What Is Cervical Spondylosis?

Cervical spondylosis, also known as cervical syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical symptoms of dysfunction. Vertebral instability and loosening; nucleus pulposus prolapse or prolapse; bone spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulate or compress the adjacent nerve root, spinal cord, vertebral artery and cervical sympathetic nerves, etc. Causes a range of symptoms and signs.

Basic Information

nickname: Cervical syndrome
English name: cervical spondylosis
Visiting department: orthopedics

Multiple groups: Middle-aged and elderly people, poor sleeping posture, long-term improper sitting posture
Common causes: Cervical spine degeneration, developmental cervical spinal stenosis, chronic strain, etc.
Common symptoms: Neck pain, weakness of upper limbs, numbness of fingers, weakness of lower limbs, etc.

Causes of cervical spondylosis

Degeneration of cervical spine

Cervical spine degenerative changes are the main cause of cervical spondylosis. Among them, the degeneration of intervertebral discs is particularly important. It is the first cause of cervical spine structural degeneration, and it has evolved a series of pathological anatomy and pathophysiology of cervical spondylosis. Degeneration of the intervertebral disc; The appearance of ligament-disc space and the formation of hematoma; Spur formation at the edge of the vertebra; Degeneration of other parts of the cervical spine; Sagittal diameter and volume of the spinal canal decreased.

2. Developmental cervical spinal stenosis

In recent years, it has been clear that the internal diameter of the cervical spinal canal, especially the sagittal diameter, is not only closely related to the occurrence and development of cervical spondylosis, but also has a close relationship with the diagnosis, treatment, surgical method selection and prognosis of cervical spondylosis. Some people have severe cervical spine degeneration and obvious osteophytic hyperplasia, but they do not develop disease. The main reason is that the cervical spinal canal has a wide sagittal diameter and there is a large compensation gap in the spinal canal. In some patients, cervical degeneration is not very severe, but symptoms appear early and are more severe.

3. Chronic strain

Chronic strain refers to all kinds of over-limit activities that exceed the maximum range of normal physiological activities or the local tolerable time. Because it is different from obvious trauma or accidents in life and work, it is easy to be ignored, but it has a direct relationship with the occurrence, development, treatment and prognosis of cervical spondylosis. The causes and causes of such strains mainly come from the following three conditions:

(1) Poor sleep position Poor sleep position due to its long duration and inability to adjust in time when the brain is at rest will inevitably cause imbalance of the paravertebral muscles, ligaments and joints.

(2) A large number of statistical data on improper working postures show that some workloads are not heavy and the intensity is not high, but they are in a sitting position, especially the incidence of cervical spondylosis is particularly high for lowered workers, including domestic workers, embroidery women workers, office workers, Typing scribes, assemblers on instrumentation lines, and more.

(3) Inappropriate physical exercise Normal physical exercise is conducive to health, but activities or sports that exceed the neck's tolerance, such as human headstands or somersaults with head and neck support points, can increase the load on the cervical spine , Especially in the absence of proper guidance.

4. Congenital malformation of the cervical spine

When performing a health check or comparative research on normal cervical vertebrae, it is often found that various abnormalities can be seen in the cervical spine, of which about 5% are obvious bone deformities.

Clinical manifestations of cervical spondylosis

The clinical symptoms of cervical spondylosis are more complicated. It mainly includes neck and back pain, weakness of upper limbs, numbness of fingers, weakness of lower limbs, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia, and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the lesion location, tissue involvement and individual differences.

Nerve root cervical spondylosis

(1) It has more typical root symptoms (numbness, pain), and the range is consistent with the area dominated by the cervical spine nerves.

(2) The indenter test or brachial plexus pull test is positive.

(3) The imaging findings are consistent with clinical manifestations.

(4) No significant effect on pain point closure.

(5) Excluding diseases of the upper extremity caused by external cervical spine diseases such as thoracic outlet syndrome, carpal tunnel syndrome, elbow tunnel syndrome, and periarthritis.

2. Spinal cervical spondylosis

(1) Clinical manifestations of cervical spinal cord injury.

