Cervical disc herniation
The symptoms of nerve root or spinal cord damage due to herniated or ruptured intervertebral discs caused by cervical disc degeneration or trauma are called cervical disc herniation.
I. Diagnosis basis
1, mostly seen in young adults, with obvious history of neck trauma or occupational history of prolonged low head position work. Si Jingfu, Department of Tui Na, Xuzhou Chinese Medicine Hospital
2. In cases of nerve root compression, severe pain in the neck, shoulder and upper back with radiating neuralgia in the upper extremities; the pain is aggravated during neck movement and sleep. Muscle strength decreases, tendon reflexes are weakened or disappear, and brachial plexus nerve pull test is positive.
3.In those with cervical medullary compression, incomplete paralysis of limbs, motor sensory disorders, hyperactive tendon reflexes, knee and ankle clonus, positive pathological reflexes, and dysfunction of the second stool, etc.
4.Some patients have symptoms such as vertigo and headache.
5.X-ray examination excludes other lesions such as fracture and dislocation, and can find some non-specific signs of instability, such as angulation of the anterior and posterior edges of the cervical vertebrae, anterior or posterior tilt of the vertebral body, cervical slippage, narrowing of the lesioned vertebral space or narrowing of the anterior and posterior width, etc., but the vertebral body bones are not necessarily obvious.
6, CT scan is helpful for the diagnosis of this disease; MRI examination can show the protrusion of intervertebral disc tissue into the spinal canal and compression of cervical nerve root, dural sac or spinal cord.
Second, the classification of symptoms
1.Category of Chinese medicine symptoms
Qi stagnation and blood stasis: sudden onset or sudden aggravation of symptoms, with history of trauma before onset; stiffness in the neck, severe pain and radiation to the back and arms and fingers. Dark tongue, or petechiae, petechiae, and astringent pulse.
Interconnection of phlegm and stasis: severe pain in the neck, back, shoulder and arm, weakness in the upper limbs, dizziness, heaviness like a wrap; palpitation, nausea, tiredness and drowsiness; choking in the throat, chest tightness and distension, distention and fullness in the stomach and epigastrium, and unpleasant complexion. The tongue is purple and dark, the coating is white and greasy, and the pulse is stringent and astringent.
Liver and kidney deficiency: slow onset, pain in the neck and arms, impotence and weakness in the lower extremities, constricted tendons and veins, staggering gait, or even bedridden; soft waist and knees, difficulty in passing stool, sexual dysfunction. The tongue is fat, with tooth marks on the side, and the pulse is sunken and weak.
2.Modern medical typing
Lateral type: The main clinical manifestation is nerve root compression; MRI examination can show that the intervertebral disc protrudes posteriorly in the shape of a block or fragment, compressing the lateral side of the cervical spinal cord and one side of the nerve root; the anterolateral side of the cervical spinal cord is deformed and displaced posteriorly or to the healthy side; the nerve root is displaced posteriorly or the image disappears.
Central type: The main clinical manifestation is cervical spinal cord compression, MRI examination can show that the intervertebral disc protrudes in a mass, compressing the anterior central part of the cervical spinal cord, and the compressed spinal cord can be bent, flattened or depressed locally and shifted to the posterior side, and there are signs of signal abnormalities.
III. Treatment plan
1.Treatment by identification
Qi stagnation and blood stasis: activate blood stasis, move Qi and relieve pain by rolling, pressing and kneading or pushing with one finger on the back of the neck, shoulder and upper limb of the affected side, and applying gentle and light pulling and stretching method on the neck. For those who have cervical vertebral hyperflexion, cervical spine adjustment techniques can be reasonably applied to restore normal curvature and reduce spinal cord and nerve root tension.
Phlegm and blood stasis: dispel phlegm and remove blood stasis, promote paralysis and open the ligaments. On the basis of the cervical manipulation, the patient’s head and face can be gently manipulated with the one-finger zen pushing method and the fish interval kneading method to eliminate the symptoms of vertigo. For those who have cervical vertebrae reversion, cervical spine adjustment techniques can be reasonably applied to restore normal curvature and reduce tension on the spinal cord and nerve roots.
Liver and kidney deficiency: nourish liver and kidney, strengthen tendons and bones. On the basis of cervical manipulation, roll and knead the thoracic spine, lumbar spine and lower limbs to improve the spinal curve, reduce spinal cord tension and decrease muscle spasm.
2.Other therapies
Acupuncture: Fengchi, Tianzhu, cervical spine and other points can be used.
Drugs: Chinese herbal medicines can be used to activate blood circulation and remove blood stasis internally or externally, and antipyretic and analgesic drugs can be used. Mannitol or sorbitol intravenous drip for dehydration is suitable for the acute stage.
Closure: cervical nerve root closure or sacral drip is suitable for the acute stage.
3. Complication management
After the appearance of severe spinal cord compression symptoms, patients should be promptly advised to undergo surgical treatment.
4. Precautions
Pay attention to the safety of manipulation, cervical spine adjustment techniques should not be rough, and it is recommended to inform patients of the possible hazards of manipulation before treatment.
Traction therapy should be used with caution, especially for central type cervical disc prolapse.
The acute phase should be protected by a cervical brace.
Pay attention to the position and time of work and study, the rationality of using pillows and the warmth of the back of the neck and shoulder.
After the symptoms are relieved, the functional exercise of cervical muscles should be insisted on.