Author:Yu Liqing[1] Li Xu[2]
Reviewer: Tan Liming[2]
Units: [1] The Second Clinical College of Nanchang University [2] The Second Affiliated Hospital of Nanchang University
I asked the doctor, "I have a noise in my neck, is there cervical spondylosis?" The doctor looked at it and said, "No, it's the sound of the big gold chains around your neck colliding." ”
Cervical spondylosis, also known as cervical spondylosis, is a general term for cervical osteoarthritis, hypertrophic cervical spondylitis, cervical nerve root syndrome, cervical disc herniation, and is a disease based on degenerative pathological changes. Mainly due to long-term cervical spine strain, bone hyperplasia, or herniated discs, ligament thickening, resulting in cervical spinal cord, nerve roots or vertebral arteries compression, a series of clinical syndromes of dysfunction.
First, how did cervical spondylosis come about?
occupational disease
The incidence of cervical spondylosis is relatively high for sedentary, especially low-headed workers, including assembly line workers, drivers, office workers, and long-term desk workers.
Poor sleeping posture
The ideal sleeping position should be to put the entire spine at a natural curvature and relax the muscles of the whole body.
High pillow: high pillow makes some muscles of the neck excessively tense, and it is easy to strain and spasm for a long time, prompting degeneration or bone hyperplasia of the small joints of the cervical spine, etc., and at the same time compressing the nerves and blood vessels of the cervical cord, and then the symptoms of cervical spondylosis.
No pillow or too low pillow: both can cause the head and neck to be excessively reclined, the cervical vertebrae are convex and curved too large, making the muscles and ligaments in front of the vertebral body overly tense, and even causing chronic injury.
Patient: Doctor, is it better to straighten your legs when you sleep?
Doctor: In fact, it is better to cushion a pillow and maintain a certain curvature. Similarly, when sleeping on your side, your head is slightly backwards from your shoulders, and your hips and knees are slightly bent, which is more able to maintain the natural relaxation of your muscles.
Bad habits
High heels, "Ge You paralysis", long-term playing mobile phones and computers, excessive necklaces or charms, sleeping on the table, not keeping the cervical spine warm in winter, which can easily cause muscle spasm or rheumatic changes, resulting in imbalance in the internal and external balance of the cervical spine and inducing symptoms.
Old, weak, sick and disabled
Increasing age, overuse of overload, and reduced ability to repair are the main causes of cervical spondylosis. Cervical degeneration itself is not a disease, and sometimes even the body's adaptation to the environment changes; cervical degeneration is inevitable, is a life process that everyone will experience, and is also the basis for the pathogenesis of degenerative diseases such as cervical spondylosis.
trauma
1. Sports injuries: falling from a high place during exercise, there are obvious symptoms in the acute stage, easy to diagnose, and attention should also be paid to the hidden development after the acute period.
2. Sudden accidents: such as boxing, sticks to the neck, falling objects injuries, etc. In addition to acute symptoms, chronic progressive lesions are left behind.
3. Car sharp braking: Whiplash damage caused by sharp braking is more common.
4. Construction accidents: Construction injuries are mostly multiple comprehensive trauma, but cervical spine trauma is more common, due to obvious causes and obvious symptoms, it is not easy to be ignored.
Second, the type of cervical spondylosis
Cervical radiculopathy
This type has the highest incidence, and the main lesions are: narrowing of the intervertebral foramen and compression of the cervical spinal nerves, most common in the 4th to 7th cervical vertebrae. High incidence age: 30 to 50 years old.
Main symptoms: early symptoms are neck pain and neck stiffness; radiating pain or numbness in the upper extremities, which radiate along the direction and innervation area of the compressed nerve roots, sometimes the appearance of symptoms is significantly related to relief and the position and posture of the patient's neck; the upper limbs on the affected side feel heavy, the grip is reduced, and sometimes the holding object falls.
Cervical spondylosis of the spinal cord
This type is the most dangerous, the main lesions are: cervical spine lesions lead to spinal cord compression, inflammation, edema and so on. High incidence age: 40 to 60 years old.
The main symptoms: numbness and heaviness of the lower limbs, difficulty walking, and a feeling of stepping on the feet; numbness and pain in the upper limbs, weakness and inflexibility of the hands, difficulty in writing, fastening, holding chopsticks and other fine movements, easy to fall; paresthesia on the trunk, patients often feel a belt-like feeling of binding in the chest, abdomen, or both lower limbs.
Vertebral arterial cervical spondylosis
The main lesions are: insufficient blood supply due to bone spurs, vascular variations, or lesions. High incidence age: 30 to 40 years old.