(2) X-ray film showed osteogenesis and spinal stenosis at the posterior edge of the vertebral body. Imaging confirmed spinal cord compression.

(3) Excluding amyotrophic lateral sclerosis, spinal cord tumors, spinal cord injuries, and multiple peripheral neuritis.

3. Vertebral artery type cervical spondylosis

(1) There has been a sudden onset. And accompanied by cervical vertigo.

(2) Positive neck rotation test.

(3) X-ray films show segmental instability or osteoarticular hyperplasia of the vertebral joints.

(4) Many sympathetic symptoms.

(5) Excluding ocular and otic vertigo.

(6) Excluded basal artery blood supply insufficiency caused by compression of the vertebral artery segment I (vertebral artery segment before entering the cervical transverse foramen) and vertebral artery segment III (vertebral artery segment before exiting the cervical vertebra into the skull)

(7) Vertebral angiography or digital subtraction vertebral angiography (DSA) is required before surgery.

4. Sympathetic cervical spondylosis

The clinical manifestations are a series of sympathetic symptoms such as dizziness, vertigo, tinnitus, numbness, tachycardia, and pain in the anterior region of the heart. X-rays show cervical spine instability or degeneration. Vertebral arteriography was negative.

5. Cervical Spondylopathy of Esophageal Compression

Anterior beak-like hyperplasia of the cervical spine compresses the esophagus and causes swallowing difficulties (confirmed by esophageal barium examination).

6. Cervical cervical spondylosis

Cervical cervical spondylosis is also known as local cervical spondylosis, which refers to pain in the head, shoulders, neck, and arms and corresponding tender points. There are no obvious degenerative changes such as stenosis of the intervertebral space on the X-ray, but there can be cervical physiological curves Changes, intervertebral instability, and mild osteogenesis.

Cervical spondylosis

Test of cervical spondylosis

The physical examination of cervical spondylosis includes:

(1) Anterior flexion and neck rotation test Make the patient flex his neck forward and instruct him to rotate left and right. If there is pain in the cervical spine, it indicates that the cervical facet joints have degenerative changes.

(2) The foraminal compression test (indentation test) makes the patient's head deviate to the affected side. The examiner's left palm is placed on the top of the patient's head, the fist of the right hand is flicked and the back of the left hand is tapped. Radiation pain or numbness in the limbs appears, indicating that the power is transmitted downward When the intervertebral foramen becomes smaller, there is root damage. For those with severe root pain, the examiner can place the top of the head with both hands and pressurize under the head, which can induce or exacerbate the symptoms. A positive compression test when the patient's head is in the neutral or posterior extension is called a positive Jackson indentation test.

(3) Brachial plexus pull test The patient lowers his head, the examiner holds the patient's head and neck with one hand, and the other hand holds the wrist of the affected limb. Push and pull in the opposite direction to see if the patient feels radiation pain or numbness. This is called the Eaten test. If the affected limb is forced to perform internal rotation at the same time, it is called the Eaten strengthening test.

(4) Upper limb posterior extension test The examiner puts one hand on the shoulder of the healthy side for fixation, and holds the other hand on the patient's wrist, and gradually stretches it backward and outward to increase the cervical nerve root pull. Radiation pain in the affected limb indicates compression or injury to the cervical nerve root or brachial plexus.

2.X-ray inspection

About 90% of men over 40 years of age and women over 45 years of age have bone spurs in the cervical spine. Therefore, changes in plain radiographs may not necessarily have clinical symptoms. The X-ray findings related to cervical spondylosis are now summarized as follows:

(1) Orthopedic Observation: Dislocation, fracture or loss of odontoid. Whether the seventh cervical transverse process is too long, with or without cervical ribs. Whether the hook joints and intervertebral space are widened or narrowed.

(2) Changes in lateral position The curvature of the cervical spine is straight, and the physiological protuberance disappears or reverses. Abnormal movement In the cervical spine hyperextension and flexion lateral radiographs, you can see that the elasticity of the disc has changed. Osteophyte The osteophyte and calcification of ligaments can be generated in the vertebral body near the disc. narrowing of the intervertebral disc The intervertebral disc can be thinned because the nucleus pulposus protrudes, and the water content of the intervertebral disc is reduced, resulting in fibrosis and thinning. Subluxation and intervertebral foramina become smaller After intervertebral disc degeneration, the stability between the vertebral bodies is low, and the vertebral body often undergoes subluxation, or is called vertebral vertebrae. calcification of the term ligament calcification of the term ligament is one of the typical lesions of cervical spondylosis.

