Cervical disc degeneration

Introduction Cervical spondylosis, also known as cervical vertebra 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 vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Cause

The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.

The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.

an examination

Related inspection

Cervical CT examination of the spine MRI examination neck test neck mobility test test

Clinical examination

Including the following aspects.

(1) tenderness point paravertebral or spinous process tenderness, tenderness position is generally consistent with the affected segment.

(2) The range of cervical vertebra activity is the examination of flexion, extension, lateral flexion and rotational activity. Nerve root cervical spondylosis patients with limited neck activity, and vertebral artery type cervical spondylosis patients can appear dizziness when moving in a certain direction.

(3) Intervertebral foramen crush test: The patient's head is tilted to the affected side. The examiner's left palm is placed flat on the top of the patient's head. The right hand grips the palm and gently slams the back of the left arm. If there is root pain or numbness, it is positive. In patients with severe radicular symptoms, pain, numbness, or exacerbation can occur with gentle pressure on the head.

(4) Intervertebral foramen separation test: For patients with suspected root symptoms, the patient is seated, hands are placed on the head and pulled upwards, and if the upper limb pain is numb, it is positive.

(5) nerve root pull test. Also known as brachial plexus pull test, the patient sits, the head turns to the healthy side, the examiner holds the hand against the back of the ear, and holds the wrist in one hand and pulls in the opposite direction. If there is limb numbness or radiation Pain is positive

(6) Hoffman's expedition to check the right arm of the patient's forearm, the index finger of one hand grips the middle finger, and the thumb is used to slam the middle finger nail. If there is a positive four-finger buckling reflex, it indicates that the spinal cord and nerve are damaged.

(7) The cervical spine test is also called the vertebral artery twist test: the patient sits in the position and actively rotates the neck activity, repeated several times. If vomiting or sudden fall occurs, it is a positive test, suggesting vertebral artery type cervical spondylosis.

(8) Sensory Disorder Examination A skin sensory examination of a cervical vertebra patient can help to understand the extent of the lesion. Sensory disturbances in different parts can determine the segment of the cervical vertebrae; pain usually occurs early, and when it appears numb, it has entered the middle stage, and the feeling disappears completely in the late stage of the lesion.

(9) Muscle strength examination Cervical spondylosis injury nerve root or spinal cord, muscle strength decreased, if the nerves are lost, the muscle strength can be zero. The location and segment of the nerve injury can be determined according to the different nerves of each muscle.

Differential diagnosis

Differential diagnosis of cervical disc degeneration:

1. Cervical degeneration: The degenerative process of cervical spondylosis is a gradual process. The cervical vertebrae develop muscle strain prematurely, followed by degeneration, and then cervical spondylosis is formed step by step.

2, cervical vertebra hyperplasia: cervical vertebra hyperplasia refers to cervical degenerative lesions and bone hyperplasia oppression of the cervical spinal cord or cervical nerve root disease, also known as cervical syndrome, Chinese medicine is "bone callus", "chronic strain" category.

3, cervical spine deformation: cervical spine deformation is one of the symptoms of cervical spondylosis, cervical spondylosis, also known as cervical vertebra syndrome, is the general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, cervical disc herniation, is a kind A condition based on degenerative pathology.

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