Main symptoms: episodic vertigo, diplopia with nystagmus; sometimes accompanied by nausea, vomiting, tinnitus, or hearing loss, which are associated with changes in neck position; sudden weakness of the lower extremities, but consciousness, mostly occurs when the head and neck are in a certain position; occasional limb numbness and paresthesias.
The main lesions are: various neck lesions irritate the sympathetic nerve endings of the nerve roots, joint capsules or neck ligaments. High incidence age: 30 to 45 years old.
The main symptoms: dizziness, headache, poor sleep, memory loss, difficulty concentrating; eye distension, unclear vision; tinnitus, ear blockage, hearing loss; nasal congestion, allergic rhinitis, pharyngeal foreign body sensation, dry mouth, vocal cord fatigue, etc.; nausea and even vomiting, bloating, diarrhea, indigestion, belching, etc.; palpitations, chest tightness, heart rate changes, arrhythmias, blood pressure changes, etc.; excessive sweating, no sweating, chills or fever on the face or one of the limbs.
In addition to the above four types, it is common in clinical practice for different symptoms of the above four types to occur at the same time, which we call mixed types. At present, the clinical manifestations of radiculopathy cervical spondylosis and spinal cord cervical spondylosis are more typical, so there is less controversy in diagnosis and treatment, while the clinical manifestations of vertebral arterial cervical spondylosis and sympathetic cervical spondylosis are more similar to neurology diseases and ENT diseases, and there are still more controversies in diagnosis and treatment.
3. Knowledge classroom
What tests should patients with cervical spondylosis do?
Plain X-ray: The most widely used and popular plain X-ray of the cervical spine in clinical practice.
Cervical spine X-ray plain film is of great clinical significance, and it is also the most conventional and basic special examination measure in the diagnosis of cervical spondylosis. Moreover, the examination is simple and convenient, the price is cheap, and it is easy to be accepted by the majority of patients. Plain x-rays can identify boneless destruction and cervical spine deformities, and observe the presence or absence of bone spurs, stenosis of the intervertebral space, and ossification of the posterior longitudinal ligament of the cervical spine. More importantly, plain x-rays are an indispensable basis for positioning during surgery.
In addition to plain X-rays of the cervical spine, there are many special imaging tests, such as magnetic resonance imaging (MRI), CT, myelography, tomography, etc., as well as other electromyography, evoked potentials, and cerebral blood flow maps as functional tests. (MRI and CT are not necessarily better than plain X-ray technology in the diagnosis of diseases, and what auxiliary tests are used should be applied by specialists according to the needs of the disease.) ）
What makes a good working posture?
First of all, the height and inclination of the desktop should be adjusted, in principle, the head, neck and chest should maintain a normal physiological curve, and the line of sight should be level forward or slightly looked up 5 ° -10 °, so as to avoid the head and neck in a state of extension or flexion for a long time.
Secondly, at any time should not be fixed in a certain position for a long time, at least every 1-2 hours to be able to move for about 5 minutes, until the neck fatigue is eliminated before continuing to work, which is conducive to alleviating chronic strain on the cervical spine.
Is "high pillow" really "worry-free"?
As the saying goes, "sit back and relax", is that really the case? In fact, from a medical point of view, long-term use of pillows that are too high can easily induce cervical spondylosis.
From the side view, the cervical spine of a normal person is not straight, but there is a physiological curvature that protrudes forward. Too high a pillow will cause the cervical spine to be excessively flexed forward, and the muscles and ligaments at the back of the cervical spine are prone to strain in this state for a long time, and the pressure on the intervertebral disc in front is large, resulting in the aging and degeneration of the intervertebral disc. Over time, the hypertrophic and degenerative structure compresses the spinal cord, nerves, and blood vessels, and symptoms of cervical spondylosis such as neck and shoulder pain, upper limb numbness, dizziness, or walking instability occur.
The length of the pillow is generally more than 10-16 cm wider than one's shoulder when lying flat, and the height is usually equal to or slightly lower than the height of one's fist after the head and neck are pressed down. For people who are accustomed to lying on their sides, the height of the pillow should be compressed to match the height of one's shoulder on one side.
Is dizziness necessarily caused by cervical spondylosis?
Dizziness is a complex condition, sympathetic cervical spondylosis can cause dizziness, but its clinical manifestations are the most complex, the symptoms are changeable, there are no specific signs, and it is difficult to diagnose the diagnosis.