(3) Oblique The left and right oblique films of the spine are mainly used to observe the size of the intervertebral foramen and the bone hyperplasia of the hook joint.

3. EMG examination

Cervical spondylosis and cervical disc herniation can indicate that the nerve roots have been decompressed for a long time and degeneration has occurred, thereby losing the inhibitory effect on the dominant muscles.

4.CT inspection

CT has been used to diagnose spinal canal enlargement or bone destruction caused by posterior longitudinal ligament ossification, spinal canal stenosis, spinal cord tumors, etc., measuring bone density to estimate the degree of osteoporosis. In addition, the soft tissue and subarachnoid space inside and outside the dural sheath can be clearly seen due to the cross-sectional image. Therefore, it can correctly diagnose disc herniation, neurofibromas, cavities of the spinal cord or medulla, and has certain value for the diagnosis and differential diagnosis of cervical spondylosis.

Cervical Spondylosis Diagnosis

Can be diagnosed based on clinical manifestations and examinations.

Differential diagnosis of cervical spondylosis

1. Nerve root cervical spondylosis needs to be distinguished from the following diseases

Cervical rib and anterior scalene syndrome, spinal canal and extramedullary subdural tumors, intervertebral foramen and peripheral neurofibromas, and tumors near the apex of the lung can all cause pain in the upper limbs, neuralgia, and angina Rheumatic polymyalgia.

2. Spinal cervical spondylosis should be distinguished from the following diseases

Amyotrophic lateral sclerosis, multiple sclerosis, spinal tumors, and spinal cavity.

3. Vertebral artery type cervical spondylosis should be distinguished from the following diseases

Verification of vertebrobasilar insufficiency caused by other reasons, such as vertebral atherosclerosis and abnormal development. Vertebral arteriography is the most reliable method of identification.

4. Sympathetic cervical spondylosis should be distinguished from the following diseases

Coronary artery insufficiency, neurosis, menopause syndrome, vertigo caused by other reasons.

5. Esophageal compression cervical spondylosis should be distinguished from the following diseases

It should be distinguished from dysphagia caused by esophagitis and esophageal cancer.

6. Identification of cervical spondylosis and chronic cervical soft tissue injury

Because of long-term work of lowering the head, the head is often in a forward flexed posture, which causes the front of the cervical intervertebral disc to be compressed, the nucleus pulposus moves backward, and the fibrous ring and the posterior longitudinal ligament are stimulated, thereby causing discomfort.

Cervical Spondylosis Complications

Swallowing disorder

Obstructive sensation when swallowing, foreign body sensation in the esophagus, a few people have nausea, vomiting, hoarseness, dry cough, chest tightness and other symptoms. This is because the anterior edge of the cervical spine directly presses the posterior wall of the esophagus and causes esophageal stricture. It may also be caused by the rapid formation of bone spurs that stimulate the soft tissue around the esophagus.

Visually impaired

Presented as decreased vision, eye pain, fear of light, tears, pupil size, and even visual field reduction and sharp vision loss, individual patients can also suffer from blindness. This is related to the ischemic lesions of the occipital lobe visual center caused by cervical spondylosis caused by autonomic nervous disorders and insufficient blood supply to the vertebral-basal artery.

3. Cervical heart syndrome

Presented as pain in the precardiac area, chest tightness, arrhythmia (such as premature beats), and changes in the ST segment of the electrocardiogram, it is easy to be misdiagnosed as coronary heart disease. This is due to the stimulation and compression of the cervical spine by the cervical spine.

4. Hypertension cervical spondylosis

Can cause blood pressure to rise or fall, among which the increase in blood pressure is more, known as "neck hypertension". Because cervical spondylosis and hypertension are common diseases in the elderly, the two often coexist.

