loss, diplopia, hallucinations, and blindness, which are mainly caused by ischemia of the posterior cerebral artery. Visual impairment is mainly caused by ischemia in the visual center of the occipital lobe of the brain, so it can be called cortical visual impairment. Ischemia of the third, fourth and sixth cranial nerve nuclei and medial longitudinal capsule can cause diplopia. In addition, because the pushing vein is connected to the internal carotid artery system by the posterior communicating artery, it can reflexively cause retinal artery spasm and result in ocular pain and changes in the vascular tone of the fundus. Dilatation of the fundus venosus and thinning of the arteries are common during episodes, especially during neck hyperextension. Individual patients may develop vasospastic retinitis. Blepharospasm, conjunctival congestion, decreased corneal sensation leading to ulcer formation, impaired lacrimal secretion, retrobulbar optic neuritis, proptosis, glaucoma, and Horner’s sign have also been reported in some patients.
(5) Medullary paralysis and other cranial nerve symptoms: such as slurred speech, swallowing disorder, loss of gag reflex, choking, soft palate paralysis, hoarseness, tongue extension disorder, eye and facial muscle twitching and facial nerve paralysis, etc.
(6) Sensory disorders: there may be numbness of the face, perioral area, tongue, extremities or half of the body, some with pins and needles sensation, ankylosis, and some may have deep sensory disorders.
From the above manifestations, it can be seen that the symptoms of this disease are many and mixed, but the diagnosis can still be made based on physical examination, x-ray and cerebral hemogram. Therefore, it is appropriate to rest on the back during the attack, and the pillow should be lowered to reduce the movement of the cervical spine. In addition, it is especially important to prevent new injuries caused by quenching and falling.
4.Spinal cord type cervical spondylosis.
①Motor disorders:Firstly, it manifests as weakness of lower limbs, clumsy gait, trembling, etc. It gradually develops into muscle twitching, easy to fall, and spastic paralysis in the late stage. According to the site of compression, motor disorders can have the following types; quadriplegia, paraplegia, triplegia, hemiplegia, cross paresis and anterior spinal artery type (only motor disorders without sensory damage).
②Sensory impairment: usually starts with numbness in the lower extremities and gradually progresses upward. However, the plane of sensory impairment is not neat and is often below the plane of the lesion. Dissociative sensory impairment may occur, i.e. pain and temperature sensation are significantly impaired while tactile sensation is normal or mildly impaired.
(iii) Ataxia.
④Physeal nerve and sphincter dysfunction, such as limb coldness, swelling, blood flow disorders, urinary and fecal dysfunction, etc.
⑤ Presence of pathological reflexes.
If mixed with other types of cervical spondylosis, the symptoms and signs are more complicated.
5.Sympathetic cervical spondylosis
(1) Five sensory symptoms.
1, eye: there are symptoms of sympathetic nerve stimulation (eye distension disease, photophobia, tearing, blurred vision, vision loss, pupil enlargement, eye danger weakness, gold stars in front of the eyes, flying mosquitoes, etc.) and sympathetic nerve paralysis symptoms (eye sunken, eye danger drooping, eye dryness, pupil narrowing.
2.Nose: nasopharyngeal discomfort, pain, nasal congestion or a sense of odor, etc.
3.Ear: tinnitus, hearing loss, and even deafness.
4.Throat: there may be throat discomfort, dryness, foreign body sensation, warmth, and toothache, etc.
(2) Head and facial symptoms: headache, migraine, head sinking and dizziness, pain in the comb or the back of the neck, as well as facial fever, congestion, and numbness.
(3) Vasomotor disorders.
1, vasospastic symptoms: coldness, cyanosis, numbness, pain, edema in the limbs, as well as decreased skin temperature.
2, vasodilatory symptoms: redness, burning, pain, and swelling of the finger ends.
(4) Neurotrophic and sweat gland dysfunction: skin cyanosis, coolness, dryness, thinning, excessive or little sweating, excessive hair, or hair in withering, shedding, dry and lusterless nails, as well as trophic skin ulcers, etc.
(5) Cardiovascular symptoms: panic, heartbeat, arrhythmia, precordial pain, paroxysmal tachycardia, high and low blood pressure.
(6) Other symptoms: nausea, warmth, stomach discomfort, pain, loose stools or constipation, frequent urination, urgent urination, dribbling, and amenorrhea may be present. Many patients also have emotional symptoms such as insomnia, dreaminess, irritability and impulsiveness. Sympathetic cervical spondylosis alone is rare and difficult to diagnose. The initial diagnosis is usually made based on the above-mentioned manifestations of phytonadic dysfunction, the effect of cervical spine activity and posture on symptoms, degenerative changes in the cervical spine, such as narrowing of the intervertebral space, asymmetry and hyperplasia of the hook vertebral joints, misalignment of small joints, narrow intervertebral foramina and bone spurs, and other similar diseases are excluded. If necessary, planetary ganglion or supracervical sympathetic ganglion and high-best epidural closure can help in the diagnosis. The diagnosis is easier for those with radicular or medullary cervical spondylosis and signs.