Cervical spondylosis has a high incidence rate and shows an upward trend in recent years, it is a common and frequent disease in middle-aged and elderly patients. It is mainly caused by various degenerative changes of the intervertebral disc, cartilage, and ligaments, resulting in narrowing of the intervertebral spaces, narrowing of the intervertebral foramina, intervertebral arthritis, and partial dislocation of the vertebral body. Clinically, it produces symptoms of nerve root and spinal cord stimulation or compression.
The symptoms of cervical spondylosis are complex. In addition to the local symptoms of cervical spondylosis, clinical symptoms can also be divided into nerve root type, vertebral basilar artery type, sympathetic nerve type, and spinal cord type. Among them, the nerve root type, sympathetic type, and spinal cord type all manifest as sensory and motor function disorders of the limbs.
Some patients even suspect whether they have suffered a stroke. In fact, stroke and cervical spondylosis are completely different diseases and should be distinguished. In addition, due to long-term ischemia of the vertebral basilar artery, vertebrobasilar cervical spondylosis is prone to thrombosis and can also complicate stroke. Therefore, active treatment of cervical spondylosis is of great significance for preventing the occurrence of stroke.
Cervical type
Cervical spondylosis of cervical type is a mild type of cervical disease, characterized by neck pain as the main symptom. It is often caused by improper neck position during sleep (i.e., pillow), cold exposure, or sudden neck injury during physical activity. The pain usually occurs after waking up in the morning, presenting as a persistent ache or dull pain, exacerbated by head and neck movement, and often accompanied by a feeling of stiffness in the neck. Due to neck pain and muscle tension, the head often leans to the affected side, and the normal physiological convexity of the neck becomes straight.
The neck muscles are tense, with limited movement and multiple tender points. Neck X-ray shows mild to moderate changes of cervical spondylosis. Although this type of cervical spondylosis has mild clinical symptoms, it should be actively treated, otherwise it will become more severe over time.
Spinal cord compression cervical spondylosis
Spinal cord compression cervical spondylosis is a more severe type of cervical spondylosis, mainly caused by posterior cervical osteophytes, intervertebral disc herniation, and hypertrophy of the ligamentum flavum, which directly compress the spinal cord or affect the anterior spinal artery. Clinical manifestations include unilateral or bilateral compression symptoms.
1.Unilateral compression:
Due to the semi-transverse injury of the spinal cord, the upper and lower limbs, especially the lower limbs on the injured side, show incomplete paralysis. It often presents in a spastic manner, similar to stroke patients, but spinal cord cervical spondylosis also shows numbness of the opposite side of the hemiplegia, and the condition progresses gradually, which is different from the sudden onset and only one side of the stroke patients.
2.Bilateral compression:
Initially presenting with intermittent numbness, coldness, pain, weakness, and trembling in both lower limbs, which later becomes persistent and eventually develops into bilateral incomplete spastic paralysis, which is distinct from stroke hemiplegia. Cervical X-ray contrast and cervical CT scans can assist in diagnosis.
The nerve root type
The main symptom of cervical spondylosis of the nerve root type is pain in one side of the upper limb, which generally does not present with motor disorders similar to stroke, so it is not easy to be misdiagnosed as stroke. The pain is usually limited to one or a few nerves on one side, presenting as drilling or cutting pain that radiates to the shoulder, arm, and fingers. The pain is often induced or exacerbated by activities such as flexing and extending the head and neck, coughing, and sneezing.
When the doctor examines the patient, they can find neck stiffness, limited mobility, and tenderness at the cervical spinous process, transverse process, and supraclavicular fossa. When raising the affected arm, there will be pain and sensory loss. In the long course of the disease, muscle atrophy may occur on the affected side. X-ray contrast and CT examinations can reveal changes of cervical spondylosis.
Sympathetic cervical spondylosis
The main symptom of sympathetic cervical spondylosis is pain, often caused by stimulation of the sympathetic nerves due to degenerative changes in the cervical spine, resulting in numbness or burning pain on the upper half of the trunk, head, and upper limbs, sometimes accompanied by muscle spasm or rigidity. This is distinct from stroke, which is mainly characterized by motor dysfunction of the limbs.
In addition, sympathetic cervical spondylosis can also manifest as blurred boundaries of hyperalgesia or abnormal pain sensitivity; stimulation of the sympathetic nerves in the neck can cause vertigo and headache due to vertebral artery spasm; long-term nerve disorders can lead to limb coldness, cyanosis, edema, abnormal sweat gland secretion, and skin thinning.
Furthermore, sympathetic cervical spondylosis has a unique symptom of angina pectoris, caused by stimulation of the sympathetic nerves by cervical pain, hence the term cervical angina. Apart from the difference in electrocardiogram results, X-ray and cervical CT examinations can distinguish between cervical spondylosis and coronary heart disease-induced angina.
The vertebrobasilar type
The following symptoms caused by compression of the vertebral artery due to formation of bone spurs in the cervical spine are referred to as cervical spondylosis of the vertebrobasilar type. The main clinical manifestations include:
- 1.Headache: Vascular headache caused by ischemia of the vertebrobasilar artery leading to expansion of collateral circulation vessels. Some attacks may be preceded by visual premonitions such as blurred vision or flashing lights. The pain is usually episodic and pulsating, accompanied by nausea, vomiting, and salivation. The pain is located on one side of the cervical or occipital region, similar to migraine, also known as cervicogenic migraine.
- 2.Dizziness: Disorders of balance can be induced by posture changes, excessive head rotation or extension, presenting with episodic vertigo or general dizziness. It is accompanied by tinnitus and hearing loss, and may be misdiagnosed as Ménière’s disease, but without spontaneous nystagmus.
- 3.Visual symptoms: Attacks of decreased vision, flashes, dark spots, and visual field defects can occur due to ischemia of the posterior cerebral artery.
- 4.General symptoms and other manifestations of cervical spondylosis, such as neck pain, stiffness, limited mobility, and nerve root pain.
- 5.X-ray and CT examinations of the cervical spine show characteristic changes consistent with cervical spondylosis.
After a confirmed diagnosis of cervical spondylosis and exclusion of stroke precursors, hypertension, Ménière’s syndrome, and other diseases, treatment should be initiated promptly to avoid the development of the disease.