5. Chest pain

Manifestations of slow and intractable unilateral pectoralis major and breast pain, with pectoralis major tenderness upon examination. This is related to the compression of cervical spurs by cervical 6 and cervical 7 nerve roots.

6. Paralysis of the lower limbs

Early manifestations are numbness, pain, and lameness in the lower limbs. Some patients feel like walking on cotton when walking. Individual patients may also have defecation and urinary disorders such as frequent urination, urgency, poor urination, or incontinence. This is because the lateral vertebral bundle is stimulated or compressed by the cervical spurs, which results in lower limb movement and sensory disturbances.

7. Burst

Often when standing or walking, he suddenly falls over because of a sudden loss of support from the body. He can wake up quickly after falling to the ground, without conscious disturbance, and without sequelae. Such patients may be accompanied by symptoms of autonomic dysfunction such as dizziness, nausea, vomiting, and sweating. This is because the cervical spine proliferative change compresses the vertebral artery and causes basal artery blood supply disorder, which results in temporary cerebral blood supply insufficiency.

Cervical Spondylosis Treatment

Drug treatment

Analgesics, sedatives, and vitamins (such as B ₁ and B ₁₂ ) can be selectively used, which have a certain effect on the relief of symptoms. Try glucosamine sulfate and chondroitin sulfate for supportive care. Glucosamine sulfate and chondroitin sulfate are used clinically to treat osteoarthritis in various parts of the body. These chondroprotective agents have a certain degree of anti-inflammatory and anti-chondrogenic effect. Basic research has shown that glucosamine can inhibit the production of inflammatory factors by spinal cord nucleus pulposus cells and promote the synthesis of glycosaminoglycans, the components of the disc cartilage matrix. Clinical studies have found that injecting glucosamine into the disc can significantly reduce lower back pain caused by degenerative disc disease and improve spinal function. Case reports suggest that oral glucosamine sulfate and chondroitin sulfate can reverse the degenerative changes of the disc to a certain extent.

2. Exercise Therapy

When the symptoms of all types of cervical spondylosis are alleviated or chronic, medical gymnastics can be started to promote the further elimination of symptoms and consolidate the curative effect. Acute onset of symptoms should be local rest, should not increase exercise stimulation. Exercise is contraindicated when there are more obvious or progressive symptoms of spinal cord compression, especially the cervical backward movement should be contraindicated. Vertebral artery type cervical spondylosis should be gentle and slow, and the amplitude should be controlled appropriately.

3. Traction therapy

"Traction" has been one of the preferred methods for treating cervical spondylosis in the past, but in recent years, it has been found that after using "traction" in many patients with cervical spondylosis, especially those who have been using "traction" for a long time, cervical spondylosis has not been alleviated. Instead it gets worse.

Traction can not only promote the recovery of the physiological curvature of the cervical spine. On the contrary, traction straightens the cervical spine, but weakens the physiological curvature of the cervical spine. Therefore, traction therapy should be used with caution in cervical spondylosis.

4.Manual massage therapy

It is a more effective treatment for cervical spondylosis. Its therapeutic effect is to relieve tension and cramps in the cervical and shoulder muscle groups, restore cervical spine activity, and release nerve root and soft tissue adhesions to relieve symptoms. Spinal cord cervical spondylopathy generally prohibits gravity massage and reduction, otherwise it may easily aggravate the symptoms, or even Causes paraplegia, even if early symptoms are not obvious, surgery is generally recommended.

5.Physiotherapy

In the treatment of cervical spondylosis, physical therapy can play a variety of roles. It is generally believed that iontophoresis, ultrasound, ultraviolet, or intermittent current are feasible in the acute phase; ultrasound, iodine ion penetration, induction electricity, or other hyperthermia are used after pain is reduced.

6. Warm compress

This treatment can improve blood circulation, relieve muscle spasms, eliminate swelling to reduce symptoms, and help stabilize the affected vertebra after manual treatment. This method can be applied topically with hot towels and hot water bottles. Warm compresses should not be used when patients with acute pain are severe.

7. Surgical treatment

Severe nerve root or spinal cord compression can be surgically treated if necessary.