Sympathetic cervical spondylosis has the following characteristics: the patient feels that the symptoms are aggravated when the head is pressed downwards, and the symptoms can be slightly alleviated when the head is pulled upwards; the symptoms can be alleviated after the patient's bed rest; the symptoms are aggravated after cold, fatigue or poor rest; moreover, the patient may have mild symptoms in the morning, aggravate the symptoms in the afternoon or at night, and the symptoms can be alleviated after getting up in the morning or after napping. In other words, the symptoms of the patient can be alleviated after rest, and the symptoms can be aggravated after exertion.
Dizziness is not necessarily caused by cervical spondylosis, neurology, otolaryngology, ophthalmology, cardiology and other related departments of diseases may also lead to dizziness, such as: otolithiasis, hypertension, hypotension, cerebral arteriosclerosis, cerebral vascular spasm or thrombosis, Meniere's disease (Meniere), labyrinthitis, vestibular dysfunction, autonomic functional disorders and so on. When there are symptoms of dizziness, the possibility of dizziness caused by the above-mentioned diseases in related departments should be first excluded, so as not to delay the condition, delay treatment, and cause serious consequences. (Sympathetic cervical spondylosis symptoms are the subjective feelings of the patient, and the X-ray plain x-ray, MRI and CT imaging tests of the cervical spine do not have special significance for the diagnosis of the disease, and can only indicate the presence of lesions in the cervical spine, dizziness may be related to cervical spondylosis, and the current treatment effect of sympathetic cervical spondylosis is not good.) ）
3. Does cervical spondylosis require surgery?
Cervical spondylosis is not terrible, and most do not require surgery. Most of the early cervical spondylosis use conservative treatment methods, but the course of treatment is long, the recurrence rate is high, and most patients still have some symptoms left in the future, so non-surgical treatment needs to be carried out for a long time or repeatedly.
Conservative therapy is relative to surgical treatment, that is, non-surgical treatment, so clinicians often refer to it as "conservative treatment". In the use of non-surgical conservative therapy, a combination of multiple treatment methods should be used, which can improve the efficacy, alleviate the disease as soon as possible, shorten the course of treatment, and at the same time can also alleviate the adverse reactions of various non-surgical therapies, such as reducing the amount of oral anti-inflammatory analgesics, thereby reducing its gastrointestinal adverse reactions and renal adverse reactions, and also reducing the adverse reactions such as skin pigmentation caused by certain physiotherapy.
Conservative treatment
1. Oral drug therapy: For patients with neck and shoulder pain, oral anti-inflammatory and analgesic drugs can be used, supplemented by muscle relaxants and nutritional nerve drugs.
2. Traction method: through the mutual balance between traction and anti-traction, the head and neck are relatively fixed in the physiological curve state, so that the phenomenon of cervical spine curve is gradually changed, but its efficacy is limited, only suitable for mild patients; and it is forbidden to do traction in the acute stage to prevent local inflammation and edema from aggravating.
3. Physical therapy: Physiotherapy is the abbreviation of physical therapy. It is to apply various physical factors of nature and artificiality, such as sound, light, electricity, heat, magnetism, etc., to the human body to achieve the purpose of treating and preventing diseases.
4. Tuina method: Tuina method is an important part of mainland medicine. Only by relying on the hands and simple instruments of the Tuina doctor on a certain part of the body or acupuncture points, along the meridian route, the direction of the flow of qi and blood, different techniques are applied to achieve the purpose of treatment. However, it is forbidden to massage in the acute or acute attack period, otherwise it will cause inflammation of the nerve roots, aggravation of edema, and aggravation of pain. This method is also not recommended for cervical spondylosis.
5. Acupuncture method: According to the basic theory of traditional Chinese medicine, the occurrence of cervical spondylosis is mostly caused by wind and cold invasion, qi and blood disharmony, and meridian blockage, so the main role of acupuncture in the treatment of cervical spondylosis is to achieve the purpose of relieving muscles and activating blood through acupuncture. Acupuncture has a certain pain for patients, and even some patients have needle sickness and fear of needle pricking; And acupuncture can lead to some complications.
6. Intervertebral foraminal block (epidural space block) and paravertebral sympathetic block: it is an effective treatment method, and repeated single block or continuous injection of catheters can receive good results. However, most of them cannot maintain long-term efficacy, so it is necessary to repeat the operation to consolidate the effect, at least 2 to 4 courses of continuous treatment.
Conservative therapy is relative to surgical treatment, that is, non-surgical treatment, so clinicians often refer to it as "conservative treatment". Often some people think that "conservative therapy" means "conformist, not advanced, conformist, conservative thinking methods", in fact, this is these patients' misunderstanding of the term "conservative therapy".
Edited by: Yeah Reviewer: Xiao Ran